Sleeping Pills Are Not The Best Things For Sleep

I don’t like to give prescription sleeping pills.  They are a great source of disappointment to me.  It is hard to think any of the prescription stuff that is not habituating, requiring higher and higher doses to get the job done.

I have been worrying about patients taking them, literally, for years and years. I remember one of those studies that they release to the media.  It happened shortly after we moved to the San Diego area about 2004 when I heard on the radio that people who used prescription sleeping pills just did not live as long as people who did not.

Despite different receptors and names of chemicals, they are all variations of “benzodiazepines” They are related to the Valiums and Xanaxes (and whiskies) of the world.  They are frequently prescribed (granted, in smaller amounts) in the emergency rooms of the world.  They work quickly and people feel “relaxed.” Most people seem to me to end up on them much longer than expected.

I remember when I arrived at a major VA hospital in the midwest, with my lowly psychiatrist-in-training status, the senior faculty wanted us to plow through psychiatry department charts and see how many people were actually on these drugs, and for how long. I don’t know if the study ever actually got published.  I have never searched for it.  I doubt my name was on it, for somebody would have mentioned it to me. 20% of the patients were on drugs from this group for an average of five years.

I remember finding and reading the studies that got this class of drugs through the FDA.  I specific remember one of, perhaps the most virulent of these drugs, had been studied in patients who took it for six weeks. I can guess how it happened.  Patients are people who want to feel good. Most patients sign my informed consents before I can even finish discussing advantages and risks. “You’re a nice lady.  You would not give me anything bad,” is what they usually say, or something like that. “Sweetie — it’s going into your body and not mine.  I want you to know all about what goes between your lips…”

They press on.  I sigh, and usually come up with a mild ethnic expletive. “Oy vays mir,” in Yiddish (Judaeo-German, the language of my family and technically my first one) which translates, roughly “Such pain/despair,woe is me.” Sleep is a complex function and I solve it effectively but creatively.

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