HEALTH / Common Remedies: Sleeping pills

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THE IDEAL sleeping drug would induce sleep within a few minutes, give an uninterrupted, normal night's rest, and leave the sleeper bright and alert the next day. No such substance exists, despite much research by the pharmaceutical industry. Sleeping pills (hypnotics) are chemically virtually identical to tranquillisers; a calming action is much the same as a sleep-inducing action, but weaker. For most of this century the first choices for sleeping pills and tranquillisers were the barbiturates, which got people off to sleep like a sledgehammer but had substantial drawbacks. An overdose of a handful of barbiturate tablets was all too often fatal; and repeated use led almost always to dependence on the drugs so that sleep became impossible without them.

When, 30 years ago, the benzodiazepine group of tranquillisers (Librium and Valium) was introduced, they were hailed as a breakthrough on two grounds: they were safe, in the sense that even a large overdose was not lethal, and they were thought to be non-addictive. Today almost all the sleeping drugs in common use are benzodiazepines. Different pills have different lengths of action; some wear off in an hour or two and are meant simply to get someone off to sleep, while others last the whole night through.

All benzodiazepines alter the balance between dreaming and non-dreaming sleep, and this change is thought to affect the restorative value of the night's rest. Even the short-acting benzodiazepines are habit-forming, and after a week or so if no pill is taken there is likely to be great difficulty in getting to sleep and staying asleep. This dependence may lead to prolonged use of the drug - sometimes for years on end.

Sleep scientists are agreed that prolonged dependence on drugs for sleep at night is a bad thing. The sleep is abnormal, and the dose of the drug may need to be increased. Doctors are urged to prescribe sleeping drugs only when the need is specific - the night before an operation or after a bereavement, rather than for long-term problems such as unemployment or loneliness.

So what about someone who is unable to get to sleep and wakes several times during the night? None of the other drugs used as hypnotics - such as chloral or trichloroethanol - is free of the risk of dependence. Alcohol induces sleep reliably enough, but its effect lasts for only an hour or two and so it does nothing to help people who wake in the early hours. Milk drinks, especially those with cereals, have been shown in research studies to help people get off to sleep. Current advice from doctors is to use psychological methods so that lying down in bed triggers sleep. This link is most likely if bed is not used for non-sleep activities. People should not lie in bed after waking in the morning; nor should they read in bed at night. The times of going to bed and getting up should be consistent, so that habit patterns are induced.

A certain recipe for a bad night's sleep is the typical dinner party: several sorts of alcohol, rich food, and then a lot of coffee. The alcohol induces a short sleep; the coffee has a more prolonged effect, waking the miserable guest in time to contemplate his or her indigestion. Adding a sleeping pill to this mixture will only make things worse.