Sleeping with the Enemy?

Vikram Sobti B.S.


Sleeping pills are all the rage these days.  From commercials with butterflies flapping their wings to dreams of missing you…the sleeping pills have become front and center in the minds of the public.  Ads often promise “The first refreshing night of sleep,” or “…more energy to start your day.”  But many individuals want to know if long-term use of sleeping pills causes more harm than good?

Most sleeping pills used today are Gamma Amino Butyric Acid agonists, in that they increase the amount of the neurotransmitter GABA in your brain.  GABA is the neurotransmitter that is associated with inhibitory signals in the brain and allows us to become drowsy, lethargic, and sleepy.  GABA is the target of many medications including many anti-seizure medications and the oldest known anesthetic…Alcohol.  In fact, the mechanism of action for sleeping pills is almost the same exact mechanism as drinking our favorite cocktail! 

Whether it’s Lunesta™, Sonata™, Ambien™, etc, all promise the best night of sleep! But who has the time to check the side effects?  For those so inclined, however, a wonderful book entitled The Dark Side of Sleeping Pills, by Daniel F. Kripke, MD provides answers.  This book illustrates the dangers of sleeping pills ranging from addiction to depression.  A glaring side effect that I became aware of when researching these little “gems” was that most of them have a black box warning on the label stating “Sleeping pills make daytime function worse the next day; do not operate heavy machinery (i.e. a car).”  Isn’t that somewhat contrary to the very idea that all of those precious commodities were promising?

Some other side effects also caught my eye while preparing this article.  Many sleeping pills increase the frequency of parasomnias. A randomized trial performed by a Dr. JF Pagel, a sleep physician at the University of Colorado Medical School showed that although the general incidence of bizarre actions being acted out during sleep has been decreasing, they are still very prevalent with the use of sleeping pills.  In fact, there have been 4 known cases of murder in which the defendant was found NOT GUILTY due to this bizarre condition where the defendant has no idea of what he is doing as he is acting out his/her dreams!  Another very prevalent side effect is called “rebound use insomnia.”  As the name implies, after using the pill for a “good nights rest,” the next night may include late night TV and staring at the clock as inability to fall asleep may occur.  This is easily explained by the fact that because the sleeping pills increase your amount of GABA, your body naturally decreases the amount of GABA secreted in a response called “down-regulation.”  Then, following your body’s response, you have less GABA the next night and thus, inability to fall asleep.

Granted that sleeping pills and sleep aids have many side effects, they remain useful and widely used in today’s society.  Some insomniacs literally need these pills for at least one solid night of sleep a month, and in fact, most of the sleep aids prescribed have FDA approval for this exact scenario.  Sleeping pills also have many anxio-lytic properties in that they decrease the amount of anxiety one would have possibly on long plane rides or a couple days before a very big presentation or test.  The safest way to take these pills is to allow at least 10 hours of “in-bed-time” so that the effect of the sleeping pill can ware off, and also have the next day off, as to avoid the “sleeping pill hangover” the next day.  Remember, the safest way to sleep is using the sleep hygiene techniques prescribed by your sleep physician, and always remember that your body knows best; sometimes chemicals do more harm than good!

Kripke, Daniel F.  The Dark Side of Sleeping Pills.
August 2006


Sleeping Pills Information Database.

Pagel JFMedication effects on sleepDepartment of Family Practice, University of Colorado Medical School, Rocky Mountain Sleep Disorders Center, Pueblo,     Colorado,
USA. Dent Clin North Am. 2001 Oct; 45(4):855-65.