Some doctors are comfortable prescribing sleeping pills and others aren'tThe use of sleeping pills is on the rise, with 8 percent of Americans now using them at least a few nights a week. By some folks’ lights this is not a good thing. Doctors are too quick on the draw with the prescription pad, is a complaint I often hear.

But I’ve had more experience with doctors of the opposite persuasion, who declare they don’t do sleeping pills at all. I’ve moved quite a few times over the years and had to change health plans and doctors, and I’ve come across several of these pharmacological Puritans. The minute I mention even occasional use of sleeping pills for insomnia and ask for a prescription, I morph into Hester Prynne with a scarlet letter on my chest: “A” for Ambien.

I know these drugs have their downsides, and there are certainly reasons to avoid them. Arguably there are better ways to deal with insomnia over the long term. But if a prescription is simply not on the table for discussion, I have to wonder what century these doctors think they’re living in.

One Woman’s Experience

I met May as I was conducting interviews for my book. A soft-spoken retired mathematics professor, May had reported sleep problems to her doctors for years. One advised going to a mental health clinic, but aside from poor sleep she wasn’t having any problems so she didn’t pursue it. Another suggested taking Benadryl, but May had read that antihistamines had negative side effects so she decided not to do it. A third doctor simply checked a box for sleep problems on his patient history form and moved on.

One year May took matters into her own hands. “I took my cat’s Valium,” she said. “My cat was prescribed Valium and since he slept all the time, I tried taking them. Not every night, though — I’ve read too much about getting addicted. I took them just about five times a month. They were 2 mg tablets and I would break them in half.” One milligram of Valium – hardly enough to make a wombat blink – taken every five or six days was all it took to give May the best year’s sleep of her life.

Where, oh where, is the harm in that? I know some people are prone to abusing sleeping pills, and physicians are rightfully leery of prescribing them to patients they suspect might take that path. But May would be the last person to use pills unwisely, and after years of treating her as a patient, her doctors should have known that.

A Different Approach

Humor, I sometimes think, might be a way to avoid the awkwardness of raising the issue of sleeping pills with new GPs. The minute the doctor walks into the consulting room, I announce my credentials as a pharmacological conservative. “The truth is,” I tell the doctor, “I don’t like drugs. My mother was a Christian Scientist so I grew up thinking they were evil. I’ll never ask for an antibiotic. When I get a cold, not even Tylenol crosses my lips. But when it comes to getting to sleep, pure thoughts don’t always suffice …”

I’m sleeping a lot better these days, so I don’t feel the need for as many sleeping pills as before. But I don’t have much patience for pharmacological Puritans. If a doctor responds to my request for a prescription with a lecture, our relationship is history. I’m out the door.

 

Posted by Lois Maharg, The Savvy Insomniac

Lois Maharg has worked with language for many years. She taught ESL, coauthored two textbooks, and then became a reporter, writing about health, education, government, Latino affairs, and food. Her lifelong struggle with insomnia and interest in investigative reporting motivated her to write a book, The Savvy Insomniac: A Personal Journey through Science to Better Sleep. She now freelances as an editor and copy writer at On the Mark Editing.

10 Comments

  1. I love your phrase “pharmacological Puritans”. It evokes
    the rigidity and shaming that can occur with some docs who
    are not trained to deal with the complexity of sleep problems. I’m looking forward to reading your book!

    Like

    Reply

  2. I take Depakote and Seroquel every night for Bipolar Disorder. I am told that the Seroquel helps with sleep. I rarely have any difficulty with sleeping and have no side effects.

    Like

    Reply

  3. Good article Lois. Trazadone works great for me and an occasional 2 mg. Valium is a charm!

    Like

    Reply

  4. Yes, the phrase “pharmacological Puritans” conveys all of the things you mention here, Eileen. But I can’t claim it as my own. The psychiatrist Gerald Klerman coined the phrase “pharmacological Calvinism” in 1972 to describe some people’s negative attitude toward the use of mind meds in general. But I read somewhere that he later regretted the use of “Calvinism” and felt he should have used “Puritanism” instead. I think so, too.

    My sense is that among the mind meds, and some are mentioned above, hypnotics are more disapproved of than other kinds. I take that issue up in my book.

    Like

    Reply

  5. Rather B. Napping November 27, 2012 at 10:29 am

    It’s hard enough for some of us to make the decision to go to a doctor … and then to be lectured on curiosity about pills is insulting! I look forward to more of this blog, and of course, your book.

    Like

    Reply

  6. Lois, I eagerly await your book. I was first prescribed Ambien many years ago, and don’t think I could have continued my work life this long without it. I sleep soundly eight hours every night, wake up with lots of energy, and have always wanted to meet the discoverer of the formula to thank him or her. My gratitude is deeply felt. My mother, who died in 1983, sat up half the night for years. I think there are genetic issues, hormone issues, aging issues….I could walk 20 miles a day and I still wouldn’t be able to fall asleep. Some people have asked, “What if you become addicted?” to which my answer has always been “So what?” I am addicted to sleep, good health, and a strong work ethic. Ambien has made it all possible for me into my mid-70s.I await your thoughtful commentary in the book, Lois!xxoozzzz

    Like

    Reply

  7. Roberta Shaw-Reeves November 27, 2012 at 9:46 pm

    Lois, I’ve enjoyed reading your blogs and the responses to them. When I worked as a children’s librarian at several public libraries over the years, I always slept well and peacefully. Returning to school for 2 1/2 years to become an elementary school teacher brought comforting sleep to an end. When I landed my first teaching job as a first grade teacher, my sleep became fragmented. I spent many hours tossing and turning. When I finally got back to bed after drinking hot milk and downing a banana, I slept fitfully with one eye on my alarm clock. Awakening at 5 AM every morning to be ready to leave at 7 AM was painful. If there’s one thing a teacher can’t do without it is a good night’s sleep. Desperation drove me to my gp, who totally understood teachers. He had several in his family. You’re all so stressed out he said. Trazodone was the tried and true prescription at the time. We finally found the correct dosage and I found great relief. Now retired, I still take trazodone every night. Thankfully,it works. I couldn’t have enjoyed my teaching career without it.

    Like

    Reply

  8. Rather B, your comment about it being hard enough to decide actually to GO to the doctor to talk about sleep issues, never mind the lecture, really resonates. I think I always felt sleep was something I should be able to manage on my own. The fact that it was such a problem made me feel incapable, a little like an adolescent thinking, “Now when am I going to grow up and sleep like an adult?” Of course receiving a lecture in the doctor’s office only reinforced my feelings of inadequacy.

    Jane, a toast to your health and vitality! I can’t believe anyone would feel you should trade the life you’ve had for a life where you sat up half the night. Genes, hormones, aging CAN affect sleep, and I’m glad you’ve found a way to get a good night’s rest (and that you — and obviously your doctor — are comfortable with it).

    Trazodone seems to be easier for doctors to prescribe than hypnotics like Ambien and Lunesta. Unlike these newer drugs, trazodone is an unscheduled drug, meaning the abuse potential is considered to be very low or negligible.

    The curious thing about trazodone, though, is that while it’s been widely prescribed for people with sleep issues because of its sedative properties, not many clinical trials have shown it to be effective. But I’ve spoken to several people who use it for sleep and swear by it. Roberta, I’m glad it got you through those years of teaching and that it’s continuing to do the trick!

    Like

    Reply

  9. When referring to Doctors and the Sleeping Pill Question, I have been extremely fortunate. My doctor who has people fill out a form prior to each appointment indicating our current health issues, makes it easy to address specific issues. She has every single area of concern listed and all a person has to do is circle the concern and it is then addressed during the appointment. She has me taking an antidepresent which has a sedentary side effect, which has worked well for me. Initially she had me using a sleeping pill but after a while, it was eliminated.

    Interestingly, I still find myself feeling guilty that I am taking something to help me sleep. I find my doctor trying to convince ME of the importance of a good night sleep. I guess I should just count my blessings!

    Like

    Reply

    1. All of us poor sleepers should be so lucky!

      Seriously, though, I’m sure there are many GPs and internists willing to go the extra mile to address their patients’ sleep complaints in the best way possible. Hats off to all of them!

      Like

      Reply

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s