Dear Dr. Roach: Again and again, I read how vital quality sleep is. Well, for many years now, I have not gotten any. I have followed many suggestions, from supplements to acupuncture, without success. The only reasonable amount of sleep I get comes via a sleeping pill, which I take only when desperate. Is the sleep induced chemically as beneficially as “normal” sleep; meaning, does the benefit gained from taking a pill outweigh the possible side effects of the medication?
Dear C.L.: Most sleeping pills do change the type of sleep you get, and they especially cut the amount of REM (rapid eye motion) sleep and deep restorative sleep. That’s part of why many people wake up the day after taking a sleeping medication feeling groggy and exhausted: The brain did not get the type of sleep it needs. (Another reason may be that the medication is still in the system upon awakening, but this is less of a problem with medications today.)
Some newer agents don’t have as large a risk for disruption of most beneficial types of sleep, but any sleep medication can cause people to become dependent on it. Further, all types of sleep medicines can have side effects, the most worrisome of which, to me, is the increased potential for falls; a fall, especially in an elder person, can lead to a catastrophic cycle of disability. It’s not an exaggeration to say that sleeping pills can lead to death in a small proportion of people who take them.
Most people get good results from nondrug treatments, such as sleep hygiene, relaxation training and cognitive therapies. For people who have really tried these and have not had success, I recommend seeing an expert in sleep medicine to determine the least dangerous medication treatment.
Dr. Roach writes: I recently answered a question about “bird lung,” discussing two possibilities: an infection, psittacosis, and an allergic reaction, hypersensitivity pneumonitis. A reader wrote in about an infection she had called mycobacterium avium-intracellulare complex. Despite its name, it is not caught from birds. It is most commonly found in older adults, sometimes with chronic lung disease, or people with suppressed immune systems, especially with HIV. It is treated with multiple antibiotics for a prolonged period.
Email questions to ToYourGoodHealth@med.cornell.edu.