How to use Sleeping tablets effectively to get sufficient sleep but not become dependent

[Elizabeth CP]

My anxiety & depression has a strong link to fatigue levels. My psychiatrist has prescribed sleeping tablets to break the cycle of lack of sleep-fatigue to depression & back in a vicious cycle. Last month I tried them for one or 2 nights when I slept better. After a week of going to bed early & sleeping in as long as possible or at least lying in bed to rest after waking up tired I started feeling mor human & started doing normal things again. I had been too tired to do much before. Unfortunately a few things happened which meant I didn't get the sleep I needed. For example hot nights I can't sleep as I need the fan to keep the temperature down & that keeps me awake. Worrying about people I care about who are currently struggling & extra demands on my time have also interrupted sleep so I am back as bad as ever. The psych now wants me to take the sleeping tablets more regularly at least once a week to stop this cycle.

My query is how do I know when to take them. I don't want to take them if I am able to fall asleep without but I don't want to be getting up in the middle of the night after trying to sleep & being unable to. What do others do.

[Croix]

Dear Elizabeth

As you can imagine Im somewhat restriced in waht I can say here. The following is specifically sanctioned by my doctor for me.

I am prescribed 2 night-time medications, one 3-tablet dose that is designed to last an hour or so, and another different tablet that lasts around 4 hours. Neither have much in the way of side-effects, perhaps dreams are a tad more vidid (read unpleasant at times) or then again that may be just me.

My routine. I take the short-term every night, have been doing so for over 2 1/2 years. Dosn't matter if I'm sleepy or not. The sort term is a three tablet dose. I aim to take all three one after another with pauses. I may fall asleep after one, two or three. If so well and good.

If sleep does not come within a reasonable period and I''m wide awake I get up and have a hot drink.

Then I take 'the other sort of tablet (by now it's probably 1am.) If That does not work I simply stay awake.

By and large this technique works for me, can't say for anyone else. My tolerence to these medications has not increased significantly.

All the above pre-suppose a 'healthy sleeping' lifestyle (bed is for sleep, not TV, books must be soporific if any, and so on.

Don't know if this helps

Croix

[PatT]

Hi Elizabeth,

As with a large proportion of medications the potential for abuse does exist and you need to be wary at times. The thing I think you would most need to be careful around is whether you start going against your common sense and taking more/more often than prescribed. Apart from the medication have you sought out alternative treatments like good sleep hygiene, cutting back/eliminating caffeine, meditation, possibly going to a sleep clinic to get a comprehensive check, exercise etc.?

If you aren't doing things to compliment your efforts at getting better sleep they could definitely be a good idea to begin investing in. But as for your concern re the meds, just be careful, don't overdo it, save them for when you really feel like you need them. There is a growing trend of sleeping tablet abuse in Australia in the past few decades but you don't need to consider following your psych's advice to mean you may join that quota. Just be careful, follow instructions and be honest with your psych.

Pat

[Elizabeth CP]

Thanks Croix & Pat,

Croix I don't want to take something every day. I have declined any further anti depressents & simiar as I can't cope with side effects. A routine like you have wouldn't suit me.

Pat I am aware of the risks of sleeping tablets. I have tried all the other sleep hygiene measures although I could do better. The problem is that my circumstances lead to frequent situations leading to stress & poor sleep. Most of these cannot be changed. For example when my husband is ill he often keeps me awake coughing & choking. Moving to another room is not an option as I need to monitor him to remind him to take whatever measures are needed to be safe. Hot weather is also unavoidable & affects my sleep even though I take all the measures I can think off to be as comfortable as I can. The suggestion of regular (weekly( sleep tablets is designed to prevent the act as a circuit breaker to stop me getting into a bad sleep pattern.

[Croix]

Dear Elizabeth~

I probably did not explain things very clearly, my apologies. It was the incrementing technique with break I was talking about - not the frequency, which is just my own case.

I was trying to say the regime is designed to cater for the situation you mentioned in your last paragraph, in which if I understand you correctly, you did not want to take anything if it was not necessary, but equally did not want to suffer without sleep until it is too late to do anything.

Pat's suggestion of a sleep clinic might well be a good idea too. I don't have any such facilities near me and so have no experience.

​Anyway I hope you find some answers, if so please sing out, I'd be interested too.

Croix

[Elizabeth CP]

Thanks Croix, I'm trying to work out how to adapt what you've said to my situation. I could try sleeping without anything but if still awake after an hour take the tablet. I just need to be mindful of what time I need to get up because if I don't have long enough to sleep after taking the tablet it will create other issues.

[Croix]

Dear Elizabeth

Firstly the tablets are ultra low dosage, which is whay I can take the longer lasting one at 1 am and it will not leave me dozy the next day. I could not take it much later in the night.

Secondly the very first tablet (the first one of the three) is just enough to make relaxation exercises effective - without that they do not work.

I'm normally pretty lucky and don't go beyond the very first dose. It is only if something has happened or my anxiety level is high that I have to proceed to the full regime. Even then it does not always work, so Im tired the next day, not so much from medication, just pure lack of sleep.

The whole thing only became possible when my psychiatrist started me with the 2 different sorts of very low dosage meds.

Dunno if any of this is a help,

Croix

[Dr_Kim]

Hi Elizabeth CP, I can’t give you specific advice as I dont know your individual situation but I will make some general comments that may help.

Firstly, concern around sleep and feeling tired is really common - just generally, and especially where there are mental health conditions complicating the picture. Many GP consultations are centred around people feeling tired, run down ,unable to sleep. I always make sure that there are no “organic” causes of fatigue as a starting point, so double checking things like Iron levels , thyroid, sleep apnoea  etc are important in evaluation of fatigue.

Secondly, I sort out what are things that are reasonable to fix and what are things that are not . So for example, some people are great sleepers and will put their heads on a pillow and drift off within minutes and sleep for a solid 8 hours and wake refreshed. Great for them !

Many many people are not like that. Sometimes it's important to lower our expectations of what is realistic and attainable. Some people are never going to be “great sleepers” and may need to lower expectations to reduce the upset and stress around what their bodies will do for them. Some may have 6 hours of broken sleep and if that is the case, as long as it doesn’t cause them distress, that's ok ! It’s I guess part of the philosophy of just being a bit more forgiving of yourself and just sitting with whatever is. ( I’m sounding very Zen today which might be infuriating , but the thing is you can’t FORCE sleep and sometimes it's not the lack of sleep that is the issue but the upset that the inability to sleep induces that is more distressing .)

The way into breaking this cycle is with mindfulness training - discuss this with a psychologist, or maybe even try mindfulness Apps like Headspace or Smiling Mind.

The issue with taking sleeping pills is the possibility of dependance. Elizabeth CP, you have the guidance of a psychiatrist and I think this is ideal as this is likely to help you NOT develop bad habits .

Taking the pills say once or twice a week, maybe Sunday and Wednesday for example whether or not you “need them“ that night might be a ploy to help your mind not panic on the other nights … as you know that even if you have a bad night sleep for one or two nights, you will have a good night sleep at least twice a week .

Anything that reduces the worry around getting to sleep or whether you will feel tired forever, is helpful and maybe this regime is geared to that end . I would discuss this with your psychiatrist so you are fully on board with their thinking. 

One is unlikely to develop dependance if you are not taking the medications consistently.

You mention things like heat and fans and noise as issues with your sleep quality. Small changes like earplugs ( you can still hear some things through them like coughing!) , eye masks, different blankets , hot water bottles.. can aid sleep so don't forget to look at the little things too. Many patients keep a note pad by their beds to jot down their worries .. so they can defer thinking about them until the morning… saying to themselves that now is not the time to sort that one out.

In summary, there is no one answer but try lots of different things and keep talking to your psychiatrist about things - develop a sense of being in partnership with them. In looking at the big picture though, don't forget the small things that can really make such a difference.