Hypnotics are often used by patients to relieve sleep problems. Most of us think that it is enough to swallow the pill and the problem will go away. Is it really that simple? Are we right to buy over-the-counter sleeping pills instead of seeking help from a specialist? Dr. Michał Skalski, a psychiatrist from the Department of Psychiatry and Clinic of Psychiatry at the Medical University of Warsaw and the Sleep Disorder Treatment Clinic, talks about the effects of hypnotics and insomnia.

Insomniais the most commonsleep disorder . It can be a disease in itself, or - like pain or fever - a symptom of another physical or mental illness. Research shows that about 50 percent of people suffer from insomnia. Poles. Despite the widespread occurrence of the disease, knowledge about it is insufficient, both among patients and doctors. Michał Skalski, MD, PhD talks about the effects of using hypnotics in insomnia.

  • Is insomnia just a problem for mature people?

Michał Skalski, MD, PhD:No. Children, teenagers, young people, mature people and the elderly suffer from insomnia. In children, insomnia can manifest as daytime hyperactivity or ADHD-like behavior.

In adolescents, the consequences of insomnia are depressive states, sometimes even with the risk of committing suicide. The Polish phenomenon is almost universal insomnia among women over 45.

I asked many specialists - gynecologists, endocrinologists, doctors specializing in the treatment of menopause - but none of them could explain this phenomenon. The problem is very serious.

According to an expertDr. Michał Skalski, psychiatrist

There is still no single and universally accepted definition of insomnia. Generally speaking, it is a subjective complaint of the patient about problems with falling asleep, maintaining sleep continuity, premature waking up or non-regenerative sleep that worsens functioning during the day.

  • How do we deal with sleep problems, what are the consequences of untreated insomnia?

M.S.:Among people over 70, 15 percent she systematically takes sleeping pills. Often, sleeping pills are taken without consultingdoctor.

The latest research carried out in our clinic shows that 1/4 of Poles regularly suffer from sleep disorders. Everyone has a different explanation - excess responsibilities, stress at work, trouble in the family.

It can all disturb your sleep. However, sleep deprivation, or sleep deprivation, has consequences. The most common are:

  • problems with concentration,
  • memory loss,
  • worse self-esteem,
  • irritation
  • or a general decline in vitality.

Too little sleep could be:

  • overweight,
  • over-stimulation,
  • diabetes,
  • depressed,
  • and even cancer.

But also prolonged bed rest, which happens with older people, can lead to trouble falling asleep. In short, young people need to find time to sleep, and older people shouldn't force themselves to sleep.

  • But we don't think about the causes of sleep problems. Much easier to go to the pharmacy and buy sleeping pills. Is this a good remedy for insomnia?

M.S .: Hypnotics Do Not Treat Insomnia . They only help you sleep. They are one of the elements of therapy, but not the only one.

To cure insomnia, first find the cause. And there are many of these.

First of all, they are:

  • mental disorders (e.g. depression, anxiety, stress),
  • disorders that make it difficult to sleep (e.g. restless leg syndrome),
  • taking various medications,
  • sleep apnea,
  • disturbances in sleep and wake rhythm (e.g. during shift work),
  • various diseases (in men, for example, prostate enlargement, which makes you get up several times at night and urinate).

Once the cause of insomnia is found and can be overcome, sleeping pills are no longer needed. Unfortunately, in 15-25 percent cases the cause of the trouble cannot be found.

  • So maybe a good way to get some sleep through the night is to take a sedative?

M.S.:Not always. If the day was full of emotions and we are restless in the evening, trouble falling asleep is almost inevitable. This is where mild sedatives, such as herbal remedies containing valerian or hops, can help.

If nervousness is not the cause of insomnia, these measures may not be effective.

Important

Types of insomnia

  • Casuallasts up to a few daysand is caused by an acute reaction to stress, traveling with time zones or switching from day to night work. It is not yetdisorder! You can take sleeping pills.
  • Lasting up to 3 weeks , being a prolonged reaction to stress, adaptation disorders - you can also take sleeping pills.
  • If the insomnialasts more than 3 weeks , it is declared chronic and then it is a disease. Her treatment is more complicated and cannot be based on medication alone.

  • Are over-the-counter sleep aids safe?

M.S.:There are no drugs (including sleeping pills) that are 100% safe. Various groups of drugs are used in the fight against insomnia, including:

  • melatonin,
  • antihistamines
  • and sleeping pills of natural origin.

Few epidemiological studies show that natural medicines are used by 30 to 70 percent. people suffering from insomnia. Meanwhile, even these seemingly "innocent" herbal preparations can also cause side effects.

For example, the elderly should be very careful with drugs containing valerian (valerian). It is easy for them to overdose this drug, and then not only dizziness, but even consciousness disorders may appear.

  • What do you think about homeopathic preparations?

M.S.:There are no clinical trials confirming their effectiveness. It is known, however, that in medicine there is the so-called placebo effect. This means that if someone believes in the effectiveness of therapy, it can be effective for him.

  • When saving ourselves from a sleepless night, we reach for the aforementioned melatonin, which mimics the natural sleep hormone, and thus helps to overcome insomnia

M.S.:The lady herself said thatmelatonin mimics the sleep hormone. However, this does not mean that it cures insomnia.It plays a role as a regulator of the circadian rhythm. I'll explain what that means.

Well, melatonin is secreted by the pineal gland only in the dark. Its task is to tell the brain that it is dark, lower the body temperature, reduce activity, release the appropriate hormones, etc. When it gets light, the level of melatonin drops - it is a signal that you can get up and act.

Melatonin plays only an indirect role in inducing sleep. It works well when, for example, we work shifts and go to bed after a busy night.

It's light, so your body's natural melatonin levels are low. Taken in a nutshell, it deceives the brain that it's evening and it's time to sleep. The same is true when we make long journeys and cross time zones.

But I must add that the systematic use of melatonin tablets when having trouble falling asleep has its justification in the elderly. As the body ages, it releases less and less of this hormone. You just have to remember that the effects of the drug are usually visible only after 2-4 weeks of regular taking of the tablets.

  • Are hypnotics addictive?

M.S.:This truth applies to both over-the-counter and prescription medications. In he althy people, the evening ritual related to going to bed - brushing teeth, making bed, turning off the light - activates the mechanism of falling asleep.

However, if for some reason we cannot fall asleep, after a few sleepless nights, the same activities begin to be associated with the inability to fall asleep and the mechanism of falling asleep starts working upside down.

When evening comes, the tension of fearing another sleepless night prevents you from trying to fall asleep. The next day, the fears are even greater, so we reach for example for an over-the-counter hypnotic.

If we managed to fall asleep, the drug became part of the evening ritual - after some time it becomes impossible to fall asleep without it.

Not only that, after a short time the dose of the drug becomes too small to fall asleep. We increase it and … there is a problem of drug addiction and the so-called consolidation of insomnia. The tablet, instead of helping, caused another problem.

  • But are prescription drugs more addictive?

M.S.:It used to be like that, and it still is today. Older-generation agents (barbiturates) became addictive just like drugs after a few months of taking.

Higher and higher doses were needed, and the next day after taking them, you felt devastated. Abrupt discontinuation of the drug resulted in the following symptoms:

  • neurological (tremors, seizures),
  • mental (restlessness, anxiety, hallucinations)
  • and physical (circulatory disorders, heavy sweating, abdominal pain).

These substances accumulated in the body, which sometimes caused poisoning. Fortunately, they are a thing of the past today. Their place was taken by benzodiazepine derivatives.

We do not get used to drugs from this group as much as to barbiturates, but they also become addictive after some time and worsen the quality of sleep - they reduce deep sleep, which means that the next day we are broken and distracted.

We already have a new generation of sleeping pills:

  • zolpidem,
  • zopiclone,
  • zaleplon,

or organic chemicals that have a strong sleep-inducing effect and a lotfewer side effects than benzodiazepines, but if taken for more than a few weeks, they also lead to habituation and addiction.

Unfortunately, doctors in Poland still prescribe older sleeping pills too often and often prescribe chronic sleeping pills.

  • It is difficult to understand why, since you do not have to take new generation preparations every day and for a long time

M.S.:Indeed, new generation preparations should only be taken when needed. Scientists who are constantly looking for an effective and safe sleeping medication take into account three criteria:

  • for the drug to work fairly quickly after taking it,
  • ran for 5-7 hours without leaving a breakdown feeling for the next day
  • and that it does not accumulate in the body.

The new generation preparations meet these criteria. They do not shallow deep sleep and there is no so-called withdrawal effect.

They are addictive in that, with prolonged daily use, the reflex "I will not take - I will not fall asleep" may develop in us.

It is recommended to take the drug only when necessary - first try to fall asleep, and if it does not work out, you can take the pill (but not in the morning, because the drug will work before noon).

It turns out that people suffering from insomnia are often satisfied with the fact that they have a medicine at home that allows them to fall asleep, sleep well and is not addictive. They don't even need to take a pill in the evening to get a good night's sleep.

Where to go for help

Warsaw sleep disorder clinics at the Psychiatric Clinic of the Medical University of Warsaw (ul. Nowowiejska 27) and at the Institute of Psychiatry and Neurology (ul. Sobieskiego 9) accept all insured persons in the National He alth Fund without referral.

  • Can you stop taking sleeping pills overnight?

M.S.:Sudden discontinuation of the drug may cause very unpleasant side effects - abstinence, not only in the form of insomnia, but also anxiety, and even a seizure, even though the patient does not suffer from epilepsy.

The principle of weaning is that if the patient is taking a drug with a short half-life, we replace it with a drug with a longer half-life, so that its concentration in the blood is stable, then the severity of withdrawal symptoms decreases when the drug stops working.

Only after determining the equivalent dose of this longer-acting drug, we proceed to lowering the doses. Sometimes this process takes six months. It is actually psychotherapy, because the patient must understand the need to wean ourselves off drugs, even at the cost of self-sacrifice, and therefore worse.sleep and well-being.

Insomnia is not just a bad, non-regenerative sleep. A few years ago it was proved that people with insomnia have increased secretion of stress hormones, catecholamine metabolism products and cortisol.

The metabolic rate is also faster, as measured by oxygen consumption and increased body temperature. Insomnia increases the risk of infection due to a weakened immune system.

  • Are sleeping pills a salvation or a curse for us?

M.S.:The treatment of insomnia must be approached individually. The therapy is to be, above all, effective and safe, and the dose of the drug is selected in this regard.

Since there are many causes of insomnia and we have a lot of medications to choose from, it is not always possible to choose the right dose after one or two visits to the doctor. If the drug doesn't help, you don't have to come to terms with the situation and tell yourself that "it is supposed to be this way."

You should inform your doctor about problems, because - perhaps - the drug or dose is not well-chosen. First of all, I want to emphasize that any form of insomnia must be treated and that is why people who have problems falling asleep or wake up at night should seek help from a doctor.

Insomnia can be cured, although remember that it may still come back, e.g. due to some stress or unhappiness. Therefore, I think that for some of us sleeping pills can be a godsend, and for others a curse.

  • Insomnia - how to deal with it? Ways to fight insomnia
  • Insomnia - don't underestimate your sleep problems
  • Sleep disorders - types, causes, treatment

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