Hypnotized by Hypnotics
Picture a serene, dimly lit bedroom. Curtains flap in a gentle breeze as an angelic night moth glides gracefully across the room, bestowing sweet slumber upon some lucky soul. Leave the rest to Lunesta says the tagline.
Anyone who has flipped through a popular magazine or turned on a television set in recent months is all too familiar with this scene. Consumers are now being barraged by an unprecedented campaign to promote the sale of sleeping pills or so-called hypnotics—a $4.5 billion a year and rapidly growing pharmaceutical cash cow.
Hypnos, the sweet-natured Greek god of sleep and namesake for hypnotics, would turn over in his grave. The sleeping pills that bear his name do not provide true sleep. At best, they produce a kind of simulated sleep—a chemical knock out with potentially dire long-term health consequences.
Sleep professionals and advocacy groups keep reminding us that sleep disorders are rampant and pernicious, while their pharmaceutical bedfellows simultaneously offer convenient, ”safe and effective” solutions in the form of new and improved hypnotics.
Recent advertising campaigns as well as extensive media coverage of sleeping pills draw our attention to interesting questions of safety, effectiveness, convenience, and side effects. Although such discussions appear to be germane, the question of which hypnotic might work better sets up a false dichotomy. It diverts our attention from a deeper, more substantial and pressing issue—that of how to obtain truly healthy sleep.
Sleeping pills commonly result in dependence. They can alter normal sleep patterns, cause amnesia, residual daytime ”hangovers,” and rebound insomnias upon discontinuation. Although they might offer temporary relief by masking the symptoms of insomnia, they do not provide true sleep. Masking the symptoms of insomnia does not constitute good sleep any more than masking the symptoms of anxiety with alcohol provides good mental health. Perhaps most alarming, evidence suggests that chronic sleeping pill use is associated with a significant increase in mortality.
At best, most sleep aids should be seen as a short-term aid, a component of a more comprehensive sleep health regimen. Like a cast on a broken bone,a sleeping aid can provide a temporary structure that supports, but does not substitute for, real healing. After years of tolerating the unendorsed long-term use of Ambien by consumers, the FDA’s recent approval of a number of sleeping pills for long-term use is tantamount to approving the long-term use of a cast. This will only worsen the already widespread atrophy of our own, innate ability to fall asleep.
In the end, sleeping pills offer only negligible improvements in sleep, extending sleep time on average for less than one-half hour. Recent research suggests that these medications mask awakenings, misleading people into thinking their sleep is much better than it actually is.
Sleep cannot be reduced to squiggly EEG tracings and the cascade of neural humors. There is a critical but forgotten, deeply personal and even mythic dimension to sleep that has been obscured by our narrow, overly-clinical medical approach.
Hypnos, the god of sleep, is calling for resurrection. The favorite son of Nyx, the mighty Greek goddess of night, he would remind us that sleep is naturally born of night and darkness. Research is confirming that exposure to dusk and darkness is an essential though all but absent component of healthy sleep. So many of us have slept poorly for so long, we have forgotten what it is like to experience truly deep and refreshing sleep. Natural slumber calls for a gentle and intentional surrender to night, a voluntary relinquishment of the day, a letting go our waking selves.
Our inclination to take something to sleep must be tempered with a fundamental psychological and spiritual practice of letting go of something in order to sleep. To awaken from our sleeping pill trance, I believe we must carefully reconsider the key role of night, dusk and darkness as a natural medium for letting go. Straight up, in its undiluted form, even with long-term use, night itself may be the best sleep medicine.