The stress of the pandemic has left me tossing and turning at
bedtime, and if I awaken in the middle of the night, I often start ruminating
on
COVID-related worries or my to-do list for the next day, unable to nod off
again.
اضافة اعلان
I’m not the only one: In a 2021 systematic review, researchers
reported that 36% of people in the United States and 12 other countries have
experienced sleep problems during the pandemic, and, according to a 2021 report
from the American Psychological Association, 32% of U.S. adults reported
changes in sleeping habits because of pandemic stress.
Like many people with insomnia, I have turned to sleep aids.
During much of the pandemic, I was taking over-the-counter antihistamines —
drugs sold under the brand names Benadryl, Sominex and ZzzQuil. But when I saw
my primary care nurse practitioner last summer, she warned me that these
medications aren’t recommended for long-term use and suggested that I switch to
melatonin, a hormone that regulates the body’s sleep cycle. I have been taking
it nightly ever since, with varying degrees of success. (One recent night was a
bad one. After a middle-of-the-night bathroom trip, I began worrying about the
note from my son’s school saying he had recently been exposed to the coronavirus.)
But the world of sleep aids is clearly a confusing one.
The first thing to know is that not all sleep medications are
the same.
“The myth is, ‘It doesn’t matter which one you choose, they all
work the same way, they all do the same thing.’ They don’t,” said Dr. Andrew D.
Krystal, a psychiatrist at the University of California, San Francisco, who
specializes in sleep disorders.
Some drugs, like zaleplon (Sonata), decrease the amount of time
it takes to fall asleep, he said, while others, such as suvorexant (Belsomra),
block signals in the brain that cause you to wake up. The hormone melatonin, as
well as prescription drugs like ramelteon (Rozerem) that act on melatonin
receptors, help regulate the body’s internal clock but don’t necessarily help
you stay asleep.
The best drug for you will largely depend on what causes your
insomnia.
“It really is about choosing the right medication for the
patient,” said Dr. Aruna S. Rao, a neurologist at Johns Hopkins Medicine.
If your problem is that you can’t fall asleep at bedtime, then a
drug that prevents you from waking in the middle of the night may not help. If
you fall asleep easily but can’t sleep toward the end of the night, then drugs
that wear off within a few hours, like zaleplon (Sonata), aren’t going to do
you much good, either.
Many people, too, have sleeping problems that won’t be resolved
with any sleeping pill. One such condition is sleep apnea, which afflicts 22
million people in the United States and causes frequent wake-ups, said Dr.
Grace Pien, a pulmonary, critical care and sleep medicine physician at Johns
Hopkins Medicine. Sleep apnea is best managed with a machine that provides
continuous positive airway pressure (CPAP), not with medication.
Another issue is that many sleep aids don’t have convincing data
behind them. The over-the-counter antihistamines I used to take, which contain
diphenhydramine, “were never really systematically studied for their effects on
sleep,” Krystal said. They are recognized for their allergy benefits but are
often used as a sleep aid because they cause drowsiness, he added.
The few studies that have been done on diphenhydramine suggest
that it doesn’t help much at all: Clinical practice guidelines from the
American Academy of Sleep Medicine say the antihistamine’s benefits, in terms
of extra sleep, are “below the level of clinically significant improvement.”
Sleep aids can also have side effects, some of them serious. A
2017 study found that, when compared with older adults who did not take
sleeping medications, those who took sleep aids of any kind recommended by
their doctor were 34% more likely to suffer a fall, perhaps because the drugs
affected their balance or incited clumsiness. Another study found that people
who had recently, for the first time, been
prescribed sleep medications such as temazepam, trazodone or zolpidem (Ambien)
were 90% more likely to be involved in car crashes, and that their increased
risk was on par with that of driving drunk.
Some research even suggests that the long-term use of hypnotic
drugs such as nordazepam, clonazepam (Klonopin), flurazepam (Dalmane) and
zolpidem (Ambien) can more than double the risk of dementia.
Some sleeping pills can also cause physical dependence — a
condition where people need higher doses over time to get the same effect, or
when they stop taking the medication and experience withdrawal symptoms or have
even more difficulty than usual falling asleep. According to Pien, dependence
is possible with zolpidem (Ambien), zopiclone (Imovane) and zaleplon (Sonata),
and even more likely with benzodiazepine pills like flurazepam (Dalmane),
temazepam (Restoril), quazepam (Doral) and triazolam (Halcion). People can also
experience a psychological form of dependence with many sleeping pills, Rao
added, making them feel unable to sleep without the medication.
The bottom line: Sleep aids can help in the short term, but you
need to take the right one for your needs. So instead of randomly choosing one
as I did, talk to your primary care physician or a sleep specialist to get a
more tailored recommendation, Pien said. And remember that as with any
medication, they do pose risks.
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