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Sleeping pills: The hidden addiction

It was on the advice of close friends that she took `a sleeping pill' to overcome in somnia. Over time, this mid dle-aged, successful professional was taking over 30 pills of alprazolam daily! But her insomnia persisted and she became increasingly anxious and agitated. So she combined alprazolams with alcohol. She would drive out to get them when her chemist was prevented from delivering them home. On several occasions, she had been found passed out in her car by passers-by or her family . One such episode scared her into seeking treatment. That was when we realized that insomnia wasn't the primary problem. It was masking severe depression, untreated for years. She was selfmedicating to feel better.



Admitted to the hospital for a month-long detoxification, she was gradually weaned off the pills and treated with antidepressants and psychotherapy . Her treatment continued postdischarge, and she now leads a contented life.



Most people are not so fortunate.



We often don't realize when the innocuous-looking sleeping pill becomes integral to our survival, and takes us down the road to addiction, which is more com mon than we realize, though rare ly talked about. According to a Na tional Sleep Foundation, USA, re port, “one out of three America women use sleep medication a few times in a week“. Closer home, a elderly patient told me she wa married to the sleeping pill for 3 years! Another patient from th Far East told me that benzodiaze pines from India“were sold at ove 150 times their cost in his coun try!“ This is clearly a public healt problem that has reached epidem ic proportions.



Sleeping pills include benzo diazepines ­ diazepam, alprazo lam, lorazepam, nitrazepam, tria zolam, clonazepam, temazepam chlordiazepoxide, etc. ­and non benzodiazepines such as zolpidem, eszopiclone, zaleplon, antihistaminergic medications, etc.These are consumed as a quick fix to insomnia, which is often symptomatic of an underlying condition, such as a depressive or anxiety disorder, which require com pletely different, supervised physician-prescribed medication.These are antidepressants, moodstabilizers, antipsychotics etc. They are not sleeping pills; they treat the cause of insomnia and may actually lead to excessive sleepiness as a side-effect.



What makes benzodiazepines dangerous are the desirable initial results. They increase the activity of gamma amino butyric acid (GABA) ­ an inhibitory brain chemical that has a calming effect.After the initial `positive' effects of lowered anxiety and a good night's sleep, the GABA receptors get down-regulated within a few weeks or even days, becoming less responsive to benzodiazepines due to compensatory changes in the brain. With `benzos', people who grow accustomed to its effects increase their intake, or take it with pain medication or alcohol, perpetuating a vicious cycle of psychological and physical dependence, making de-addiction proportionately more difficult.



Non-benzodiazepine sleeping pills are equally hazardous. Zolpidem is known to make people do things while asleep that they don't recall when awake ­ such as sleep walking, sleep eating, sleep texting, sleep tweeting and even sleep driving! Fatal car crashes have also been reported, since they slow down one's reflexes. Indeed, all of us are at a risk due to misuse of sleeping pills.



Does this mean that such pills are all bad? Not if administered under strict supervision of the prescribing physician, in the lowest possible dose. In fact, shortterm usage can be extremely effective in treating certain medical conditions, including epileptic seizures, or providing immediate relief in case the primary medication is for the longer term such as for a severe anxiety disorder. If used correctly , short-term, judicious use under the guidance of a physician is usually associated with lower risk of addiction. It is imperative, however, that they are not used indiscriminately and for long durations.



Recovery from sleeping pill addiction, although slow, is possible.The first step towards this must come from the individual a realization that he or she has got used to them and may already be dependent. Then comes supervised treatment. For mild addictions, gradual dosage reduction and treating the underlying cause are helpful. For severe, long-term cases, the patient may need to be hospitalized. Stopping medication on one's own, especially in higher doses, may cause withdrawal symptoms anxiety , insomnia and convulsions and increase the risk of relapse.



If sleep is a problem, try some lifestyle changes for starters ­ regular exercise, a healthy diet, lowering stress. Or go to a physician you trust and figure out if there is another reason for insomnia and stress. If you are already on prescription sleeping pills and feel like you are losing control over its use, discuss with your physician.



But the most important thing you need to do is be unafraid to seek the right kind of help. Over and above all of that, you need to believe in yourself and know that you will find a way to tap into your inner resources, trust your physician, harness the support you need from your loved ones, and overcome any problem you're facing. And when you do find the solution, it is likely to have a definite, positive and long-lasting effect.



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