“Sleeping Pills”: The dangers associated with their use

Mar 13, 2022 Dr Zulfikar Bux, Features / Columnists

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By Dr Zulfikar Bux
Assistant Professor of Emergency Medicine

Kaieteur News – I am often faced with patients who are on sleeping pills and cannot come off. What’s worse is that they have become dependent on the drug and cannot come off it or sleep.
Sleeping pills or anxiolytic (antianxiety) drugs slow down the activity of the brain. Benzodiazepines (Ativan, Halcion, Librium, Valium, Xanax, Rohypnol) are the best known. Alcohol has some properties similar to the above drugs, but alcohol is so common that health experts classify alcohol-related problems separately.
Regular use of these drugs often leads to “drug dependence.” That is, the body adjusts to them and it takes a higher and higher dose to achieve the desired effect. Dependence also can develop, meaning withdrawal symptoms will occur if the drug is suddenly stopped. Many of these drugs have legitimate uses. Benzodiazepines are a good treatment for anxiety and are also useful in sleep disorders. But they should be avoided as long term remedies.
Combining any of these drugs, or using them with alcohol, can lead to dangerous effects. People often take these combinations to try to boost the feeling of intoxication or to counter unpleasant effects of other street drugs.

ARE THERE SYMPTOMS OF SLEEPING PILLS DEPENDENCE?
Yes. Symptoms of dependence on sleeping pills include:
• A craving for the drug, often with unsuccessful attempts to cut down on its use
• Physical dependence (development of physical withdrawal symptoms when a person stops taking the depressant)
• A continued need to take the drug despite drug-related psychological, interpersonal or physical problems.
People with drug dependence eventually develop physical tolerance (the gradual need for greater amounts of the drug to feel the same effects). But addiction implies that the person is also craving the drug’s effect or relying on the drug for a reason other than the intended therapeutic uses of the drug.
If the person suddenly stops taking the drug, the body’s accustomed internal environment changes drastically, causing symptoms of withdrawal: anxiety, tremors, nightmares, insomnia, poor appetite, rapid pulse, rapid breathing, blood pressure abnormalities, dangerously high fever and seizures.

CAN THIS BE PREVENTED?
To help prevent problems, follow any prescription directions exactly and avoid taking more of the medication than your doctor ordered. The biological, psychological and social forces that lead to addiction, however, are difficult to prevent. If you feel that you need the medication for longer than prescribed, consult your doctor immediately. Never take medication that has been prescribed for anyone else. Avoid using sleeping pills as a long term solution.

WHAT ARE THE TREATMENT OPTIONS FOR SLEEPING PILLS DEPENDENCE?
The first goal of treatment is detoxification (withdrawal from the drug). Detoxification usually involves gradually reducing the dose of the drug or temporarily substituting a medication that has less serious withdrawal symptoms. The substitute medication, if used, also will be reduced gradually.
Depending on the severity of the drug dependence and other factors (significant heart or lung disease, liver failure, high blood pressure, a person’s age and general health status), detoxification may need to take place in the hospital.
All addictions are complex and have multiple causes. A drug use disorder is usually not an isolated problem. Commonly, people with sedative, hypnotic or anxiolytic drug addictions are also struggling with other mental disorders, such as anxiety or depression.
Thus, treatment is best tailored to the multiple needs of the individual. This should begin with a comprehensive evaluation (medical, psychological and social) to identify the variety of troubles that are fueling the drug use.
Counseling, behavioral therapies, and group programs can help a person address the addiction. Medications or psychotherapy can address craving or habits that could lead to relapse. They also are helpful for other symptoms or problems that are discovered in the course of evaluation and treatment.

WHEN TO CALL A PROFESSIONAL
It is best to seek help as soon as possible. Like alcoholism, sedative, hypnotic or anxiolytic drug use disorder is a real illness, not a sign of weakness or poor character.
Sometimes, if an addiction has caused problems at home, at work, or with the law, an external push from family, employers, or the law can further motivate an addiction sufferer to seek treatment.
Sleeping pills dependence is difficult to shake without support and without treatment for the root causes. Withdrawal is likely to be safe when the dose of the substance is reduced gradually. People who develop withdrawal symptoms that get bad enough to require hospitalization have a 2% to 5% risk of death, a rate similar to severe alcohol withdrawal. However, most people get help before reaching that stage. Since it is easy to overdo it with some of these drugs, the risk of accidental overdose is significant. In general, formal treatment is likely to reduce the risk of relapse (or returning to the addictive behaviour).

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