It’s late at the end of a busy day; you’re tired and looking forward to your bedtime routine and a good night’s sleep. You slide into the covers, expecting to drift off, but instead, you toss and turn and find it difficult to get comfortable. Soon, you’re thinking of the day’s events, what’s ahead of you tomorrow, and you stare at the ceiling, wide awake.
This is a common occurrence among people who struggle with insomnia. It’s frustrating and debilitating, and the question is, what’s causing it?
External factors such as light emitted by streetlamps or technology can easily disrupt sleep. But this doesn’t necessarily explain the tossing and turning. Environmental conditions, like ambient temperature or mattress stiffness, may influence comfort, but respondents to our surveys rarely cite these as primary causes of sleeplessness.
No, something literally deeper is at work here, and to understand it, we need only examine the mechanism of sleep medications. When doctors write prescriptions for sleep, they’re not trying to create a darker, cooler, or more comfortable environment. Their objective is to alter brain chemistry to induce sleep.
The Chemical Tug-O-War
Deep inside our brains, chemicals, known as neurotransmitters, are constantly at work, modulating the activity levels of our nerve cells. Some neurotransmitters stimulate nerves, resulting in excitation and arousal, things that allow us to think and perform. Others inhibit nerves, making it more difficult for them to become active, and as a result, have a calming and relaxing effect.
During our active hours, there is a normal and healthy balance between excitation and inhibition; sort of a chemical tug-o-war. This allows us to perform at an optimal level, without being hyper- or hypo stimulated. When our goal is to sleep, however, the chemical balance must shift towards inhibition, lowering our state of arousal, quieting our brains and relaxing our bodies.
But when we’re anxious or stressed, the balance flips in the opposite direction, increasing our state of arousal, keeping our minds churning and our bodies tossing, and interfering with sleep. For these reasons, physicians write prescriptions for sleep meds.
The Effect of Prescription Medications
Sleep prescriptions fall under the category of Schedule IV drugs. There are two general types, benzodiazepines (anti-anxiety), such as Diazepam, and Z-meds (hypno-sedative), such as Zolpidem. Both drug types help to increase the action of the primary inhibitory neurotransmitter, gama-aminobutyric acid (GABA), which blocks the stimulation of nerve cells and creates a calming effect.
Do they work? Well, let’s put it this way, in a meta-analysis of 45 research studies5 examining nearly 3000 patients, benzodiazepines were shown to increase total sleep duration by over an hour. Z-meds can reduce sleep latency – the time it takes to fall asleep – by as many as 24 minutes.4 In fact, as of 2019, schedule IV drugs were the most commonly dispensed controlled substances in the United States, with nearly thirteen million adults receiving them for sleep disorders.1
Yes, They Work, But…
Sleep medications do, in fact, perform their intended functions, but there’s a cost, and it’s not measured in dollars and cents. Both benzodiazepines and Z-meds are associated with serious side-effects and potential long-term debilitating outcomes.
Users of hypnotic drugs like Zolpidem, for example, have reported episodes of sleepwalking, sleep eating, and even sleep driving. While seemingly comical, these behaviors usually occur without recollection, may be associated with serious physical harm, and are the sources of multiple recorded legal actions.2
Benzodiazepines are commonly associated with residual dizziness, lightheadedness, and daytime drowsiness.5 Of far greater concern, however, are the results of a 2014 study linking their use to an increased risk of Alzheimer’s disease.3
The risks may certainly outweigh the rewards.
Help is Just a Touch Away
If you’re struggling with insomnia and you don’t want to risk the side-effects of prescription drugs, there may be a more wholesome alternative for you. A report in the journal Energy Psychology6 has cited acupressure as an effective means of desensitizing heightened brain activity through a biochemical relaxation response. In other words, there seems to be a link between the stimulation of acupoints and GABA production.
New studies7 examining this phenomenon are underway, leading to the conclusion that acupressure can produce the same calming benefits of prescription medications, without the noxious side-effects.
Adding acupressure to your nightly routine may be a great way to ease into sleep and ease off of medications.
Stay tuned.
References
1. Bykov, K., He, M., and Gagne, J. (2020). Trends in utilization of prescribed controlled substances in US commercially insured adults, 2004-2019. JAMA Internal Medicine. Published Online: April 20, 2020. doi:10.1001/jamainternmed.2020.0989.
2. Daley, C., McNiel, D., and Binder, R. (2011). “I did what?” Zolpidem and the courts. J Am Acad Psychiatry Law. 39:535-542.
3. De Gage, S., Moride, Y., Ducruet, T., et.al. (2014). Benzodiazepine use and risk of Alzheimer’s disease: case-control study. 349: 1-10.
4. Elie, R., Ruther, E., Farr, I., et.al. (1999). Sleep latency is shortened during 4 weeks of treatment with zaleplon, a novel nonbenzodiazepine hypnotic. J Clin Psychiatry. 60: 536-544.
5. Holbrook, A., Crowther, R., Lotter, A., et.al. (2000). Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ. 162(2): 225-233.
6. Lane, J. (2009). The neurochemistry of counterconditioning: acupressure desensitization in psychotherapy. Energy Psychology. 1: 1-14.
7. Wu Qiqi, Jiawei Wang, Lijuan Fan, et.al., (2024). Efficacy and safety of auricular acupressure on reduction of estazolam in patients with insomnia: a study protocol for a three-arm, blinded randomized controlled trial. BMC Complimentary Medicine and Therapies. 24: 367-377.
