Is Overusing Sleeping Pills Dangerous for Insomnia Sufferers?

Is it okay to take too many sleeping pills when you can't sleep?

Dear Dr.
Chang,
I have been experiencing insomnia for some time and consulted a doctor who prescribed a medication called Suan Zhi Meng for me.
Initially, I found that I couldn't sleep for long and would wake up easily, taking a long time to fall back asleep.
After taking the medication for a year, I felt like I was developing a dependency on it, and I also started experiencing lower back pain.
I tried to stop taking the medication and sleep without it, but strangely, I would worry about not being able to sleep before going to bed.
Eventually, I ended up taking the sleeping pills again.
At first, I could still fall asleep, but now, for some reason, even after taking one pill, I would lie in bed for about 20 minutes without falling asleep.
I would then take a second pill, and after another 20 minutes, still couldn't sleep, so I took a third pill.
Ultimately, I felt like I couldn't take any more, and somehow, after a while, I would fall asleep, but only for about three hours before waking up again.
This cycle continued for five to six days, during which I took a total of four sleeping pills each night, with the most severe instance being five pills in one night.

The last time I took the medication, I felt very uncomfortable the next morning, experiencing nausea and persistent lower back pain, so I went back to see my original psychiatrist.
After explaining my situation, I asked if I could switch to a stronger sleeping medication.
The doctor seriously informed me that I couldn't change medications, as this was already the strongest one available, and emphasized that I should not exceed two pills at most and not to self-medicate.

I would like to ask Dr.
Chang: Am I worrying too much and actually able to sleep, causing me to self-medicate unnecessarily? Do I need to continue taking the sleeping pills? If I keep taking them, will it cause problems with my kidneys? Is my unexplained lower back pain and nausea due to an overdose of sleeping pills? Should I continue seeing a psychiatrist, or should I consult another psychiatrist for my insomnia? Thank you.

Xiao Qiang, 40~49 year old female. Ask Date: 2017/04/10

Dr. Zhang Fangrong reply Psychiatry

Dear Sir/Madam,
Thank you for your inquiry.
Based on the process you described, it is evident that this issue has significantly affected your daily life and sleep.
You mentioned the need for sleeping pills; considering the duration and severity of your sleep disorder, as well as your previous use of higher medication doses, I would recommend that you have a thorough discussion with your psychiatrist.
This will allow you to sleep using the lowest effective dose and, with clinical approval, gradually reduce the medication dosage, which would be the best option.
Wishing you mental and physical well-being.
Sincerely,
Dr.
Fang-Rong Chang, Psychiatry

Reply Date: 2017/04/10

More Info

Overusing sleeping pills can indeed be dangerous for individuals suffering from insomnia, and your situation highlights several important aspects of this issue. It's crucial to understand the potential risks associated with the long-term use of sleep medications, as well as the psychological and physiological effects they can have on your body.

Firstly, many sleeping pills, particularly those in the benzodiazepine class or other sedative-hypnotics, can lead to tolerance. This means that over time, you may find that the same dosage no longer provides the same sedative effect, prompting you to increase the dose to achieve the desired result. This cycle can lead to dependence, where you feel unable to sleep without the medication, as you've experienced. Dependence can create a vicious cycle: the more you rely on the medication, the more difficult it becomes to sleep without it, leading to increased anxiety about sleep, which in turn exacerbates insomnia.

The symptoms you describe, such as waking up frequently and taking longer to fall asleep, are common among individuals who have developed a tolerance to sleeping pills. Additionally, the physical symptoms you mentioned, like back pain and nausea, could be side effects of the medication or a result of the stress and anxiety surrounding your sleep issues. It's important to note that while some discomfort may be related to the medication, it could also stem from other factors, such as stress or underlying health conditions.

Moreover, the risk of developing more serious health issues, including kidney problems, can increase with the prolonged use of certain medications, especially if taken in higher doses than prescribed. Your doctor’s advice to limit your intake to a maximum of two pills is crucial, as exceeding this can lead to adverse effects and complications.

It's also worth considering that psychological factors play a significant role in insomnia. The anxiety about not being able to sleep can create a self-fulfilling prophecy, where the fear of sleeplessness leads to increased difficulty in falling asleep. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a highly effective treatment that addresses these psychological aspects and can help you develop healthier sleep habits without relying solely on medication.

Given your current situation, it would be wise to continue consulting with a mental health professional, preferably one who specializes in sleep disorders. They can help you explore alternative treatments, including therapy options that focus on managing anxiety and improving sleep hygiene. If you feel that your current psychiatrist is not addressing your concerns adequately, seeking a second opinion from another specialist could provide you with new insights and treatment options.

In summary, while sleeping pills can be effective in the short term, their long-term use poses significant risks, including dependence and tolerance. It’s essential to work closely with a healthcare provider to develop a comprehensive treatment plan that addresses both the psychological and physiological aspects of your insomnia. Exploring non-pharmacological treatments, such as CBT-I, may offer a more sustainable solution to your sleep difficulties while minimizing the risks associated with medication overuse.

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