The instant refuge of the insomniac is, naturally enough, the sleeping pill. An incredible number of insomniacs have built a sleeping pill routine into their way of life, and would no more think of going to bed without their chemical sedative than without their pyjamas. Middle-aged women are especially dependent on the nightly sleeping drug, and most of us will take a sleeping pill occasionally.
A belief has been fostered in the minds of doctors -and their patients – that we have in our possession today drugs that do one thing and one thing only, and that is to promote good sound sleep at the drop of a hat. Unfortunately such a drug is still a pharmacological pipe dream. The drugs that exist to promote sleep are virtually identical to those used to promote a relief from anxiety, and all have built-in snags to them.
All drugs are basically dealt with by the body in one of two ways. Some are excreted unchanged in the urine, in the breath and by the bowel. Others, including sleeping pills, are broken down (metabolized) by the liver and similarly excreted. To carry out the latter function the liver produces certain detoxifying substances (enzymes) – which is just as well, for if it did not the drugs would kill us very rapidly. Once produced by the liver these enzymes are made in ever-increasing quantities to instantly ‘mop up’ fresh input of drug. This has a two-fold effect as far as sleeping pills or any other anxiety-reducing sedative drugs are concerned. First of all, to reach a much-wanted sleep-inducing degree of sedation an ever-increasing dose of the drug is necessary, and so there is a natural tendency to increase drug dosage. This in turn produces more detoxifying enzymes.
More important, however, is a second effect. Not only do the liver enzymes mop up the sedative more quickly, but they seem to promote a state of affairs characterized by an increase in anxiety and general twitchiness. Such an effect is seen in sharper focus in the withdrawal symptoms of the major addictive drugs, like heroin (when it is known as ‘cold turkey’). The exact mechanism is unknown, but in all probability the liver enzymes which have been produced to scour the system for potentially poisonous sedative drugs also have a similar mopping-up effect on the body’s own naturally-produced anti-anxiety substances (including the little-known hormones that mediate in the relaxation response).
Unfortunately for the insomniac this adds up to one conclusion. By and large, and except in rather precisely defined circumstances, sleeping pills are disappointing therapeutically despite their widespread prescription.