“The Devil’s Aspirin”: The Dangers of Overreliance on Sleep Medication and The Potential Benefits of Cognitive Behavioral Therapy

By FPG Internal Medicine Specialist Randall C. Raine, DO

In 2004, I was treating a patient who had burned herself cooking in the kitchen. When I asked her how it happened, she gave the typical story about spilling boiling water on herself. What was unusual about her case was that she was asleep when she did it. She had taken a sleeping pill, Ambien, and risen at 2am to start cooking some rice in her sleep. I’ve also had several patients learn that they had been shopping on Amazon in their sleep only when packages started arriving at their door. These are examples of what are called Complex Sleep Behaviors caused by sleeping pills.

Sleep is so important to our health that we spend one third of our lives sleeping, and many of us take drugs to be able to do it. In a recent poll by the University of Michigan, it was revealed that 1 out of 3 adults over age 65 have taken some kind of medication for sleep, and 23% of them take prescription drugs regularly. Even various celebrities—Elon Musk, Charlie Sheen and Tiger Woods—have had public misadventures with Ambien. Sheen even gave this particular drug the colorful name: “The Devil’s Aspirin.”

But Ambien is just one of the most popular. There are many different sleeping medications, and all can be dangerous.

Serious Side Effects

When we think about it, we really should not be surprised that drugs designed to put your brain to sleep might have other negative consequences. Indeed, we are learning that taking drugs for sleep increases your risk of accidents, falls, constipation, car crashes, addiction and more. Recent evidence also shows that taking sedatives routinely can nearly double your risk of developing dementia!

Sleeping pills can also interact with other drugs that you take and should not be combined with alcohol or pain pills.

Studies have also shown that people who have a prescription for both a sleeping pill and certain pain pills are 4 times more likely to suffer an accidental overdose. When an accidental overdose occurs your breathing slows down and can suddenly stop, all while you’re asleep and unaware of what’s happening. This was the sad fate of the talented Australian actor Heath Ledger (Brokeback Mountain, The Dark Knight) who died at age 28 in 2008.

An Alternative To Ambien

As the evidence mounts against prolonged use of these drugs, experts no longer recommend medications as first-line therapy for the treatment of insomnia. The American Geriatric Society Beers Criteria advises against taking benzodiazepines and recommends restricting use of other similar sedatives to short-term use only. As recently as 2019, the FDA placed a “black box warning” on drugs like Ambien, Sonata and Lunesta. A black box warning is the most severe warning the FDA can issue.

And you should not assume that over-the-counter sleep aids are safer. They can also cause serious problems, just like prescription drugs.

The good news is that there is a safe and effective alternative called Cognitive Behavioral Therapy for Insomnia (CBTI). This is a way of training your brain to sleep properly, but it is much more sophisticated than just counting sheep. CBTI involves such techniques as stimulus control therapy, sleep hygiene, biofeedback, relaxation training, and more. This does require more effort than just swallowing a pill at bedtime, but the reward is not suffering a broken hip from a fall or developing dementia or hurting yourself and others in a motor vehicle accident.

Specific resources can be found at the Sleep Foundation website. There are also smartphone apps such as Sleepio and Somryst. I also recommend the book “Say Good Night to Insomnia” by Harvard professor Gregg Jacobs Ph.D.

So, Now What?

If you want to get better quality sleep safely you should discuss your options with your health care provider. Underlying health conditions like Restless Leg Syndrome and others should be ruled out because they are treated in a different way. You can discuss the best way to start learning CBTI.