Before you ask a doctor for a prescription for a sleeping drug:
• examine the general state of your health - sometimes insomnia is caused by somatic illness
• check if you suffer from nighttime apnea - you should not use sleeping pills in these states
• if you are a woman - avoid using sleeping pills during pregnancy
Once you start using synthetic sleeping pills:
• start by using the weakest ones
• try to use the lowest possible dose - never exceed the recommended dose
• try not to take a sleeping pill in the second half of the night
• if you are taking a sleeping medicine, try not to drive the car the next day
• if you are taking a sleeping medicine, do not drink alcohol. Interaction can be difficult to predict
• remember that usually when you stop taking the medicine you will have to "pay" for his taking period of temporary insomnia
• sleeping pills should only be used for a limited time
Warning! Dependence on sleeping pills is increasing
Many patients are convinced that they will not fall asleep without a sleeping drug, and the sudden withdrawal attempts only confirm the patient's fears. Lack of sufficient knowledge among doctors and overwhelming pressure from patients to "quickly and effectively" lead them out of insomnia, led to the widespread prescription of hypnotics. Even today, in many hospitals, patients "on request" receive sleeping pills during the night rounds. Similar habits also prevail in nursing homes. Silent night is rarely disturbed, the staff have "peace of mind" and patients in "malignie and the fumes of sleeping and sedating drugs" are stuck in beds as if after anesthesia. Of course, this is a simplified picture of such branches. Usually, however, this and that of the seniors will get up to the toilet and then, due to dizziness and disturbances of the balance, it falls over and collapses on the equipment. If he breaks his leg, it may be the beginning of the end of his stay in this ward. Getting away from taking a sleeping medicine, especially if it has been taken for a long time and the patient is over 60 years old, is very difficult.
How to overcome excessive dependence on sleeping pills?
A prerequisite for success in the withdrawal of hypnotics is that the patient is well motivated to withstand the hardships of the drug withdrawal period and trust the treating physician. The anxiety during the daytime and annoying insomnia in the first period may be so strong that the test may fail. However, these symptoms, in a similar intensity, last only for a few days. Therefore, the method of gradual dose limitation, supported by psychotherapy and explanation of the mechanism of normal sleep is strongly recommended.
Combating insomnia with antidepressant
However, if the method of limiting the dose of hypnotics is too difficult for the patient, you can try to replace this hypnotic with an antidepressant with a sedative effect, eg low doses of Mianserine or low doses of a neuroleptic, eg Diphergan in syrup.
Here is a short story of one of my patients dependent on the benzodiazepines that have been taken for years:
The patient was 64 years old when she came to my office. She was an actress by profession.
She enjoyed great artistic successes. In recent years, it has even happened that she played two performances a day. She had been married for many years, and the relationship with her husband was going well. Adult children lived outside the home. The rhythm of the patient's work resulting from late performances meant that she returned home around 24 at night. Only then did she have the opportunity to eat supper and "calm down" after a busy day.As a result, she has been falling asleep around 2 am for years. When the children were still at home, she had to get up to get them ready for school. So for years she has not gotten any sleep and had a completely unsettled sleep. When even very tired she tried to fall asleep, the emotions of the evening performance did not allow it. She saved herself by taking sleeping pills. She took many of them for almost twenty years. She was already addicted to many. Lorafen was taking Lorafen regularly.
The reason for reporting to me (previously she had met several times with various psychiatrists) was the care of her husband who observed that he was using more and more Lorafen.
It was recorded by all friends, doctors and a company doctor. In addition, getting up several times at night, she was so "dazed" that she fell over, knocked on the equipment and, as a result, she had bruises, "just like after a homemade adventure." However, the husband was a very controlled and caring man. He patiently endured her irritability and outbursts of anger in periods when she had too few Lorafen. The patient was essentially physically healthy. She managed to correct slight hypertension with medication. Intellectually efficient, she was successful professionally. Her serious problem was chronic insomnia and dependence on benzodiazepines.
I realized that I can not give my patients a 'favorite sleeping pill'.
I introduced Mianserine for the night in increasing doses up to 60 mg. At the same time, I slowly and gradually limited the administration of Lorafen. After about 3 weeks, the patient only took Mianserin overnight and, in case of irritability, small doses of Diphergan in syrup during the day. At that time, we also met quite regularly at psychotherapeutic sessions in her home. After a few more weeks, the patient stopped contacting me, but her husband informed me that she had begun to take Lorafen again. When finally, upset and depressed, she herself asked me again, she agreed to go through the Lorafen withdrawal once again. This time the improvement lasted for several months, after which our meetings were interrupted. I suppose, however, that she was satisfied with the treatment because soon she sent her friends to me.
Stopping and giving up sleeping pills, regardless of their chemical composition, is always a difficult problem for the patient. Therefore, it is better to follow a few general rules and guidelines:
• Prepare a detailed drug withdrawal plan. Reduce the dosage by gradually reducing the ¼ tablet every 2 days. Sometimes the withdrawal period may take up to 6 weeks
• it is best that the withdrawal time is associated with a period of holiday or other period of less intensive activities
• focus more intensively on your hobbies or meetings with friends during this time. You need some compensation
• learn relaxation techniques and use them
• if you fail, try to repeat the operation again
However, if you still need to take sleeping pills, try to put them away in cooperation with a doctor who knows these problems. However, if you have to take sleeping pills for some time then:
Repetytorium on the cautious use of hypnotics
• examine your health. Sometimes insomnia is caused by somatic illness. Check if you do not suffer from nighttime apnea. In these states, hypnotics should not be used. They should not be used during pregnancy
• use the medicine as weak as possible
• use the lowest dose possible. Never exceed the recommended dose
• try not to take a sleeping pill in the second half of the night
• if you are using some sleeping pills, try not to drive the car the next day
• if you are taking a sleeping medicine, do not drink alcohol. Interaction can be difficult to predict
• usually when you stop taking the medicine you will have to "pay" for his taking period of temporary insomnia
• sleeping pills should only be used for a limited time
Doctor of Medicine Janusz Krzyżowski
Psychiatrist
