Can A Psychiatrist Prescribe Sleeping Pills

Drugs Commonly Prescribed For Insomnia

Sleep disorders affect millions of Americans and insomnia is a very common one. Nearly everyone has experienced it at some point. Often, its a short-term problem that lasts for a few days or a couple of weeks. But it can become chronic when it lasts for more than a month. Chronic is a problem for up to 10% of adults in the United States. Many people turn to sleeping pills when insomnia strikes.

Insomnia occurs when you have trouble getting to sleep or staying asleep, either waking during the night or awakening too early. Short-term insomnia often goes away when the instigating stress or situation resolves. Making improvements to sleep habits and hygiene can help relieve a short-term problem. The most effective treatment for chronic insomnia is . An insomnia medication can be useful as add-on therapy in either case.

The Risky Business Of Sleep Drugs

The risks of sleeping drugs are magnified when the medications are misused. For example, combining sleeping pills with other sedatives, prescription pain drugs, or even alcohol puts you at real risk for serious side effects such as dangerously slow breathing and mental and physical impairment that may linger into the next day, Sateia says.

Buysse says that people should take warnings to use sleeping pills only as directed seriously. For example, most sleep drugs caution that you shouldnt take them unless you can spend 7 or 8 hours in bed.

I especially worry about people who take a sleep medication with 4 hours or less available to them to sleep, he says. After 4 or 5 hours, you can still have the drug circulating in your blood, so you will be less alert at precisely the time you need to be doing things that require your concentration.

Its the exact same reason that people shouldnt drink and drive, Buysse says. Even if you feel relatively alert, you could still be a danger to yourself and others.

Research backs up that concern. People prescribed sleeping pills are nearly twice as likely to be in a car crash, according to 2015 study in the American Journal of Public Health that looked at the medical and driving records of nearly 410,000 adults. The researchers estimated that people taking sleep drugs were as likely to be in a car crash as those driving with a blood alcohol level over the legal limit.

They Can Also Experience A Lot Of Pain

Those with anxiety may also experience constant pain and also constant fatigue. This is again due to the high level of stress hormones in the body. The body is also under constant stress and thus the muscles are always tightened and in tension at all times, bringing problems like joint pain, muscle strains and aches.

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Antipsychotics Can Have Serious Risks

Many people who start taking an antipsychotic drug, stop because of side effects:

• Dizziness, drowsiness, confusion, and a higher risk of falls and injuries.
• Weight gain.
• Muscle twitches, tremors, and spasms. These may not go away even when the drug is stopped.
• Blood clots. These can lead to serious problems and death if not treated.

Treatment Options For Insomnia

KALYANAKRISHNAN RAMAKRISHNAN, MD, and DEWEY C. SCHEID, MD, MPH, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

Am Fam Physician. 2007 Aug 15 76:517-526.

Patient information: See related handout on insomnia, written by the authors of this article.

• References

The American Academy of Sleep Medicine defines insomnia as unsatisfactory sleep that impacts daytime functioning.1 More than one third of adults report some degree of insomnia within any given year, and 2 to 6 percent use medications to aid sleep.2 Insomnia is associated with increased morbidity and mortality caused by cardiovascular disease and psychiatric disorders and has other major public health and social consequences, such as accidents and absenteeism.3 Risk factors for chronic insomnia include increasing age, female sex, psychiatric illness, medical comorbidities, impaired social relationships, lower socioeconomic status, separation from a spouse or partner, and unemployment.4

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Exercise, cognitive behavior therapy, and relaxation therapy are recommended as effective, nonpharmacologic treatments for chronic insomnia.

A = consistent, good-quality patient-oriented evidence B = inconsistent or limited-quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, see page 483 or .

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Medicine Choices For Sleep Disorders

In the event that sleeping meds are prescribed, it is common for the physician to start by asking the patient to try alternative therapies especially narcotic antihistamines or to prescribe a quiet top dose of sleeping meds for a sleep disorder. In the unlikely event that these actions are inadequate, further medical attention may be required.

Since sleeping disorders which are caused by medicines such as sleeping meds are taken with a variety of problems or with specific indications identified for medical conditions, it might be best to address these problems directly. Reducing the dose of sleeping meds or change in the menstrual cycle can be the first step when the drug is approved for sleep disorders. In the event that there is a real illness, addressing the problem right away is more compelling than treating the effect of sleep disorders.

The type of sleeping meds known as benzodiazepines relaxes as a result and is used for helping patients cope with sleep disorders. Zaleplon and Zolpidem are two forms of medicines in the benzos category which have shown to be effective in the treatment of sleep disorders like sleep apnea with side effects. In addition, prescribing instructions for sleeping meds intake may be helpful to certain patients.

This May Include Decisions that Are Well-Known As:

• Ambien
• Side
• Sonata

How To Safely Start Treatment

Once your doctor chooses a sleep aid, you should read the pamphlet carefully, follow your doctors instructions on dosage and timing, and ask any relevant questions. Avoid starting treatment right before an important event, in case the medication causes unexpected side effects.

Most sleep aids are designed to be effective during four or eight hours. Taking a pill when you need to wake up before this time may cause next-day grogginess. For people who have trouble falling asleep but sleep soundly once they are asleep, it may be more appropriate to use a shorter-acting sleep aid.

Experts advise against taking sleeping pills before driving or doing other activities that require your full attention. This also applies to cases where you might need to wake up during the night, such as if you are caring for a dependent person. Sleep aids should be taken right before bedtime, as taking them too early in the evening may interfere with evening activities. Keep in mind that some sleeping pills will take longer to kick in if taken with food.

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Melatonin Receptor Agonist Hypnotic Sleeping Pills

Ramelteon is the newest type of sleep medication and works by mimicking the sleep regulation hormone melatonin. It has little risk of physical dependency but still has side effects. It is used for sleep onset problems and is not effective for problems regarding staying asleep.

Ramelteons most common side effect is dizziness. It may also worsen symptoms of depression and should not be used by those with severe liver damage.

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Dependence On Sleep Drug

Many patients abuse sleep medications prescribed by their doctors. Despite therapeutic and holistic measures, sleep problems are sometimes slow-acting, and patients desire a good nights rest. Some patients may exhibit erratic behaviour due to these medications . They sometimes take higher and higher doses of these medications as they develop a tolerance for them, even if they experience less restful sleep.

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Is It Safe To Take Sleeping Pills Every Night

Most experts agree that sleep aids should not be used long-term. Sleeping pills are best used for short-term stressors, jet lag, or similar sleep problems. There is limited evidence on the safety and efficacy of using sleep aids for more than four weeks, but some studies have found that daily use of sleep aids may be linked to a higher risk of mortality. Sleep aids may also affect sleep stages, with corresponding effects on sleep quality.

Many people develop a tolerance to sleep aids, meaning they need higher doses of the drug over time to get the same effects. This may be accompanied by addiction or withdrawal symptoms, including rebound insomnia, anxiety, irritability, or strange dreams.

For people with insomnia that resists other forms of treatment, doctors may give you prescription sleeping medication to be taken regularly. To lower the risk of developing tolerance or addiction, doctors may prescribe these long-term sleep aids for only a few nights a week. OTC sleep aids are not intended for long-term use.

Psychiatrist Won’t Give Me Sleeping Pills

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Are There More Complex Sleeping Pill Side Effects

Some sleeping pills have potentially harmful side effects, including parasomnias. Parasomnias are movements, behaviors, and actions over which you have no control, like sleepwalking. During a parasomnia, you are asleep and unaware of what is happening.

Parasomnias with sleeping pills are complex sleep behaviors and may include sleep eating, making phone calls, or having sex while in a sleep state. Sleep driving, which is driving while not fully awake, is another serious sleeping pill side effect. Though rare, parasomnias are difficult to detect once the medication takes effect.

Product labels for sedative-hypnotic medicines include language about the potential risks of taking a sleeping pill. Because complex sleep behaviors are more likely to occur if you increase the dosage of a sleeping pill, take only what your doctor prescribes — no more.

Ask Why They Recommend A Specific Medication And If Other Options Are Available

Some doctors may have a specific medication they start most of their anxiety patients on because they feel it has the highest effectiveness with the fewest side effects.

Other doctors may take a variety of factors into consideration before recommending a specific medication.

Always ask your doctor why they recommend the medication they did and if other options might be more appropriate for you.

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What Are The Side Effects Of Sleeping Pills

Like most medications, sleeping pills have side effects. You won’t know, though, whether you will have side effects with a particular sleeping pill until you try it.

Your doctor may be able to tell you about some side effects if you have asthma or other health conditions. Sleeping pills can interfere with normal breathing and can be dangerous in people who have certain chronic lung problems such as asthma , emphysema, or forms of chronic obstructive pulmonary disease .

Common side effects of prescription sleeping pills such as Ambien, Halcion, Lunesta, Rozerem, and Sonata include:

• Burning or tingling in the hands, arms, feet, or legs
• Changes in appetite
• Unusual dreams
• Weakness

It’s important to be aware of possible sleeping pill side effects so you can stop the drug and call your doctor immediately to avoid a more serious health problem.

Sleeping Pills Have Risks And Side Effects

If you take sleeping pills for many days in a row, one risk is that you may start to depend on them. You may need them to fall asleep. If you stop taking them, you may sleep worse than you did before you tried the pills. This is why most doctors recommend you only take them occasionally, or for a few days in a row.

Other risks and side effects may include:

• Daytime drowsiness
• Dizziness and hallucinations
• Sleepwalking and sleep-eating

Over-the-counter sleep aids, such as antihistamines , have risks, too. Ask your doctor if these are safe for you.

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Drug Dependence And Withdrawal

When taken regularly, benzodiazepines lead to physical dependence and tolerance, with increasingly larger doses needed to get the same anxiety relief as before. This happens quicklyusually within a couple of months, but sometimes in as little as a few weeks.

If you abruptly stop taking your medication, you may experience severe withdrawal symptoms such as:

• Increased anxiety, restlessness, shaking.
• Depression, confusion, panic attacks.
• Pounding heart, sweating, and in severe cases, seizure.

Many people mistake withdrawal symptoms for a return of their original anxiety condition, making them think they need to restart the medication. Gradually tapering off the drug will help minimize the withdrawal reaction.

Safer Use Of Sleeping Pills

Because of the limited benefits and important risks of sleeping pills, the drugs should be used with great caution.

In general, sleeping pills should be reserved for short-term insomniasuch as that caused by jet lag, anxiety after the death of a family member, or stress from a job lossSateia says.

For sleeplessness lasting more than a couple of weeks that is affecting your daily life, the AASM recommends cognitive behavioral therapy for insomnia , a form of counseling that helps people identify and replace thoughts and behaviors that contribute to sleep problems. CBT-I is at least as effective as medications, the benefits are long-lasting, and its manifestly safer than any pill, Sateia says.

Some people with severe sleep problems may benefit from taking a prescribed sleep drug for a few weeks in conjunction with CBT-I and then gradually tapering off the medication as the therapy takes effect.

In the Consumer Reports survey, 40 percent of Americans who take OTC drugs and 55 percent of those who take prescription drugs have been taking the meds for a year or longer. But long-term use is typically not recommended because the drugs may become less effective over time and, in some cases, people become hooked, or dependent on them. They may crave the drug, take more than recommended, and not be able to stop even if the drug is no longer helping or is causing side effects.

Examples: Flurazepam, quazepam , temazepam , and triazolam .

Examples: Ramelteon and suvorexant .

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Can I Become Dependent On Sleeping Pills

For short-term insomnia, your doctor may prescribe sleeping pills for several weeks. Yet after regular use for a longer period, some sleeping pills such as benzodiazepines or benzodiazepine agonists such as zolpidem or eszopiclone may stop working as you build a tolerance to the medication. You may also become psychologically dependent on the medicine. Then the idea of going to sleep without it will make you anxious.

Without the sleeping pill, you might find it difficult to sleep. If that happens, it could be a sign of a physical or emotional dependence or both. Some studies show that long-term use of sleeping pills actually interferes with sleep. The best way to avoid developing a physical or emotional dependence on sleeping pills is to follow your doctor’s instructions and stop taking the drug when recommended.

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Types Of Sleeping Pills

There are different types of sleeping pills, but most of them work by slowing down your brain. This can help you relax and fall asleep. The two main types are:

• Benzodiazepines These medications include drugs such as Valium and Xanax. They work quickly to make you sleepy and have been around for a long time. However, they can be addictive if taken for a long time, and they also carry the risk of overdose.
• Non-Benzodiazepine Hypnotics These medications dont have the same risks as benzodiazepines, but they may not work as well for some people. Zopiclone is an example of this type of drug.

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When Might I Be Offered Sleeping Pills Or Minor Tranquillisers

You should only be offered these drugs if:

• you have severe anxiety or insomnia that is having a significant effect on your daily life
• other forms of treatment or support are not suitable or havent helped. For example, this may include having , or making changes to improve your sleep.

These recommendations come from healthcare guidelines produced by the National Institute for Health and Care Excellence , the Royal College of Psychiatrists and the British National Formulary . Doctors and other prescribers should follow these guidelines when they offer you any kind of drug.