Alcohol and Sleep: A Cautionary Tale

These days an old friend of mine is sliding deeper into dependence on alcohol. It’s sad and hard to watch. George stays with us twice a year while visiting his family, who live a few miles away. These family visits are fraught with discord. So by 5 p.m. George is often back at our house for the night—wine or whiskey in hand.

New research explains how alcohol dependence causes insomnia that persists for many years after withdrawal.

Alcohol abuse may harm sleep for many yearsThese days an old friend of mine is sliding deeper into dependence on alcohol. It’s sad and hard to watch.

This friend—I’ll call him George –stays with us twice a year while visiting his family, who live a few miles away. These family visits are fraught with discord. So by 5 p.m. George is often back at our house for the night—wine or whiskey in hand.

George suffers terrible insomnia. But you’d never know it during our happy hour, when he comes alive. He’s always ready with a toast to friends whose home, he says, is an oasis of calm next to the turbulence of his family. Toxic family relationships are George’s main topic of conversation during happy hour: his mother, a woman without much warmth whose love her sons still compete for; a bullying older brother; and a sister-in-law who stokes the rivalry already going between the brothers at every opportunity.

Visits in the Past

In the past George’s negative feelings toward his family would eventually work themselves out—helped by the Finian’s—and then he’d get around to asking my husband and me about our lives. George can be a wonderfully attentive listener. He’s also got wide-ranging interests and concerns.

A few years ago he confessed to worrying about the high doses of Ambien he needed to take to get even 3 or 4 hours of sleep. I can attest to the brevity of George’s nights. His room light has been on when I was up for bathroom calls at 1 or 2 a.m. And no sooner am I down the stairs at 5:30 than he’s in the kitchen asking for strong coffee. It doesn’t matter how wasted he feels, he says. Once he wakes up in the morning, it’s impossible to get back to sleep.

On This Visit, Changes

Our happy hour conversation didn’t get very far on George’s recent visit. Each night he glommed onto the family drama and could not let it go. Nor could he stop drinking. One night he drank a beer and then a bottle of Pinot Noir and, just as he was heading toward the pantry for more, my husband and I fled up the stairs, begging off because of tiredness. Really it was the relentless talk about his family we wanted to escape. At midnight I tiptoed downstairs to adjust the heat and there was George, still drinking and talking on the phone.

In the morning, he came down behind me for his coffee. But when I put the water on, he changed his mind: he was going back upstairs for a little more shut-eye, he said.

That’s odd, I thought to myself. Never in all his other visits had George gone back to bed. Once he was up, he was up for good. My hunch was that he’d taken a sleeping pill quite a bit later than usual and, deciding it wasn’t working, got out of bed only to be hit by sudden sleepiness when the Ambien finally kicked in.

Reflecting on the Situation

George’s situation has taken a turn for the worse–there’s no denying it—and this is upsetting enough. But when I consider what lies in store for him, no scenario I can imagine looks good.

Continuing to drink at the level he’s drinking now is compromising his overall health, and plainly it’s hurting his sleep. But new research shows that even if George does someday go in for alcohol treatment, his sleep may be irreparably harmed.

Science Suggests Why

Adenosine is a neurotransmitter important to sleep, and it’s through adenosine that alcohol exerts its effects on the sleep-wake system, say researchers at the University of Missouri, following a series of lab experiments. In rats never before exposed to alcohol, a single dose resulted in the rats falling asleep more quickly and sleeping more deeply. It did this by increasing available adenosine in the rats’ basal forebrain, an area crucial to sleep. In turn, the adenosine suppressed the activity of wake-promoting neurons there, thus promoting sleep.

But in rats habituated to alcohol, withdrawal from alcohol had the opposite effect. It resulted in the rats experiencing significantly more wakefulness during both their activity and sleep periods–behavior that mimics the severe insomnia experienced by humans during acute alcohol withdrawal.

Excessive wakefulness would normally lead to a robust build-up of adenosine in the basal forebrain. But during alcohol withdrawal this did not happen in the rats. Sustained use of alcohol down-regulates the adenosine system and blunts the sleep system, the researchers concluded, making it harder to fall and stay asleep.

Long-Lasting Effects

It’s not just during acute withdrawal that alcoholics experience poor sleep. Clinical studies have shown that sustained withdrawal from alcohol in humans causes insomnia and sleep fragmentation for years to come.

My blog topics are usually more uplifting. But the only word for the story on alcoholism and sleep is bleak. However you choose to manage your insomnia—whether it’s CBT, meditation, sleep aids, alternative treatments or some combination of these–steer clear of alcohol, a harmful soporific close at hand.

Can Insomnia Be Caused by Dietary Supplements?

I’ve written about common medications that can cause insomnia. But less is known about the side effects of supplements. They’re unregulated in the United States and not required to undergo rigorous testing.

But investigators at ConsumerLab, after reviewing the results of tests that have been conducted, say there’s evidence that 6 supplements may interfere with sleep. Here’s a summary of the findings:

Six dietary supplements that may interfere with your sleepI subscribe to a newsletter from ConsumerLab, a watchdog company that tests and reviews dietary supplements. Last week a question in the newsletter caught my eye:

“Could my CoQ10 supplement be causing my insomnia?”

I’ve written about common medications that can cause insomnia. But less is known about the side effects of supplements. They’re unregulated in the United States and not required to undergo rigorous testing. But investigators at ConsumerLab, after reviewing the results of tests that have been conducted, say there’s evidence that 6 supplements may interfere with sleep. Here’s a summary of the findings:

CoQ10

Coenzyme Q10, or ubiquinone, is an antioxidant compound that cells use to produce energy. The body usually manufactures enough CoQ10 on its own, and small amounts can be gotten from beef and chicken. But CoQ10 production may fall off with age or because of heart disease. CoQ10 supplements are used for congestive heart failure and to reduce the risk of heart problems after a heart attack. They may also lessen the muscle pain associated with taking statin drugs and help to prevent migraines.

The typical daily dose is 100 to 300 mg. Yet taken in the evening, doses of 100 mg and higher reportedly cause mild insomnia in some people. Doses of 300 mg taken in the daytime may also interfere with sleep.

St. John’s Wort

The leaves, flowers, and stem of this herbaceous plant are used to treat major depression of mild to moderate severity. Two chemicals found in St. John’s wort–hypericin and hyperforin—are believed to be responsible for the herb’s antidepressant effects. They act on chemical messengers in the nervous system that regulate mood.

The typical dose varies depending on whether the product is made from an extract or the whole herb and how much hypericin or hyperforin it contains. Stomach upset is the most common side effect. Rarer side effects include anxiety, fatigue, and insomnia.

Chromium

This essential trace mineral is important for insulin function and helps move glucose from the bloodstream into cells for use as energy. The body needs just a little bit, and because chromium is found in so many foods—from meat and potatoes to whole-grain bread and fresh fruit—most people get enough in their daily diet. Adequate intake for adults is low: 20 to 45 micrograms (mcg) daily.

Chromium helps decrease fasting blood glucose levels and regulate insulin. Chromium deficiency is associated with type 2 diabetes, and people with diabetes may be prescribed two 500-mcg tablets daily. However, doses of 200 to 400 mcg daily have caused insomnia and sleep disturbance in some users.

DHEA

Dehydroepiandrosterone (try to pronounce that one!) is a hormone produced by the adrenal glands that the body converts into other steroidal hormones such as estrogen and testosterone. DHEA production peaks when we’re in our 20s and declines with age. Dietary supplements—which are manufactured from chemicals in soybeans and wild yams (DHEA cannot be gotten directly by eating these foods)—are believed to have anti-aging effects. For example, DHEA may improve bone density, skin elasticity, and mood.

The prescribed dose varies widely. Rare cases of insomnia have been reported with daily use.

Garlic

Garlic in its various forms—whole, powdered, and liquid—has been shown in studies to lower serum total cholesterol by 4 to 5 percent. So it’s used to lower cholesterol and may slow the progress of atherosclerosis.

Garlic is believed to be safe even at high doses. But some people taking high doses have experienced insomnia as a side effect.

Policosanol

Policosanol is a cholesterol-lowering supplement made from sugarcane, beeswax wheat germ, or rice bran wax. Some studies show it helps prevent heart disease.

Clinical doses range from 10 to 40 mg daily. But subjects have reported a wide range of side effects, including insomnia and daytime sleepiness.

Have you used any of these supplements? If so, did they interfere with your sleep?

OTC Sleep Aids: A Risky Business

Many of us assume that over-the-counter drugs are safer than prescription drugs.

Yet the long-term effects of any drug can remain unknown for decades, and now researchers have found a correlation between long-term and/or high-dose use of OTC sleep aids and dementia.

Over-the-counter sleeping pills may not be as safe as we thinkSome insomniacs are leery of prescription sleeping pills but feel OK about sleep aids sold at the drugstore.

“I’m not really looking for medical intervention,” said Dale, a marketing manager who spoke to me about his insomnia as I was conducting interviews for my book. “I’m absolutely not interested in anything strong. But if it’s sold over the counter and I can take a half dose of it, that’s fine.”

Many of us assume that over-the-counter drugs are safer than prescription drugs. Yet the long-term effects of any drug can remain unknown for decades, and now researchers have found a correlation between long-term and/or high-dose use of OTC sleep aids and dementia.

Which Drugs Are Involved?

These drugs are called anticholinergics, among them the first-generation antihistamines that are now marketed as sleep aids. The active ingredient in these sleep aids is diphenhydramine or doxylamine. Here’s a list of common brand names:

  • Benadryl
  • Sominex
  • ZzzQuil
  • Tylenol PM
  • Excedrin PM
  • Nytol
  • Unisom
  • Store brands containing diphenhydramine and doxylamine.

Anticholinergic drugs block the action of acetylcholine, a neurotransmitter that plays an important role in waking us up and keeping us vigilant. When we’re awake, acetylcholine neurons are active in several areas of the brain. But the brains of people with Alzheimer’s disease show a marked reduction of acetylcholine and acetylcholine-secreting nerve cells. Other common anticholinergic medications include tricyclic antidepressants such as doxepin (Sinequan) and antimuscarinic drugs for bladder control such as oxybutynin (Ditropan).

Gist of the Study

Investigators at the University of Washington began tracking the medical records of 3,434 healthy 65-year-olds to see if anticholinergic medications increased their risk of developing dementia. About 23 percent of these older adults went on to develop dementia over a 7-year period.

Compared with people who did not take anticholinergic drugs, people taking at least 4 mg of diphenhydramine daily (1 capsule of Benadryl or ZzzQuil contains 25 mg of diphenhydramine), 10 mg of doxepin daily, and 5mg of oxybutynin for more than 3 years had a small increased risk of developing dementia. The risk increased in a linear fashion with higher doses and longer use.

Results in Perspective

This is not the first study to link dementia to the use of anticholinergic drugs. Researchers in Australia found that taking more anticholinergic medications was associated with greater risk of hospitalization for confusion or dementia. Researchers in Spain have concluded that long-term use of anticholinergic drugs “may generate a worsening of cognitive functions” and can also “initiate signs of dementia.”

None of the studies show that the relationship between anticholinergics and dementia is causal. Yet they do suggest that frequent use of OTC sleep aids may not be as harmless as many insomniacs suppose.

So what to do? Several prescription sleeping pills have also been connected to an increased risk of dementia, and a small body of research suggests that poor sleep may itself be a factor in the development of cognitive impairment. Now is the time to check into drug-free treatments for insomnia and be more sparing in the use of sleep meds, whether they’re handed over by a pharmacist or you can buy them right off the shelf.

 

Magnesium May Ease Insomnia and Anxiety

Last week a new friend was telling me about her sons. She has quite a bit of anxiety about their situation and, since reaching menopause, she’s had trouble sleeping. She tried sleeping pills and didn’t like the way they made her feel. But magnesium supplements seem to do the trick.

So I looked for research on magnesium, anxiety and insomnia and here’s what I found.

Magnesium supplements may ease anxiety and improve sleepLast week a new friend was telling me about her sons. She has quite a bit of anxiety about their situation and, since reaching menopause, she’s had trouble sleeping. She tried sleeping pills and didn’t like the way they made her feel. But magnesium supplements seem to do the trick.

So I looked for research evaluating magnesium’s effects on anxiety and insomnia. Not much is out there, and most of what exists are investigations of magnesium in combination with other vitamins and supplements. But some readers of this blog want information about alternative treatments for insomnia, so here’s the gist of what I found.

Magnesium’s Effects on Anxiety Symptoms

Magnesium has several important molecular functions in the body. Both animal and human studies suggest that magnesium deficiency may be linked to anxiety and anxiety-related disorders. In the early 2000s, three randomized controlled trials were conducted to assess the effects of magnesium supplements on anxiety symptoms in humans:

  1. In 80 healthy male subjects, a 4-week treatment of a multivitamin containing large amounts of magnesium, zinc, and calcium significantly decreased anxiety symptoms and perceived stress compared with placebo. The effects got stronger the longer treatment progressed.
  2. In 44 women with premenstrual anxiety (but otherwise healthy), over 4 monthly cycles each, participants were alternately given 200 mg of magnesium, 50 mg of vitamin B6, both the magnesium and the B6, or a placebo pill. The combination treatment provided a small but significant reduction in premenstrual symptoms such as nervous tension, mood swings, irritability, anxiety. By itself, however, the magnesium was no more effective than placebo.
  3. The third study was conducted on 264 people with a diagnosis of generalized anxiety disorder (GAD) for 3 months. The anti-anxiety effects of a compound containing magnesium and two plant extracts was compared with placebo. Both the active treatment and the placebo greatly decreased participants’ anxiety symptoms—the supplement a little more than the placebo.

These results are certainly mixed. First, it’s hard to make claims about the anxiety-reducing effects of magnesium when it’s studied in combination with other substances. It’s also important to realize that the effects of magnesium on the subjects in these studies—healthy men, women with premenstrual anxiety, and people with a diagnosis of GAD—may not generalize to everyone with anxiety or anxiety-related trouble sleeping. So we’ll have to look to future research to confirm or disconfirm magnesium’s calming effects.

Effects of Magnesium on Insomnia

Magnesium affects systems that promote both wakefulness and sleep, so it might have a relationship to insomnia. Two randomized controlled trials suggest that it may improve the sleep and daytime functioning of older adults. (The rationale for exploring the question with older study participants is that as we age, we’re prone to experience changes in the way our bodies absorb, retain, and utilize nutrients, and changes in circadian rhythms. A magnesium deficiency would more likely show up in older adults.)

  1. The 46 participants in this 8-week study (ages 60–75) were divided into two groups: one taking 500 mg of magnesium a day and the other taking a placebo. Compared with the placebo takers, the magnesium takers experienced significant increases in total sleep time and sleep efficiency, and significant decreases in the time it took to fall asleep and insomnia severity. Moreover, their levels of melatonin (a sleep-friendly hormone) were up while their levels of cortisol (a stress hormone) were down.
  2. The 43 participants in this 8-week study (ages 74–82) were also divided into two groups, one taking a food supplement containing magnesium, melatonin, and zinc, and the other, a placebo. Again, compared with participants on the placebo, participants taking the supplement experienced significant increases in total sleep time, sleep quality, and ease of getting to sleep. Their early morning alertness and stamina was also improved.

The results of both studies suggest that magnesium may be an effective sleep aid for older adults. Whether young and middle-aged insomnia sufferers would experience the same benefits remains to be seen.

But if you’re comfortable experimenting with alternative treatments for insomnia, as long as you avoid taking too much, magnesium might be worth trying, especially if you’re older. It has none of the drawbacks associated with other sleep aids. Like other supplements, though, it may need to be taken a few weeks before producing effects.

If you prefer to wait for science to confirm supplementary magnesium’s effects on sleep, you may be waiting a long time. There’s little money to be made on vitamins, minerals, and plant-based supplements—so the research lags. That doesn’t mean magnesium or any other supplement won’t help your sleep. It just means it hasn’t been studied yet.

Hot Flashes and Sleep: Can Paroxetine Help?

Waking up to hot flashes now that you’re going through “the change?” You’re not alone. Up to 80 percent of women experience them during menopause.

Annoying in the daytime, hot flashes can play havoc with your sleep, making you prone to frequent wake-ups in sweat-soaked sheets. Up to 61 percent of postmenopausal women report hot flash-related wake-ups and other symptoms of insomnia.

Low-dose paroxetine, a drug prescribed at higher doses for depression, holds promise for women looking to cut down on hot flashes and night sweats and improve their sleep.

low-dose paroxetine may cut down on hot flashes and night sweatsWaking up to hot flashes now that you’re going through “the change?” You’re not alone. Up to 80 percent of women experience them during menopause.

Annoying in the daytime, hot flashes can play havoc with your sleep, making you prone to frequent wake-ups in sweat-soaked sheets. Up to 61 percent of postmenopausal women report hot flash-related wake-ups and other symptoms of insomnia.

Hormone therapy (HT) was for years touted as a panacea for women looking to avoid hot flashes, night sweats and other menopause symptoms. HT worked. The use of estrogen or estrogen combined with progestin is still recommended as a front-line treatment for some menopausal women.

For others, the downsides of HT outweigh the benefits. Hormonal treatments increase the risk of heart disease, stroke, bile stones and breast cancer. If you’re vulnerable to any of these serious ailments, you’ll want to think twice about starting HT.

What else is out there for mid-life women looking to stop these eruptions of our inner Vesuvius and get a decent night’s sleep? Low-dose paroxetine, a drug prescribed at higher doses for depression, holds promise.

What Is Paroxetine?

Paroxetine, a.k.a. Paxil, is a selective serotonin reuptake inhibitor (SSRI). Drugs in this class alter the chemical content of the brain by blocking a particular receptor that absorbs serotonin. More serotonin is then available to strengthen neural circuits that regulate and elevate mood.

Like many SSRIs, paroxetine taken at doses recommended for depression (20-50 mg.) has an unpredictable effect on sleep. While some users report improved sleep, other users monitored during clinical trials report experiencing insomnia.

Yet the results of two recent studies show that paroxetine taken at a lower dose (7.5 mg.) cuts down on nighttime awakenings due to hot flashes and increases sleep duration significantly more than placebo.

Gist of the Studies

Participants in these studies were 1,184 middle-aged women reporting moderate to severe hot flashes and night sweats. They were randomly assigned to 7.5 mg of paroxetine or placebo, taken once a day for 12 or 24 weeks.

The results? Overall, nighttime awakenings due to hot flashes were reduced 38 percent more in the women taking paroxetine than in the women who took a placebo. Also, the paroxetine subjects consistently reported sleeping longer than those taking placebo.

These results are modest. But paroxetine is believed to be safe for long-term use and, at low doses, to have minimal side effects. Paroxetine could give meaningful symptom relief to at least some women. If you’re waking up to hot flashes night after night, it’s worth exploring with your doctor.

Drug-Free Remedies

Looking for a drug-free way to control menopause-related insomnia instead? A new review of alternative treatments for postmenopausal women cites evidence that the following may help:

  • Isoflavones. These compounds exert estrogen-like effects and are found in legumes, especially soybeans.
  • Massage.
  • Yoga.
  • Physical activity.
  • Physical therapy.

If you’ve found a reliable way to cut down on hot flash-related awakenings at night, please share it!

For Sounder Sleep, Adjust Your Meds

Do you take medication for a chronic health condition? That drug may be disturbing your sleep.

Working with a doctor to adjust the dose or time you take it—or replace it with a similar drug that does not stimulate the central nervous system—may be all you need to hold insomnia at bay.

Which drugs can interfere with sleep? Here are a few most widely prescribed.

insomnia can be caused by daily medicationsDo you take medication for a chronic health condition? That drug may be disturbing your sleep.

Working with a doctor to adjust the dose or time you take it—or replace it with a similar drug that does not stimulate the central nervous system—may be all you need to hold insomnia at bay.

Which drugs can interfere with sleep? You’ll find a complete list in the 2010 edition of Principles and Practice of Sleep Medicine. Following are a few most widely prescribed.

Cardiovascular and Cholesterol-Lowering Drugs

Cardiovascular agents (for high blood pressure, heart disease, and kidney disease) and cholesterol-lowering drugs were the two most common types of drugs prescribed in 2007-2010, according to a CDC report released in May. Some may disrupt your sleep:

  • Beta Blockers, aimed at lowering blood pressure and reducing the risk of repeated heart attacks, are used by many adults. Metoprolol, for example, was the fourth most prescribed medication in the US last year, according to data from IMS Health. Yet metoprolol and other fat-soluble beta blockers—such as propranolol and pindolol—have caused insomnia and nightmares in some users, as well as reductions in REM sleep. Beta blockers also decrease the release of melatonin, which might disturb the continuity of your sleep.
  • Statins are widely prescribed to lower cholesterol and prevent heart attacks and strokes. Simvastatin, for example, was the fifth most prescribed medication in the US last year. Clinical trials of simvastatin and similar drugs—atorvastatin, lovastatin and pravastatin—have generally failed to show that these drugs impair sleep. But anecdotal reports suggest they cause insomnia and nightmares in some users.

Antidepressants

The CDC cites antidepressants as another commonly used type of medication. About 10.6 percent of Americans aged 18-64 years report using them, as do 13.7 Americans aged 65 and above. The antidepressant duloxetine (Cymbalta) was the fifth highest selling drug in 2013.

Some antidepressants are sedating (trazodone, nefazodone, and doxepin, for example). Others tend to be arousing (desipramine, nortriptyline, and protriptyline) and may disrupt sleep. But some antidepressants are neither fish nor fowl, and their effects on sleep are harder to predict:

  • Selective serotonin reuptake inhibitors (SSRIs) cause insomnia in some people and daytime sedation in others. Fluoxetine (Prozac) reportedly caused insomnia in 10 to 17 percent of users and daytime sedation in 5 to 21 percent.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs) also cause insomnia in some people and daytime sedation in others. Duloxetine, for example, caused insomnia in 10 to 18 percent of users and daytime sedation in 8 to 13 percent.

See your doctor if you’re wondering whether a drug you take is contributing to your insomnia. Small adjustments in timing or dosage may be all it takes to put you on track to sounder sleep.

Please share questions or comments about drugs you take and their effects on your sleep.

Merck's New Sleeping Pill to Come Out Soon

Roll over, Ambien! After much debate, the FDA has finally approved Merck’s new drug for insomnia. Expect to see Belsomra (a.k.a. suvorexant) on the market early next year.

So what can we hope for from this new sleeping pill and how does it differ from hypnotics available now?

Belsomra, a new sleeping pill approved for insomnia, will enter the market early next yearRoll over, Ambien! After much debate, the FDA has finally approved Merck’s new drug for insomnia. Expect to see Belsomra (a.k.a. suvorexant) on the market early next year.

So what can we hope for from this new sleeping pill and how does it differ from hypnotics available now?

 

A Different Path to Sleep

Older sleeping pills—from barbiturates and benzodiazepines to Ambien and Lunesta—induce sleep via the GABA system. GABA is the main neurotransmitter responsible for calming the brain and putting us to sleep. GABA-producing neurons are found throughout the brain, and when they start firing, other brain activity grinds to a halt. Most sleeping pills speed this process up, thus helping put us to sleep and keep us asleep.

Belsomra does not achieve its soporific effect through the GABA system. Instead, it works on the orexin system—on a much smaller group of neurons in the hypothalamus. These orexin-producing neurons are normally quiet during periods of sleep. But in the daytime they fire continuously, keeping us awake and alert. People who lack orexin neurons are narcoleptic, succumbing to irresistible sleep attacks during the day.

Insomnia sufferers may have the opposite problem, researchers have suggested. The orexin neurons in our brains may be overactive, keeping us awake at night. Orexin receptor antagonists such as Belsomra are being developed based on experiments that show that suppressing activity of the orexin neurons induces sleep.

How Effective Will Belsomra Be?

The FDA does not require new drugs to be more effective than older drugs before gaining approval. How Belsomra stacks up against Ambien, America’s most popular sleeping pill, is anybody’s guess.

But new drugs do have to work better than placebo. Here, Belsomra apparently passes muster. Compared with placebo, it has helped insomnia sufferers fall asleep faster and experience fewer middle-of-the-night awakenings. A year-long trial published in the May 2014 Lancet Neurology showed that after one month, insomniacs who took Belsomra got to sleep about 10 minutes faster than insomniacs taking a placebo and slept about 23 minutes longer. No great shakes! But we’re talking averages here.

Is the New Drug Safe?

A year ago there was quite a bit of concern that suvorexant in doses higher than 10 mg left a significant number of test subjects feeling groggy in the morning, impaired their driving, and led to other “narcolepsy-like” symptoms. But, based on documentation subsequently submitted by Merck, the FDA has decided to approve Belsomra for use in doses of 5, 10, 15, and 20 mg. Higher doses of the drug are said to be more effective—but they also tend to come with more side effects.

The US Drug Enforcement Agency will probably make Belsomra a scheduled drug. A Schedule IV classification would place it in the same category as Ambien and most other hypnotics on the market today. So if and when Belsomra comes on the market and you go on to try it, use it with care.

February 3, 2015: There seems to be a lot of interest in this new sleeping pill. Belsomra is now available here in the United States, and people are writing to me with questions about  effectiveness, side effects, and cost.

I have no plans to try it myself, so I can’t comment on it one way or another. But if you try Belsomra, I know others would appreciate hearing what you think about it.

You may also be interested in learning more about the safety and efficacy of Belsomra. You’ll find that information here.

Q&A: During CBT, Do I Have to Stop My Sleep Meds?

A long-term user of sleeping pills wrote to Ask The Savvy Insomniac with questions about cognitive-behavioral therapy for insomnia. “Before I go through CBT, will I have to give up my sleeping pills? I’d like to get off them eventually, but every time I think of doing it I freak out.”

Recently I looked into research on insomnia sufferers going through CBT while at the same time tapering off (or reducing reliance on) sleeping pills. What I found was encouraging.

Insomnia sufferers who use sleeping pills can taper off them while undergoing cognitive-behavioral therapyA long-term user of sleeping pills wrote to Ask The Savvy Insomniac with questions about cognitive-behavioral therapy for insomnia.

“Before I go through CBT, will I have to give up my sleeping pills? I’d like to get off them eventually, but every time I think of doing it I freak out.”

Some sleep therapists ask people with insomnia to refrain from using sleeping pills while undergoing CBT, a treatment that promotes sleep-friendly practices and a positive mindset. But this rule may be hard to comply with for people who’ve used sleeping pills for months and years. So hard, in fact, that it may discourage them from trying CBT at all.

Recently I looked into research on insomnia sufferers going through CBT while at the same time tapering off (or reducing reliance on) sleeping pills. What I found was encouraging, so I’ll share it here.

Sleeping Pills? I Love Them!

My aim isn’t to convince people comfortable with their sleep meds to come off them. I use hypnotics occasionally myself, and frankly I get tired of people demonizing them as if they were on par with heroin or crack cocaine.

But some nightly users complain, even when taking sleeping pills, that their sleep isn’t very satisfying. This perception is probably related to the fact that many sleep meds, especially when taken over time, tend to change the nature of sleep. Also, studies linking long-term use of sleeping pills to increasing vulnerability to colds, depression and mortality are not reassuring. It’s easy to see why some long-term users are interested in a path to sleep that feels more “natural.”

Tapering Off Sleep Meds

If you’ve used hypnotics for a long time, it’s not a good idea to go cold turkey, say Lynda Bélanger and colleagues in a paper on hypnotic discontinuation. Stopping abruptly puts you at greater risk for withdrawal symptoms and health complications. Hypnotic drugs should be discontinued gradually, they say–ideally with guidance from a trusted physician.

No guidelines exist showing what the optimal rate of tapering is. Your doctor might propose decreasing the initial dose by 25 percent every week or every other week. But, say these Canadian researchers, the pace of the tapering “may need to be adjusted according to the presence of withdrawal symptoms and anticipatory anxiety; it can also be slowed if the person finds it too difficult to cope or feels unable to meet the reduction goal.”

CBT Assists Tapering and Improves Sleep

In most studies of sleeping pill users undergoing CBT for insomnia, CBT has helped wean them off drugs (or reduce the amount they use) and improved their sleep. Here’s a snapshot of the results:

  • CMAJ, 2003: About 77 percent of those undergoing CBT while on a drug tapering program came off their meds, vs. 38 percent on the drug tapering program only.
  • American Journal of Psychiatry, 2004: About 85 percent of those undergoing CBT while on a drug tapering program came off their meds, vs. 48 percent on the drug tapering program only. CBT groups also reported greater sleep benefits than the group doing the taper alone.
  • BMC Psychiatry, 2008: Added to a drug tapering program, CBT improved sleep quality in hypnotic users even more than it did in people who didn’t use drugs.
  • Sleep Medicine, 2014: In this novel study, adding hypnotic medication to traditional CBT improved subjects’ sleep faster than CBT alone. (By the end of therapy, the sleep of both groups had improved equally).

So if you’d like to try CBT but are anxious about stopping your sleep meds, shop around for a sleep specialist who’s willing to work with you to tailor a program suited to your needs. What’s not to like about the prospect of improving your sleep and at the same time reducing your dependence on drugs?

What concerns do you have about CBT and sleeping pills?