Sleeping Pills for Insomnia: Uses, Placebo Effects, Harmful Effects, Cure

Rhythm is a ubiquitous virtue of nature that plays an essential role in the lives of all the living beings sustaining on the earth. The most beautiful rhythm on this planet is the oscillation between day and night at regular intervals. This oscillation takes twenty-four hours to get completed and is known as the circadian rhythm. The presence of the circadian rhythm has been observed in all the behavioral and physiological functions of the living organisms. In humans, it goes by the name of the sleep-wake cycle. The sleep-wake cycle is regulated by a series of complex endogenous reactions involving hormones.

The circadian cycle is responsible for maintaining a sense of wakefulness during the day and inducing sleep during the night. When this sleep-wake pattern is disturbed due to various reasons like anxiety, depression, or other comorbid conditions, it leads to the sleep disorder. The state of insomnia is treated with the help of multiple medications that fall under the category of sedative and hypnotic drugs. They induce sleep in insomnia patients by tranquilizing or sedation. These drugs are famous by the name of sleeping pills.^[1]

Insomnia or sleeplessness has emerged as a common indisposition that has been impacting around one-third of the younger population of the world in a year. The short term insomnia is observed due to stress work or disturbance in environmental conditions. However, if the situation continues for more than three weeks, it requires medical assistance.

The most common class of sleeping pills used to treat the medical condition of insomnia are barbiturates, benzodiazepines, etc. But risk and safety issues have always accompanied the use of sleeping pills in patients.

When sleeping pills are prescribed to old age patients, extra vigilance should be kept on them. Studies have documented that sleep disorders have a tendency to increase with old age. More aged people who have insomnia have been observed to consume more sleeping pills when compared to the younger ones. It might lead to decreased clearance of the drug from the body. The elevated plasma concentration can cause toxicity, sedation, or impairment of coordination in senior patients.^[2]

Placebo is considered to be an imposture treatment that is given in the form of bread pills, inert tonics, etc. These are sham treatments that healthcare professionals use to satisfy and appease the anxious condition of voracious patients. During clinical trials, blind place controlled situations are also studied and evaluated. Various factors affect the use of placebo treatment. They exhibit a sense of physiological potency in the patients that makes them feel treated.^[3]

The placebo effect is a commonly observed factor during the clinical trials of sedative and hypnotic agents. There are different experiments carried out to study whether sleeping pills are needed for a sound sleep in insomnia patients, or it is just a placebo effect that helps them to fall asleep. An experiment was executed to examine the impact of an inert compound that has been administered to patients with mild sleep disorders, claiming it to be a hypnotic agent.

The Pittsburgh Sleep Quality Index selected ten female students for the experiment. They were administered with lactose pills disguised as sleeping pills, and their sleep behavior was observed in a sleep laboratory. The students, after three days, self-rated that their sleep was restful, and the frequency of nocturnal awakening significantly decreased. The result was a comparative one based on quantitative electroencephalographic, polysomnographic, and behavioral changes, before and after the inert drug administration.

Apart from the self-assessment by the female volunteers, polysomnographic measures demonstrated that the sleep disturbance dropped down, ECG activity was lowered during the rapid eye movement sleep, and the behavioral change upon the morning awakening showed improvement. The rationale drawn from the experiment suggested that the placebo effect of an inert pill improved both the subjective and objective quality of sleep.^[4]

The use of medicine, whether it is an antibiotic or a sleeping pill, is accompanied by some potential side effects. Thus, many investigations were carried out to find the placebo effect of drugs disguised as sleeping pills. One such experiment was done to analyze whether a previous warning about the side effects related to placebo sleeping pills increases their occurrence or not. Patients or volunteers that take part in clinical trials are warned priorly regarding the side effects of the treatment.

The notion is that such warnings lead to placebo induced side effects due to the anticipation of the outcomes. To test this possibility, an experiment was done on undergraduate students, facing sleep difficulty. They were given a placebo treatment in the name of a hypnotic medication for one week. Before treatment, they were warned about some faux side effects. After one week, the volunteers reported that they observed a significant improvement in their sleep difficulty. The self-report by the students was compared with a no-treatment control group.

The exciting thing observed during this experiment was that patients who were warned previously about the bogus side effects report their occurrence. The tendency to report the side effect was more frequent in patients who were told about a single side effect compared to the ones who were communicated to have three or four side effects. Thus, the result of the experiment suggested that the occurrence of side effects from sleeping pills is related to the psychological perception of the patients received.^[5]

Every medicine has its pros and cons, and sleepings are not an anomaly. People are generally of the impression that sleeping pills will induce a good sleep pattern, and they will wake up brimming with energy and enthusiasm. But, much to their disappointment, sleeping pills have more contrary implications on human health. Some of the primary concerns of taking sleeping pills are discussed below:

1. Increase In Mortality Rate: Death is one of the darkest aspects of sleeping pills. A preliminary experiment was performed to study the risk of casualty in patients taking sleeping pills by the American Cancer Society. It was found that people consuming sleeping pills have a higher mortality rate as compared to non-users. The multitudes represented that people taking the pill every night were at a 25% increased risk of mortality, and those seeking it occasionally have a 10 to 15% increased mortality rate.
2. Increased Cases Of Cancer In Patients: The arrival of new hypnotics in the market around 2005 and 2006, we’re reported to cause nine new types of skin cancers. When the reports of randomized control trials of zaleplon, eszopiclone, and ramelteon were reviewed, it was found that these agents caused cancer in pill users as compared to the people given placebo treatment. Many such studies have indicated that sleeping pills can increase the risk of cancer in patients.
3. Impairment of Daytime Thinking: The action or benefit or sleeping pills can also contribute to its harmful effects on the human body. Hypnotics work by reducing the activity of the brain, and they are likely to impair our conscious mind even during the day. There are pieces of evidence verifying that most of the sleeping pills have a half-life that continues to remain in the blood even in the morning. It can result in a feeling of drowsiness and lethargy. However, there are a few prescription hypnotics that metabolize fast. But even such drugs are harmful to the older people as they have long-lasting impairment consequences.
4. Dependency And Addiction To Sleeping Pills: All the prescription drugs falling in the category of hypnotic medications are known to show the dependency. People who have been using sleeping pills for long find it difficult to sleep without them. They develop a reliance on the pills to get a sound sleep. The other pressing issue is drug addiction. Sleep pills resemble narcotic drugs when it comes to habit formation. For the first few doses, patients develop tolerance and, thus, increase their dose gradually. It is a problem faced by long term users and can cause severe withdrawal symptoms. The addiction is manifested in several and, and the withdrawal symptoms of barbiturates and benzodiazepines are quite striking. Tremors, seizures, anxiety, shaking of limbs, and even death are the common withdrawal symptoms
5. Episodes of Amnesia: Amnesia is a disastrous side effect of sleeping pills. There are reports of hallucinations, confusion, and disorientation associated with the use of hypnotic. As the drug shuts down the function of the brain to induce sleep, it has been known to cause short term memory loss or amnesia in some patients. They are unable to remember some fragments of their actions even during the daytime. The continuous use of sleeping pills has also made the patient a victim of depression. While it is a common belief that hypnotic is used to treat depression patients, but the real-life scenario states otherwise
6. Parasomnia in Patients: Parasomnia in patients: Parasomnia is the act, also known as sleepwalking. It is one of the side effects of the sleeping pill, where people walk their way through sleep and are not able to recollect their actions during the period. While many people would find it amusing but can be very harmful as reported by some patients. Many patients taking sleeping pills have complained that they have developed the habit of walking in sleep. They often find themselves in another room, car, etc. when they wake up with no memory of walking in sleep. It might appear harmless, but there are reports of fatal accidents by people driving in sleep due to sleepwalking. ^[6]
7. Sleeping Pill-Induced Suicide In Patients: People who are on the prescription dose of hypnotic for years have shown to develop suicidal tendencies. An experiment conducted to reveal the association between suicide risk and sleeping pills asserted that insomniac patients are likely to develop other comorbid situations like depression, bipolar disorder, schizophrenia, etc. It leads to the risk of suicide in them. They are expected to overdose themselves with sleeping pills to make a suicide attempt.^[7]

Sleeping pills have been in use for decades as prescription drugs to treat people who struggle with sleep difficulties. Sleeping pills are also considered as a cure to other medical conditions discussed below:

1. Insomnia: Hypnotics like barbiturates and benzodiazepines have been a prevalent part of insomnia treatment. These medications are known to induce sleep in patients with a disturbed sleep-wake cycle. The use is quite common among people with an unhealthy lifestyle and students. The rate of consumption for insomnia is also more in females as compared to male patients.^[8]
2. Depression and Anxiety: Most of the sleep-related problems have underlying causes that can be framed back to anxiety and depression in patients. Depression is the most common associated factor with sleep disturbances. Sleeping pills are also prescribed to patients suffering from depression. The sedative and hypnotic property of the drug makes it an acceptable choice among the physicians and the patients. The statistical data shows that around 31% of people with depression and insomnia are treated with sleeping pills while only 24% of the patients are on antidepressants. ^[9]
3. Obstructive Sleep Apnea: People suffering from hypertension are likely to suffer from obstructive sleep apnea. Obstructive sleep apnea is a sleep-related respiratory disorder that drives excessive episodes of daytime sleepiness. In such patients, sleeping pills act as a cure to their condition. Obstructive sleep apnea patients can regulate their sleep-wake cycle with the help of sleeping pills, and thus the state gradually subsides.^[10]

Sleeping pills are the commonly used prescription drugs used by the population of this era to regulate their sleep. People facing problems like insomnia, depression, anxiety, etc. seek the help of these hypnotic drugs to get a night of good and sound sleep. But, taking sleeping pills is not the desired cure for everyone as it has its pros and cons. While the sleeping pills may impart a good sleeping effect in some patients, it can be harmful to others. Some people are just victims of psychological perception of insomnia and are cured by placebo treatment. Thus, the use of sleeping pills should be done rationally and with medical consultation.

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