Misconceptions about drug abuse: unexpected dangers of legal sleeping aids.

Misconceptions about drug abuse

"Did you hear the news already? Rich Piana died last week!" exclaimed a good friend of ours. "Rich who??" was my response. Then it dawned on me he was speaking of the same person about whom I had been reading the other day and of which I only remembered his face and enormous physique.
Rich Piana, who had a large group of followers on Youtube and Instagram, as he had a most bizarre amount of muscles and was famous for his grueling workouts. 
Almost immediately everyone assumed he probably died due to overuse of steroids and associated muscle-building products.
It is not so weird to assume this as the amount of bodybuilders, who haven't lived past 50 years is staggering, because of the ever more dangerous means of attaining a muscular physique that is bigger than that of other competitors in bodybuilding demand more lives every decade.
The burning desire to create even more muscle mass wins from common sense. When discussing his death people referred a very good documentary called:Bigger, Stronger and Faster. Yet, at a lower level, the sports of recreational bodybuilders, apparently is one of the safest sports around.

In Rich' case it appeared he didn't die from the use of illegal steroids or some other illegal drug, but from the use of legal pain killers. Pain killers he needed because his body was suffering too much from his brutal training regime.
All of a sudden I had flashbacks to the recent death of Prince or, longer ago, of Michael Jackson who also died due to overdosing on pain killers. The amount of persons, dying prematurely from OD-ing on pain killers as well as sleeping aids is staggering. Same for the amount of people who are addicted to them. A good friend of mine managed to stop using pain killers, despite having chronic pain as she said she didn't want to be drugged up all the time. Another friend startled me by sending greetings from a drug detox clinic.
Startled as I know she has a good job, doesn't smoke, barely ever drinks, and isn't on the 'wild' side either! So, what on earth could she have gotten addicted to? Turns out it was sleep aids!
Indeed, sleep aids as well as pain killers belong to the opioids. Both can be as addictive as deadly. Worse yet, even at a 'safe' dose, sleep aids can shorten your life considerably.
These are the shocking conclusions from a report: "Patients who took sleeping pills died 4.6 times more often (on average) than patients who avoided sleeping pills."

We are therefore presenting you information from an ebook called 'the Dark Side of Sleeping Pills' by dr. Kripke, in shortened format.

For over 35 years I have worked to assess the risks of sleeping pills. I have learned that sleeping pills are associated with significantly increased mortality.
As of January, 2012, there were 24 published studies of the mortality risks of sleeping pills. Of the 22 studies which reported either greater or lesser mortality associated with sleeping pills, 21 studies showed that people taking sleeping pills died sooner.
We have now published a new study of over 10,000 patients who took sleeping pills and over 20,000 matched patients who did not take sleeping pills. The patients who took sleeping pills died 4.6 times as often during follow-ups averaging 2.5 years. Patients who took higher doses died 5.3 times as often. Even those patients who took fewer than 18 pills per year had very significantly elevated mortality, 3.6 times that of patients who took no hypnotics.

We went to great pains and effort to match the patients taking sleeping pills with those not taking sleeping pills for age, sex, smoking history, and various measures of poor health, so it seemed to be a fair comparison. Nevertheless, it is true that showing that sleeping pill use is associated with early death does not prove that the sleeping pills are causing the deaths. Theoretically, there could be confounding factors or biases in the selection of patients which caused these deaths without involving sleeping pills. We can only say that we found almost no evidence of such biases. Although there was certainly at least a small amount of confounding, it seemed to us unlikely that biases could entirely explain all of these excess deaths and cancers.
If sleeping pills cause even a small portion of the excess deaths and cancers associated with their use, they are too dangerous to use.

Some readers will remember when the cigarette companies claimed that the fact that cigarette smoking is associated with cancer and early death did not prove that cigarettes cause cancer. Cigarette manufacturers have by now given up on that argument. The risks are quite similar with sleeping pills. For absolute proof, we would need large randomized controlled trials of cigarettes or sleeping pills, but nobody is going to do such trials. If the cigarette companies believed that such trials would prove cigarettes were safe, they would have done such controlled trials decades ago. How about the sleeping pill companies? Of course, now that we know that particular sleeping pills are associated with excess mortality, it would probably be unethical to do such a controlled trial, so for those particular sleeping pills, we will probably never have absolute proof whether they cause mortality or not. The kind of data we gathered is probably about as good as one could get.

More lethal risks of sleeping pills

As a young medical student in my first year of training, one of the first things I learned in our student laboratory was that the kindest way to “put an animal to sleep” permanently was to administer a barbiturate such as pentobarbital. A bit later, I learned that pentobarbital was being prescribed almost automatically as a sleeping pill for patients in the hospital. Related drugs are used to execute the death penalty. Any medical student knows that these drugs can kill.

Doctors have a wonderfully complete understanding of how sleeping pills such as pentobarbital kill animals. These drugs bind with protein molecules called GABA receptors on the surface of nerve cells. The same protein receptor molecules bind at the same time with a neurotransmitter chemical called GABA, which gives them their name. Barbiturates and other sleeping pills accentuate the action of GABA, which is to cause the receptor molecule to allow chloride ions to enter the nerve cells. Since the chloride ions are negatively charged, they make the inside the nerve cell more negatively polarized, which in turn, makes the nerve cells less likely to fire (to generate nerve activity). When the nerve cells which stimulate the muscles of breathing are inhibited from firing action potentials by GABA and by sleeping pills, the animal stops breathing. When breathing stops, the animal dies within a few minutes from lack of oxygen in the lungs. No doubt these same mechanisms explain how barbiturates kill people who take too high a dosage, either accidentally or with suicidal intention.

In the 1970’s, a new group of sleeping pills became popular, molecules which chemically are named benzodiazepines. The first sold as tranquilizers were chlordiazepoxide and diazepam (Valium). Soon, the benzodiazepine flurazepam was marketed as a sleeping pill, and flurazepam soon dominated the market. The main advantage of benzodiazepines is that they are less likely to produce acute overdose deaths than barbiturates. For the last 15 years, most new sleeping pills have been benzodiazepine agonists, which means that the chemical molecules may not be classed as benzodiazepines but they act at the same receptors. All of these newer drugs seem to have less overdose risk than barbiturates, but it is still possible that single doses of these newer sleeping pills are sometimes lethal. There is certainly evidence that large doses of these drugs by themselves or modest doses combined with alcohol and other drugs can be sometimes lethal.

There is an age-old belief that sleeping pills might help depressed people, but sleeping pill manufacturers’ controlled trials prove that sleeping pills can cause depression. In fact, the sleeping pills examined in one study seemed to double the rate of new depressions.

Suicide, accidental overdose and cancer are probably not the most common ways in which sleeping pills kill, but the other ways are more poorly understood and less well documented. Here are some of the other possible mechanisms.

All of the sleeping pills can cause “hangover,” that is, they not only reduce the action potentials of our brain cells during sleep, but they can also reduce brain cell activity during the day. This can make us sleepy, less alert, confused, and weak during the day. We will discuss psychological consequences of this hangover later, but here I mention the impairments of survival. Falls are much more common among elderly people who are taking hypnotics.
Because several studies show that people who are responsible for automobile accidents are unusually likely to have sleeping pills in their blood, it is thought that hangover may often cause automobile accidents, as well as other fatal accidents.

In the last 20 years, physicians have become concerned about sleep apnea, a condition where there are pauses of breathing during sleep. Physicians suspect that sleep apnea can cause deaths during sleep. Not all studies are in agreement, but several studies have found that when a person with sleep apnea takes sleeping pills, there are more pauses in breathing and the pauses last longer, which could be dangerous. I was surprised to learn in the FDA data how well-documented it is that zolpidem makes sleep apnea worse. Because sleeping pills risk making apnea worse, many experts recommend that people with apnea should not be given sleeping pills.
The problem is that almost everybody above age 40 has some sleep apnea, and the majority of people over 65 would meet commonly-used criteria for a diagnosis of sleep apnea.
Therefore, a large proportion of people taking sleeping pills must be making their apnea worse. Over a period of many years, anything which makes sleep apnea worse would be expected to cause high blood pressure, and therefore, to increase the risk of heart attacks, heart failure, and strokes.

Lollipops, not sleeping pills

The motivations of physicians to give patients sleeping pills have not been studied extensively, but there is some interesting evidence. Physicians routinely explain their medical thinking in their medical records. Even in the medical records of a distinguished teaching hospital, not one of 331 charts of patients receiving sleeping pills had a proper record of why the pill was given. It is safe to assume that there often was no good medical justification. It has been the same in the hospitals where I taught. In the hospital, however, the staff motivations are not hard to understand.

Everyone has heard the stories of nurses awakening patients to give them sleeping pills. When I was a medical student, I learned that nurses like to keep their patients quiet for the night. Physicians routinely write sleeping pill orders in the hospital, because they hate for nurses to call at night and wake the doctor up to get a sleeping pill order. As a medical student, I was instructed that if I wanted to sleep at night, I had better routinely prescribe a sleeping pill for every patient. If we train young doctors this way in hospitals, the habits will carry over to outpatient practice.

When I was a child, my pediatrician would give me a lollipop at every visit to compensate for the pain of the injections I was likely to receive. Unfortunately, physicians don’t give lollipops to adult patients. They give sleeping pills instead, when a big lemon sucker might do less harm.

In the CPSI study, about 1/3 of people who said that they took sleeping pills “often” said that they never had insomnia.
Even if we include all diagnoses related to emotional problems and nervousness, most patients given sleeping pills were not given any diagnosis suggesting a genuine medical reason for the prescription. This suggests that gift-giving explains much hypnotic prescribing.

I don’t want to blame the physicians alone. Patients like to receive gifts! They like to feel that they are taking something which might help, even if there is no scientific evidence. In fact, patients often insist that they need sleeping pills, and may become quite irate if a doctor does not want to provide what the patient wants. When I talk to physicians about sleeping pills, they tell me these stories again and again. I am certain that most physicians try to be ethical about sleeping pills, but they also realize that the patient given a sleeping pill is likely to return for a renewal prescription, whereas the patient refused a sleeping pill may look for another doctor.

The problem of addiction

Nearly all prescription hypnotics may be physically addicting drugs, and all are sometimes attractive to drug addicts. By addicting, we mean that these drugs have two properties. First, when we take addicting drug such as narcotics or barbiturates, we develop tolerance so that a given dosage has less and less effect or “stops working.”
People who develop tolerance are prone to increase their dosage more and more. I frequently see this problem with long-term users of sleeping pills. Second, addicting drugs cause physical withdrawal symptoms when they are stopped abruptly. The withdrawal symptoms of hypnotics such as barbiturates and benzodiazepines are very well known.
They include shakiness and tremor, nervousness and anxiety, panic, hyperactivity and increased reflexes, rapid heart rate, and epileptic seizures and death in the most severe cases.
In one sense, the withdrawal syndrome with hypnotics can be worse than withdrawal from heroin, because while the heroin addict experiences withdrawal as a terrible anguish, it is rare that addicts do not survive even the most severe heroin withdrawal.
Severe withdrawal of sleeping pills can produce death. The risk of seizures and death is probably more severe with withdrawal of barbiturates than with benzodiazepines. As compared to heroin, the withdrawal syndrome may be more lasting with the hypnotics, perhaps more than a month in some cases.

If you listen to the drug companies and many experts who receive research grants from drug manufacturers, they would emphasize that most people who take sleeping pills use them for less than 15 doses in a year and do not become habituated.
While this is true, it is likewise true that a small percentage do get into the habit of taking one or more hypnotic pills every night. Because these long-term users take so many pills, it turns out that most of the hypnotic prescriptions sold go to these chronic users.
About two-thirds of sleeping pills are taken by people who use them chronically for several years.
It gives quite a different picture of the sleeping pill industry, when we realize that they are profiting primarily from chronic users who have become habituated or physically addicted to these medicines.

Studies of barbiturate addicts showed that while taking huge doses of these sleeping pills, many addicts slept very little. In some cases, after a long and unpleasant withdrawal, the abstinent addict found himself sleeping more than he had been while taking high sleeping pill doses.
It seemed that long-term usage of the barbiturates had actually decreased sleep.
Certainly, studies show that people who use sleeping pills often sleep less than people who do not use them, although that relationship does not distinguish which is cause and which effect. It appears that patients who stop chronic sleeping pill use may find that their sleep actually improves. Maybe it becomes a circular process, where people take sleeping pills because of poor sleep, but sleeping pills cause poor sleep. The situation may be similar to that with alcohol, which can be a sleep-inducing drug with a very short half-life.

I know of little study of how much alcoholics sleep while they are drinking, but after abstinence, it is clear that abstinent alcoholics sleep very poorly, and they are unable to obtain a normal sleep duration. It appears that in the long run, chronic usage of alcohol damages the sleep system.
One advantage of some over-the-counter sleeping pills [edit: available in the USA w/o prescription] is that there is less evidence that they cause habituation and addiction.

Strange sensations of benefits

Studies of sleeping pill effects on insomniacs show that they often describe a greater improvement in their sleep than EEG recordings measure. Although the hypnotic medication may hasten sleep onset rather little and decrease awakenings only modestly, the patient feels that the benefit is greater. It often appears based on objective recording that insomniacs are mistaken in their estimate of whether the sleeping pills are helping with sleep.
Another element may be that the sleeping pills simply make insomniacs forget how much they are awake at night.

It appears that benzodiazepines may make people less aware of their awakenings or less disturbed by them, because the drug may produce a sense of well-being. Indeed, any number of studies have documented that patients like how they feel when they take sleeping pills. To give perspective, let me mention that people also like how they feel when they take heroin. A good feeling does not mean that taking the drug is wise. I am not insensitive to the idea that some dying people at the end of their lives should receive medications to ease their pain when they want them, even if it shortens their lives. Most people who take sleeping pills are a long way from being ready to die. I do not think that relief of distress justifies a drugs which may shorten life for most people who take sleeping pills. Regardless of whether or not you agree with assisted suicide, most patients who seek sleeping pills are not ready for this assistance.

Good Sleep Habits and Attitudes

The alternative to sleeping pills is to develop good sleep habits and good sleep attitudes. Good sleep habits and attitude are the best approach for a long-term sleep problem, and they produce surprising improvement.

First, remember that most people do not need 8 hours of sleep per night. That old idea just is not true. The average adult is actually asleep only between 6 and 6.5 hours a night. National polls give similar results. Moreover, in the recent Cancer Prevention Study II results, people who said they slept 6.5 to 7.5 hours lived a bit longer than people who slept 8 hours or more. The shorter sleepers lived longer! Even people who said that they slept as little as 3.5 hours lived longer than those who slept 8 hours or more! In a group of women over age 65 who volunteered for the Women’s Health Initiative, wrist recording indicated that they actually slept about an hour less than they thought they slept. According to the recordings, those who slept 5.0-6.5 hours had the lowest mortality.
If you feel you sleep 5 to 7 hours a night and feel rested, there is no evidence that you have to sleep any more as far as life expectancy is concerned. Incidentally, controlling for other illnesses, age, and so forth, people who said that they had insomnia lived a little longer than those who did not have insomnia! Therefore, do not worry about insomnia!

· People who said that they slept as little as 3.5 hours lived longer than those who slept 8 hours or more.
· People who said that they had insomnia lived a little longer than those who did not have insomnia.

Short sleep is associated with good health as well as long life. Studies show that in the range that most Americans sleep (which is 6, 7, or 8 hours or so), there are few discernable differences between people. This may surprise you, but people who sleep 6 hours seem to be at least as happy as people who sleep 8 hours. Moreover, people who sleep 6 hours get just as much work done and are just as rich as people who sleep 8 hours. There may be some tendency for people with the shortest sleep times (5 or 6 hours) to be outgoing and energetic, whereas people with the longest sleep times (9 or 10 hours) seem to be more introverted, imaginative, or perhaps a bit depressed. Notice the surprise! People who sleep less are less depressed!

Indeed, hospital studies of depressed patients show something very surprising. When depressed patients are kept awake all night (or at least for the second half of the night, e.g., after 2 AM), they actually feel less depressed the following day. The sleep loss actually helps depressed mood. Moreover, after the wake therapy, taking a nap makes depressive symptoms recur. Wake therapy would be a very popular treatment for depression except for one problem: people with depression who stay up at night do get sleepy, and after they sleep soundly the next night, the low mood relapses. This relapse can be avoided with bright light. Evidently, although it is true that people who are getting depressed have poor sleep, it is not proven that getting more sleep helps depression. It may be quite the opposite. In fact, it has now been proven that cognitive-behavioral therapy which restricts sleep improves the mood of patients with insomnia. Less time in bed can lessen depression.

For these reasons, depressed people should not struggle to get more sleep, and should certainly avoid sleeping pills, which tend to cause depression. People may actually improve their moods by getting up a bit earlier.

There is another factor. Spending too long in bed causes people trouble with falling asleep and makes them more likely to awaken while in bed. Sometimes, the frustration of lying in bed awake adds to the problem, and it builds on itself, getting worse and worse. The more time the person spends in bed trying to get more sleep, the more trouble develops in falling asleep and the more the person awakens in the night. Surprisingly, it seems that spending too long in bed might be a major cause of sleep trouble among both elderly and depressed people. Fortunately, there is an easy solution.

People who are spending a lot of time in bed lying awake should spend less time in bed. This means either going to bed later or getting up earlier. Getting up by a regular time seems to be important, so trouble falling asleep should not persuade you to sleep late. The less time you spend in bed, the more sleepy you will be the next evening. Think about it. If you spend less time in bed, you will surely tend to fall asleep more easily and sleep more soundly in the future. Moreover, the less time you spend in bed, the more you will restore the habit of falling asleep quickly after going to bed, and the more you improve the habit of sleeping soundly. Some doctors would recommend that you should not spend more time in bed than you actually sleep. If you think you only sleep 5 hours a night, spend only 5 hours in bed until you are sleeping all 5 hours. Then you can try increasing time-in-bed about 15 min., e.g., to 5 hours and 15 minutes. You can gradually increase your time in bed on a weekly basis until you are no longer sleepy enough to sleep at least 85% of your time in bed. Once you are sleeping only 85%, that is the longest bed time which you should allow yourself.

Most sleep experts also recommend that whatever bedtime you allow yourself, you should not go to bed if you do not feel sleepy. Moreover, if you awaken at night and no longer feel sleepy, get out of bed, and do not go back until you are sleepy again and expect to fall asleep. Even after being up during the night, you should get out of bed by your regular awakening time, because sleeping late tends to make the problem worse. Getting out of bed when you are not sleepy makes you sleepier the next night and helps maintain good sleep habits.

Almost all of us have stayed up entirely for a night or two, so we know that nothing terrible happens to us. Many of the patients I talk to say that they have slept only a few hours a night for years, and yet they are somehow afraid that losing sleep will hurt them. Probably not. Remember that if anything, people who sleep a bit less than average tend to live longer and be less depressed. If you are willing to stay out of bed and amuse yourself somewhere else when you are not sleepy, soon you will stop worrying about sleep. If you lose a whole night’s sleep or part of a night, so what? It will not be so bad, as long as you do not worry about it. When you do go to bed (because you are finally sleepy), you will have restored your confidence that you are likely to fall asleep, so the long-term problem resolves.

If you do begin to worry about how a bad night of sleep will affect you the next day, remember that there is no reason to take a sleeping pill. The sleeping pill is likely to make your performance worse the next day, and very unlikely to help.

Experts also advise that you avoid worrying in bed, watching TV (especially those scary late-night movies), reading scary mysteries, and doing other things besides sleep and sex in bed. The idea is not to make a habit of being worried or alerted in bed. If you are a person who worries, select a place to worry (such as a chair in another room), and sit down to worry there. When you are tired of worrying, then go to bed.

Good sleep habits also require avoiding coffee or anything else with caffeine within 6 hours of bedtime. Alcohol is sometimes a cause of sleep trouble, because although it relaxes us at first, it leads to insomnia as soon as the blood alcohol level falls. Drinking early in the evening may cause trouble falling asleep. Drinking at bedtime may cause midsleep awakenings and early awakening.

People say that exercise helps sleep, but I think the benefit is minimal. Probably it is being outdoors in daylight, which is often where people exercise, which is helpful. We have found that people who are outdoors more have fewer sleep problems.

Controlled scientific studies show that adopting good sleep habits and attitudes is extremely effective in solving long-term sleep problems. It is more effective than sleeping pills

If good sleep habits and good attitudes do not solve your problem, there is a good chance that you are suffering from depression. You should consult your doctor. You might also consult a sleep specialist at a sleep clinic. You might have a problem with your body clock or another sleep disorder which could benefit from specific treatment. For a chronic problem, I do not advise that you ask a doctor for sleeping pills. It is the wrong approach.

Getting Off Sleeping Pills

As I have explained, because of mortality, cancer, depression, infection, and behavioral risks, I cannot recommend circumstances when anybody should continue taking zolpidem, eszopiclone, zaleplon, temazepam, triazolam, flurazepam, estazolam, quazepam, barbiturates, or diphenhydramine as hypnotics.

The manufacturers generally claim that a person taking only the recommended dosage each night should safely be able to stop the pill immediately. Actually, patients who have been taking higher doses or a regular dosage for a long time may need to slowly taper off the medication, reducing their dosage by a small portion every week or two. Withdrawal from sleeping pills can cause at least a few nights of insomnia, anxiety (both day and night), tremulousness, and other symptoms.

It is always recommended that a patient consult the prescribing doctor before discontinuing a prescribed sleeping pill.

For most patients, it will not be necessary to replace a sleeping pill with any other drug merely for treatment of insomnia. If related illnesses such as depression, anxiety, etc. are involved, an approved medication for those conditions may be needed.

Even people with no intrinsic depression or anxiety are likely to become anxious when withdrawing from a sleeping pill. It helps to understand that this anxiety and fear of insomnia is probably a drug withdrawal reaction which will go away in time, often within a day or two, so starting a replacement drug may not be advisable. People withdrawing from sleeping pills may become filled with the idea that they can never do without their pill, when a few days later, they do perfectly well without it.

There are some drugs which could be substituted for the sleeping pills which I have recommended discontinuing because of mortality and cancer risks. I do not say that I recommend such substitution. Certainly I would not recommend substituting in ordinary circumstances, but I recognize that physicians will encounter some patients for whom at least short-term substitution seems a good idea. I do not think that the possible substitutes have been shown to be associated with mortality or human cancer.

The most reasonable substitute drugs might be trazodone, doxepin and melatonin, but I say this without recommending substitution.

Melatonin in an immediate release form sometimes has a benefit in reducing the time to fall asleep, but it is less effective or ineffective in prolonging sleep later in the night, so its benefits for total sleep time are often weak or absent. Melatonin may accelerate sleep onset, but it is a timing drug, not a hypnotic as such. Rodents have the highest melatonin blood concentrations when they are wide awake. There is evidence that melatonin has a variety of minor side effects such as headache and nightmares, and some effects on the reproductive endocrine system, but little or no evidence of serious side effects. A sustained release melatonin preparationhas been approved as a sleeping pill in Europe. Initial published reports suggest that sustained release melatonin have a favorable benefits/risks ratio.

There is a specific use for melatonin for people with delayed sleep phase disorder (nightowls who have trouble falling asleep and trouble getting up in the morning). There is considerable evidence that very low doses of melatonin (50-500 micrograms) may be useful for these patients. The recommended dosage is much lower than the 1-5 mg usually sold over the counter.

Why Haven’t You Heard This Opinion of Sleeping Pills From Every Expert?

“The treatment of insomnia by drugs is always to be avoided as much as possible.” - H.C. Woods, 1893
The idea that sleeping pills have a dark side is nothing new. Indeed, generations of physicians have shared my opinion, based on their own clinical experiences. Probably, the majority today agree. They are a silent majority, with little to be gained by making their opinions public.

The sleeping pills industry has over two billion dollars of yearly sales, and it has thought of many subtle ways of keeping its products popular. To be frank, the manufacturers of sleeping pills have often given the leaders of sleep research large monetary grants to test their products. These colleagues are very nice people who are not the sort to bite the hand which feeds them. Some of the most prominent leaders of sleep research have been supported mainly by drug company grants. The drug companies have used many subtle free offers and not-so-subtle methods of influencing the wider group of sleep clinicians to mute their critical attitude towards sleeping pills.

For several years, the National Sleep Foundation has launched a yearly publicity campaign about the dangers of insomnia, encouraging everybody to sleep 8 hours. Scientific evidence to support 8 hours sleep is almost nonexistent: for example, people live longer who sleep less (see above). Could this campaign be influenced by the fact that much of its money comes from sleeping pill manufacturers? The public relations firm for Ambien bragged that National Sleep Foundation publicity was effective in increasing sleeping pill sales.

Unfortunately, nobody advertises for behavioral treatments, or for hypnotic abstinence. The advertising for bright light treatment is minuscule compared to pharmaceutical advertising.

Why haven’t you heard from the FDA?

When we reported that people who took sleeping pills died 4.6 times faster and suffered more cancer, I thought the FDA would ban the drugs studied or warn people. Forgive my naivety. Ignoring, now, 21 studies showing that people who take sleeping pills die sooner or suffer more cancer, and might be as dangerous as cigarettes, the FDA still claimed (in August, 2012) that sleeping pills are safe and effective. I had made quite certain that the FDA had reviewed the new studies, but the FDA decided to require no black box warnings about these risks and to require no further studies to confirm whether the mortality and cancer risks are so serious.

Perhaps we should not have expected the FDA to protect the public.
In July, 2012 we learned that not only had the FDA fired scientists for trying to protect the public from health risks, but FDA allegedly invaded the computer systems of Congressional offices to catch whistleblower leaks about the risks of industry products. In a September, 2012 law suit and press release, Public Citizen alleged that the FDA was acting unlawfully in failing to protect the public from an Alzheimer’s Disease drug, because it had “chosen to support the profit interests of a large pharmaceutical company.”

Given their health impact, the National Institutes of Health (NIH) should clarify the risks of sleeping pills. NIH has made no effort. With planned budget cuts, one cannot anticipate that NIH sleeping pill research will expand. The medical insurance companies can tell from their own medical data bases whether hypnotic users are developing more cancers or dying sooner. Medical insurance companies and Medicaid might ask themselves why they are paying for sleeping pills which are increasing medical costs. They might warn their clients. Unfortunately, private insurance companies have a conflict of interest. The higher medical costs become, the more profits these companies can make. Oddly, drugs which shorten life span might decrease Medicare and Department of Veterans Affairs costs. Medicare and the VA also fail to warn.

Our concluision

What a story. Though most of what is written pertains to the US situation, the Dutch health institutes often follow whatever the US counterparts are doing. The take-away message seem to be : don't worry when you can't sleep and worry where you don't sleep as well as that sleeping less than 7 hours a night is perfectly normal. 

When you do want to use a supplement, we heartily recommend taking magnesium and vitamin B12 supplements and tryptophan or its derivative 5-HTP. Some swear by CBD oil because of its relaxing effect. And then AOR and Jarrow also offer their own dedicated sleep supplement Ortho Sleep and Sleep Optimizer that are proven to be safe and natural. 

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