I have had trouble sleeping for some time and am at the point where I am considering medication, but I've heard that you can become dependent on sleep medications. Any advice you can offer?
Insomnia is a common condition that can involve difficulty falling asleep, waking up in the middle of the night or waking up too early in the morning and not being able to go back to sleep. In Canada, approximately one out of seven people suffer from insomnia symptoms. Not getting enough sleep can cause memory and concentration impairment, worsen preexisting medical conditions, and can trigger or worsen depression and anxiety.
There are many causes of insomnia including stress, anxiety and medical illnesses such as depression, sleep apnea, heart disease and chronic pain. Also, prescribed medications or over-the-counter pain or cold remedies that contain caffeine or stimulant ingredients can disturb regular sleep patterns.
Before trying medications, consider changing some habits that may help to regulate your sleep pattern:
1. Have a regular bedtime and waking time, including on weekends and days you don't go to work.
2. Limit or stop using nicotine and caffeine - especially close to bedtime.
3. Avoid alcohol before sleep. While alcohol may help you fall asleep, it can limit your ability to have a deeper, more restful sleep.
4. Exercise during the day, but not too close to bedtime. Exercise can make it easier to fall asleep and can increase sleep quality.
5. Reserve your bed for only sleep and intimacy.
6. Avoid daytime naps.
7. Keep your bedroom dark, quiet and at a cool yet comfortable temperature.
8. Consider keeping a sleep diary to record your bedtime, waking time and potential triggers or positive behaviours that may effect your sleep to be able to see if there is a link to your sleep disturbance.
If you still suffer from insomnia despite making these changes, a visit to your doctor may be helpful to rule out any medical conditions or medication side effects.
In general, medications for sleep are prescribed for a short duration (on average one to two weeks) because while they can be effective at regulating sleep, long-term use can lead to tolerance and dependence, which can occur when a person's body adapts to the presence of a drug.
Tolerance can develop over time with sleeping pills, meaning that larger doses are required to achieve the same effect as when the medication was first taken. With physical dependence, when a medication is stopped suddenly withdrawal symptoms can occur. Depending on the intensity of symptoms, this can make sleep disturbance worse or have more serious consequences.
No one plans to become dependent upon a medication but if this is a concern for you, I would suggest discussing your worries with your doctor to minimize the risk. The medications used for sleep come in different strengths, are processed in the body at varying speeds, and have different risks for dependence. These differences can help guide the choice of medication that may work best for you in combination with lifestyle changes - to minimize the risks and side effects, and to get your sleep safely back on track. Finally, if you are already using over-the-counter sleep aids, let your doctor know as they can have potential dangerous interactions with prescribed medications.
Send family doctor Sheila Wijayasinghe your questions at email@example.com. She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.
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The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.
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