Adequate sleep is crucial for good health, and Westerners lack sleep – about half of American adults experience one or more symptom of insomnia a few nights each week, and it is estimated that up to 10% of Americans took prescription sleep aids in 2010.1,2
Insomnia itself can be dangerous because in many cases it often causes daytime fatigue. However, new research has shown that the drugs used to treat insomnia are even more dangerous.
Drugs called “hypnotics” are prescribed to induce sleep in those experiencing insomnia. Some commonly prescribed hypnotics include zolpidem (Ambien), exzopiclone (Lunesta), temazepam (Restoril), and alprazolam (Xanax). These medications have been generally regarded as safe, especially when used only for short-term relief of insomnia.3
Elevated risk of death at low levels of use, and risk increases with number of pills taken
A recent study evaluated the relationship between hypnotic drug use and risk of death in a large sample of over 30,000 American adults. For participants taking any hypnotic drug, the elevated risk of death was substantial, and it was dose-dependent: the more pills taken, the higher the risk of death. Compared to no hypnotic drugs, even those in the lowest level of use (averaging 8 pills per year) more than tripled their risk of death within the 2.5-year follow-up period.
|Use of hypnotic drugs:
||Increased risk of death compared to non-users:
||Increased risk of cancer compared to non-users:
|0.4-18 pills/year (average 8)
|18-132 pills/year (average 57)
|More than 132 pills/year (average 469)
This is not the only study to report an increased risk of death associated with hypnotics. The authors cite 24 previous studies on the topic, of which 18 reported a significant increase in risk of death, plus 4 studies specifically reported increased risk of death from cancer.2
The results of this study means that anyone on these hypnotic medications must get off of them ASAP. In some cases, it could be harmful to stop them suddenly if using them daily. So with the help of a physician the dose should be lowered gradually and then discontinued.
How might hypnotics increase risk of death?
- Side effects of hypnotics include daytime drowsiness, impaired motor and cognitive skills, and sleepwalking, all of which can lead to falls and accidents.2-5
- Hypnotics have been linked to DNA damage, which may underlie their association with cancers.6
Effective, safe, and natural methods for improving sleep
Insomnia is often secondary to other conditions such as anxiety or depression, or a stressful life situation.1 Addressing these underlying factors by using my natural depression solution below plus establishing sleep-promoting habits will help to improve sleep.
My natural depression solutionhas produced excellent results, alleviating or eliminating symptoms for many depression sufferers. The interesting point here is that this same protocol is also effective for insomnia, even when the insomnia is not associated with depression.
- High-nutrient diet. Excellent nutrition is key to excellent overall health, mood and sleep included. The high antioxidant load of a high-nutrient diet protects the brain, which is the organ most susceptible to oxidative stress. Depression is associated with high levels of oxidative stress and low intake of green vegetables.7-9
- Exercise is as just as effective as medication at improving the symptoms of depression, and is also effective against anxiety disorders. Exercise fights these mood disorders by increasing the production of serotonin, a neurotransmitter associated with feelings of well-being. Regular physical activity is well-documented to promote healthy sleep, and exercise has also been shown to effectively improve sleep in insomnia sufferers, as well as improving mood and quality of life. 10-15
- Morning light therapy is another strategy shown to be just as effective as antidepressants for depression. Morning light therapy is also effective at for seasonal affective disorder, and insomnia. Bright light applied first thing in the morning increases mood-elevating substances in the brain and helps to correct the biological clock, normalizing nighttime melatonin secretion and promoting a healthy sleep/wake cycle. 16-18
- Vitamin D supplements. Low vitamin D levels are common in those with depression and Seasonal Affective Disorder (SAD). There is some evidence that Vitamin D may regulate mood and daily biorhythms, and it has shown to be effective at improving feelings of well-being in those with SAD.19-22
- Omega-3 fatty acids. Low omega-3 intake is associated with depression. DHA adequacy is important because DHA is a structural component of brain tissue, and EPA is effective at improving depression symptoms. 23
Some additional sleep-promoting strategies:
- 5-hydroxytryptophan (5-HTP) supplements. Similar to exercise, 5-HTP works by increasing serotonin levels in the brain, and has been shown to be effective in depression, anxiety, and insomnia.24,25
- Tart cherry juice at bedtime has been used as a sleep-promoting supplement, because of cherries’ high levels of natural melatonin.26
- Stress management and relaxation techniques. For example, mindfulness meditation practices are associated with improved sleep quality.27,28
- Improving sleep habits:4,29-31
- Sleep restriction: reducing the amount of time spent in bed to be closer to actual sleep time, which increases sleep drive, over time making it easier to fall asleep.32
- Stimulus control: if 20-30 minutes go by without falling asleep, get out of bed, move to a different room, and engage in relaxing activity until sleepy– this helps to eliminate the mental association between lying in bed and feeling awake, alert, and frustrated.
- Establish a regular bedtime and wake time.
- Make the bedroom quiet, totally dark, and comfortable.
- Avoid caffeine and alcohol.
- Avoid food and exercise within a few hours of bedtime.
- Avoid bright light (including television and computer screens) close to bedtime. Consider reading with a dim light.
These natural sleep-promoting methods are certainly safer than hypnotic drugs, and simultaneously combining all of these methods will maximize the sleep-improving benefit, forming a comprehensive alternative treatment program for insomnia.
1. National Sleep Foundation: Can't Sleep? What to Know About Insomnia [http://www.sleepfoundation.org/article/sleep-related-problems/insomnia-and-sleep]
2. Kripke DF, Langer RD, Kline LE: Hypnotics' association with mortality or cancer: a matched cohort study. BMJ Open 2012;2:e000850.
3. MedlinePlus: Hypnotics [http://www.nlm.nih.gov/medlineplus/ency/article/002376.htm]
4. Gustavsen I, Bramness JG, Skurtveit S, et al: Road traffic accident risk related to prescriptions of the hypnotics zopiclone, zolpidem, flunitrazepam and nitrazepam. Sleep Med 2008;9:818-822.
5. Dolder CR, Nelson MH: Hypnosedative-induced complex behaviours : incidence, mechanisms and management. CNS Drugs 2008;22:1021-1036.
6. Kripke DF: Possibility that certain hypnotics might cause cancer in skin. J Sleep Res 2008;17:245-250.
7. Tsuboi H, Shimoi K, Kinae N, et al: Depressive symptoms are independently correlated with lipid peroxidation in a female population: comparison with vitamins and carotenoids. J Psychosom Res 2004;56:53-58.
8. Ng TP, Feng L, Niti M, et al: Folate, vitamin B12, homocysteine, and depressive symptoms in a population sample of older Chinese adults. J Am Geriatr Soc 2009;57:871-876.
9. Sachdev PS, Parslow RA, Lux O, et al: Relationship of homocysteine, folic acid and vitamin B12 with depression in a middle-aged community sample. Psychol Med 2005;35:529-538.
10. Gill A, Womack R, Safranek S: Clinical Inquiries: Does exercise alleviate symptoms of depression? J Fam Pract 2010;59:530-531.
11. Uebelacker LA, Epstein-Lubow G, Gaudiano BA, et al: Hatha yoga for depression: critical review of the evidence for efficacy, plausible mechanisms of action, and directions for future research. J Psychiatr Pract 2010;16:22-33.
12. Saeed SA, Antonacci DJ, Bloch RM: Exercise, yoga, and meditation for depressive and anxiety disorders. Am Fam Physician 2010;81:981-986.
13. Ma Q: Beneficial effects of moderate voluntary physical exercise and its biological mechanisms on brain health. Neurosci Bull 2008;24:265-270.
14. Passos GS, Poyares D, Santana MG, et al: Effects of moderate aerobic exercise training on chronic primary insomnia. Sleep Med 2011;12:1018-1027.
15. O'Connor PJ, Youngstedt SD: Influence of exercise on human sleep. Exerc Sport Sci Rev 1995;23:105-134.
16. Golden RN, Gaynes BN, Ekstrom RD, et al: The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. Am J Psychiatry 2005;162:656-662.
17. Miller AL: Epidemiology, etiology, and natural treatment of seasonal affective disorder. Altern Med Rev 2005;10:5-13.
18. Shirani A, St Louis EK: Illuminating rationale and uses for light therapy. J Clin Sleep Med 2009;5:155-163.
19. Vieth R, Kimball S, Hu A, et al: Randomized comparison of the effects of the vitamin D3 adequate intake versus 100 mcg (4000 IU) per day on biochemical responses and the wellbeing of patients. Nutr J 2004;3:8.
20. Stumpf WE, Privette TH: Light, vitamin D and psychiatry. Role of 1,25 dihydroxyvitamin D3 (soltriol) in etiology and therapy of seasonal affective disorder and other mental processes. Psychopharmacology (Berl) 1989;97:285-294.
21. Bertone-Johnson ER: Vitamin D and the occurrence of depression: causal association or circumstantial evidence? Nutr Rev 2009;67:481-492.
22. Murphy PK, Wagner CL: Vitamin D and mood disorders among women: an integrative review. J Midwifery Womens Health 2008;53:440-446.
23. Martins JG: EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. J Am Coll Nutr 2009;28:525-542.
24. Birdsall TC: 5-Hydroxytryptophan: a clinically-effective serotonin precursor. Altern Med Rev 1998;3:271-280.
25. Turner EH, Loftis JM, Blackwell AD: Serotonin a la carte: supplementation with the serotonin precursor 5-hydroxytryptophan. Pharmacol Ther 2006;109:325-338.
26. Pigeon WR, Carr M, Gorman C, et al: Effects of a tart cherry juice beverage on the sleep of older adults with insomnia: a pilot study. J Med Food 2010;13:579-583.
27. Brand S, Holsboer-Trachsler E, Naranjo JR, et al: Influence of Mindfulness Practice on Cortisol and Sleep in Long-Term and Short-Term Meditators. Neuropsychobiology 2012;65:109-118.
28. Gross CR, Kreitzer MJ, Reilly-Spong M, et al: Mindfulness-based stress reduction versus pharmacotherapy for chronic primary insomnia: a randomized controlled clinical trial. Explore (NY) 2011;7:76-87.
29. Jacobs GD, Pace-Schott EF, Stickgold R, et al: Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med 2004;164:1888-1896.
30. Sivertsen B, Omvik S, Pallesen S, et al: Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA 2006;295:2851-2858.
31. Smith MT, Perlis ML, Park A, et al: Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry 2002;159:5-11.
32. Kyle SD, Morgan K, Spiegelhalder K, et al: No pain, no gain: an exploratory within-subjects mixed-methods evaluation of the patient experience of sleep restriction therapy (SRT) for insomnia. Sleep Med 2011;12:735-747.