Q: A lot of women battling insomnia or anxiety rely on sleeping pills. They seem harmless enough, but are they really safe? And are the effects of sleep deprivation worse than the long-term use of sleeping pills?
Understanding the underlying physical, mental and social causes of sleep deprivation is important before asking your doctor to reach for a prescription pad. A short-term solution isn’t going to help if the underlying problem isn’t being addressed.
A lot of women in their 30s are concerned about sleep, but that’s only the beginning. Women in their 40s and 50s dealing with perimenopause often wrestle with sleep problems, and many people sleep less — and worse — as they age. So what constitutes “normal sleep” looks different at different stages of life.
If a woman comes into my office and says, “I work all day and then I have the kids and I’m dealing with email, and when I get into bed I can’t shut off my brain,” those are life circumstances that aren’t likely to change any time soon. So your coping skills have to. Meditation, mindfulness training, avoiding caffeine in the afternoon, finding time to exercise: These are things that will improve your quality and quantity of sleep in the long term.
When there’s a short-term issue with a patient — maybe she is working 14 hours a day to meet a deadline, or anxious from taking care of an ailing parent — I will often write a prescription. But sleeping pills need to be treated with respect. They shouldn’t be taken every night. They must be kept out of the reach of children. They can’t be mixed with a glass of wine. Remember what these pills are: a potentially addictive substance with side effects.
If you pop a pill every night, it will soon be difficult to sleep without it, and you’ll need a bigger dose to get the same effect. At higher doses, side effects like daytime sedation can kick in. Withdrawal can lead to anxiety, irritability, shaking, agitation or worsened sleep difficulties. Consuming alcohol while on sleeping pills can lead to confusion and severe drowsiness. And for older women, pills like these can be dangerous because they can throw you off balance, contributing to falls.
Bottom line: If your lack of sleep is so bad that you can’t function, the benefits of a sleeping pill for the short term outweigh the risks. But a rolling prescription cannot be a long-term strategy.
Dr. Danielle Martin is a family physician and vice-president, medical affairs and health system solutions, at Women’s College Hospital in Toronto.