Do We Really Need Eight Hours of Sleep? And a Pill To Help Us Get That?
By Doug Bremner MD

When treating insomnia it is important to consider its impact in its proper context. The manufacturers of sleeping pills make much of the fact that one out of four people complain of insomnia, and of these, half have severe functional disturbances. In a review of all of the data from studies of sleeping pills, Drs Jennifer Glass, Usoa Busto and colleagues from the University of Toronto, writing in the British Medical Journal in 2005, said that "...clinical benefits [of sleeping pills] may be modest at best. The added risk of an adverse event may not justify the benefits, particularly in a high risk elderly population."

While medications for the treatment of insomnia may increase the amount of sleep time you experience, they do not lead to improvements in quality of life, cognition, daytime function, or feelings of sleepiness. They can also increase accidents, falls, fractures, mortality, particularly in the elderly, and dependency. Based on this I do not recommend medication for the treatment of insomnia. If you do have to take a pill for sleep, I prefer over the counter medications like Benadryl before the prescription pills, and strongly advise you to not take medications for more than a few days. And remember, if you do take a prescription pill, you can drink no alcohol, not even a single glass of wine.

Overall, patients who take sleeping pills have a 25% increase in mortality.209 Older patients are prescribed sleeping pills 8 times as much as younger people, even though they have less of a tendency to be anxious. Fourteen percent of hip fractures can be attributable to confusion related to a sleeping pill or other psychotropic drug; in the elderly, hip fracture is associated with a high mortality rate. Another study found that out of 308 older adults with cognitive impairment, 11% was related to a drug they were on, and in 46% of those the culprit was a sleeping pill. Often cognitive function had slowly gotten worse as they had been on the sleeping pill for many years. After stopping the pill, all patients had long-term improvement in cognitive function.

Most studies of these medications involve only six weeks. However it is known that patients with chronic insomnia develop tolerance over time and lose the beneficial effects of medication. Guidelines from a National Institute of Health Consensus Conference recommend that hypnotics not be used for more than six weeks because of problems with rebound insomnia, withdrawal, dependence, and other poor health consequences. However in the real world patients are treated for months or years with medication, and nothing is known about the long term side effects or potential for dependency.

In addition, the average insomniac sleeps six hours a night based on objective monitoring in the laboratory. Increased mortality does not occur until sleep is less than six hours, in the range of four or five hours. The average person sleeps seven hours a night, and has the best health outcomes. So it is not true that you need eight hours a night of sleep. In fact when people started to sleep more than eight hours, they had worse health outcomes.209 Six hours of sleep is adequate for most people.

A common myth is that it is abnormal to wake up in the middle of the night (something that may need medication). Sleep studies show that when people are removed from artificial light, they tend to fall asleep when it gets dark, sleep for three or four hours, wake up in the middle of the night at some random time, lie awake for several hours, then fall asleep again for three to four hours. Studies in primitive hunter-gatherer societies show that these people sleep in the same way. One hypothesis is that this has adaptive value, since if one of the clan is always awake at some particular time during the night they are more likely to detect predators and wake up the rest of the clan. It is artificial to stay up until 11 pm every night with the help of artificial lights, and then sleep eight straight hours through the night (secondary to the exhaustion of having stayed up for 15 straight hours). Therefore, if you wake up in the middle of the night, you should not jump to the conclusion that you need to be medicated for it.

Pleasant dreams!

Learn more about alternatives to medications and hidden risks of prescription medications in Before You Take That Pill: Why the Drug Industry May be Bad for Your Health: Risks and Side Effects You Won't Find on the Label of Commonly Prescribed Drugs, Vitamins and Supplements by researcher and physician J. Douglas Bremner, MD.