When it comes to sleep, I’m convinced that quality is more important than quantity. Hands down, I’ll take 5 ½ hours of sound slumber over restless dozing that stretches out for 7 hours. So I have mixed feelings about sleeping pills. Many meds invented to give us more sleep degrade the Zzzz’s we get and can actually worsen insomnia.
The case of Michael Jackson is relevant here. Propofol, the hypnotic Jackson was given by Dr. Conrad Murray for sleep, knocked Jackson out but robbed him of precious REM sleep. Sixty days of propofol injections amounted to the equivalent of Jackson being sleepless for 60 straight days, Harvard sleep specialist Charles Czeisler testified during Jackson’s wrongful death trial, according to Time Magazine online. The accumulated effects of propofol may have led to Jackson’s untimely death.
Of course, propofol is an anesthetic, not a sleeping pill. It has never been approved for the treatment of insomnia, likely because it so radically alters the nature of the sleep it provides. But sleeping pills also affect sleep quality, and it’s important to understand how.
What Does Quality Sleep Look Like?
There is no objective measure of sleep quality. But normal sleep consists of both REM sleep (when we’re dreaming) and non-REM, or quiet, sleep. Deep sleep is a key component of the non-REM sleep. Apparently we need a certain amount of both REM and non-REM sleep (particularly deep sleep) to survive.
REM Sleep Deprivation
Subjects deprived of REM sleep are moody and emotional and have memory problems. Barbiturates—sleeping pills widely prescribed through the 1970s—put people to sleep but, like propofol, deprived them of REM sleep. Nightly users who tried to stop taking drugs like Nembutal and Seconal experienced “REM rebound”—nights fraught with terrifying dreams.
REM rebound was so awful that it led people to resume taking the drug, and eventually to drug dependency and ever-increasing doses, sometimes resulting in overdose and death. This is why barbiturates are rarely prescribed for insomnia anymore.
Deprivation of Deep Sleep
Subjects deprived of deep sleep have memory and learning problems, experience compromise of various bodily systems, and typically wake up feeling unrested. Benzodiazepine drugs such as Restoril, Halcion, and Ativan—which are prescribed for insomnia today—reduce the amount of deep sleep users get. They may keep you sleeping longer, but, if you take them for prolonged periods, you wake up feeling unrefreshed.
What about the popular “Z-drugs,” zolpidem (Ambien) and eszopiclone (Lunesta)? Taken nightly, they too may result in small reductions in deep sleep, although not to extent that benzodiazepines do. And zolpidem was recently discovered to increase the occurrence of “sleep spindles”–events during non-REM sleep that, in excess, heighten users’ memory for negative events.
I’ll be the first to argue that sleeping pills have a place in the treatment of insomnia. I don’t have patience for pharmacological Puritans who insist they be avoided at all costs. Yet to use them—especially for long periods—is a little like robbing Peter to pay Paul. Keep this in mind as you’re deciding if and when to pop an Ambien.
If you’ve used sleeping pills for extended periods, what effect did they have on your sleep?