Anxiety and Sleep Medications

Anxiety and sleep medications can be dangerous, especially when used inappropriately. Zolpidem (Ambien) is a very common one that many people take to get to sleep at night. Alprazolam (Xanax) and clonazepam (Valium) are also fairly common drugs that are seen in the pharmacies and in the cupboards of many people. They are taken whenever a person feels anxious, which these days seems like all the time.

Zolpidem is classified as a sedative-hypnotic. It puts you to sleep and that is why so many people like it. Take one sometime before bed and it’s lights out for the next few hours. So what’s the problem?

Zolpidem affects a specific omega-subtype of the GABA receptor in the central nervous system. This subtype is what puts you to sleep but doesn’t seem to affect muscle tone and doesn’t show anxiolytic properties (anti-anxiety). This also may be why so many people have reported all kinds of crazy incidences of sleep walking or other activities without remembering a thing. You can read about some of those here:

http://www.peoplespharmacy.com/2013/01/10/fda-lowers-dose-of-popular-sleeping-pill-ambien-zolpidem/

As with many receptors it’s also likely that since they are being activated so often by meds like zolpidem they get down regulated with time and people don’t get the benefit of the drug. I’ve talked with several people in the pharmacy about this. They are so frustrated that they can’t get sleep. Some take double the dose that is normally prescribed and still only sleep a couple of hours.

This quite honestly scares me. I’m worried that some people are going to take it too far one day for that one night of sleep and then not wake up. We Americans especially forget that more isn’t better to a problem that actually requires less.

Another problems that scares me is the sharing of these types of meds between family and friends. This is especially true among teenagers. A recent article talks about this:

http://www.foxnews.com/health/2014/11/24/abuse-sleep-anti-anxiety-drugs-growing-issue-among-teenagers-study-shows/

SAMSHA (Substance Abuse and Mental Health Administration) reported that “the estimated number of emergency department visits involving zolpidem overmedication (taking more than the prescribed amount) nearly doubled from 21,824 visits in 2005-2006 to 42,274 visits in 2009-2010” [1]. By comparison they report that in 2010 there were a total of 4,916,328 drug-related visits to emergency departments throughout the nation.

It’s not the most abused drug in the country but it is on the rise.

Drugs like clonazepam mentioned earlier aren’t so selective as zolpidem and can cause other problems. Originally they were developed for people with seizure disorders and they work well for that. People now take them primarily for finding relief from anxiety and stress.

Like zolpidem, people can become tolerant to them over time and require higher and higher doses to get the desired effect. It’s no different from a person on pain medications. These are more likely to cause a euphoric effect on a person than the zolpidem and many become psychologically dependant. It’s very important to note that people wishing to discontinue these after having been on them for some time must do so slowly. The withdrawal symptoms in people on high enough doses can actually land them in the hospital and cause death. While going cold turkey off narcotics isn’t recommended it typically doesn’t cause death like the benzodiazepines (clonazepam, alprazolam) can.

What can a person do to help with sleep?

insomnia

Exercise seems to be beneficial to those who have insomnia. In a study with insomniacs, researchers looked at walking on the treadmill for 50 minutes at a time, 3 days a week for 6 months. What they found was that participants were able to fall asleep faster and had decreased amounts of wakefulness during the night. [2] The effect was seen in both the morning and evening groups.

Another study found similar results but the best were achieved in those performing moderate amounts of activity and not all out, balls to the wall type of stuff. It was also done on the treadmill for 50 minute intervals.[3]

In another analysis done in diabetics, the loss of belly fat with diet or exercise or a combination of both resulted in better sleep. [4]

There are other things that can help. Getting into a sleep schedule and actually going to sleep at the same time every day. I know that seems impossible or at best unlikely but it does help.

Managing a proper diet and exercise/activity level also decreases anxiety and symptoms of depression. I realize the catch-22 of people with depression. They don’t want to do anything, especially exercise. They don’t have the energy to do it and even if it makes sense logically that it will help, emotionally they are too drained to even think about it. If that’s you I encourage you to do whatever you can, even if it is walk to the mailbox. Any start is better than nothing.

CIAO

 

1.http://www.samhsa.gov/newsroom/press-announcements/201408111015

2.Passos, Giselle Soares, et al. “Effects of moderate aerobic exercise training on chronic primary insomnia.” Sleep medicine 12.10 (2011): 1018-1027.

3.Passos, Giselle S., et al. “Effect of acute physical exercise on patients with chronic primary insomnia.” Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 6.3 (2010): 270.

4.http://www.hopkinsmedicine.org/news/media/releases/losing_weight_especially_in_the_belly_improves_sleep_quality_according_to_a_johns_hopkins_study

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