Is Canada addicted to sleeping pills?

Source: Web exclusive, April 2011

It started to feel like the movie Groundhog Day. Every night, Jessica Kishi*, a 28-year-old executive assistant at a Toronto film company, would head to bed, ragged and bleary-eyed but knowing she was destined to lie awake struggling with insomnia. Every morning, she’d wake up after three or four restless hours of shut-eye and drag herself to work. She might manage to get a better night’s sleep once or twice a week, but not often enough to feel anywhere close to well rested’especially since Kishi has battled poor sleep patterns since she was a child.

‘It was at least more manageable in university because there was less structure in my life and more opportunities to nap or sleep in, so I could get away with staying up later,’ she says. ‘But now I’m working in an office, working overtime, and trying to be active or social. I don’t get home at six o’clock and have five hours to wind down [before bed], so I end up still awake at four a.m.’ After several months of sleeplessness began to wreak havoc on her body, she turned to her doctor for some pharmaceutical help.

Canada’s struggle to sleep

Of course, Kishi is far from alone in her struggle with sleep. Canadians are exhausted’one in three of us suffers from sleeplessness and one in 10 experiences chronic insomnia. The causes are multifold, says Judith Davidson, a sleep researcher and clinical psychologist at Queen’s University in Kingston, Ont. ‘Insomnia can be due to a loss, relationship stress, high stress at work, illness, or pain; the cause may also involve racing thoughts and worries, including worries about the effects of not sleeping.’ Our overreliance on technology may also be keeping us awake: exposure to the artificial light of televisions, computers and phones before bed enhances alertness and suppresses the release of the sleep-promoting hormone melatonin. Heightened emotions and menstrual cycles are also factors, which might explain why women are twice as likely to report insomnia than are men.

Solution in a bottle

But while insomnia’s culprits are varied, one solution has emerged as a clear favourite among the sleepless: like Kishi, Canadians are increasingly seeking refuge in sleeping pills’and doctors are readily handing out prescriptions. ‘All too often, upon hearing that a patient has had trouble sleeping, the physician’s reaction is simply to write a prescription for pills and leave it at that,’ says Dr. Jeffrey Lipsitz, medical director of the Sleep Disorders Centre of Metropolitan Toronto. ‘There’s no detailed history [taken], no physical examination, no referral to a specialist and no follow-up.’

In the years between 2003 and 2007, the use of zopiclone, a drug in the benzodiazepine family of sedatives that is prescribed specifically for insomnia, rose almost 50 percent. And according to IMS Brogan, a private company that monitors the pharmaceutical industry, pharmacists across Canada filled nearly 7 million prescriptions for sleeping pills last year alone, amounting to $162 million in sales. Most recent statistics show that 60 percent of those prescriptions were written for women.

There are advantages to short-term use of sleeping pills, Davidson says: ‘They can give you immediate help with sleep and a somewhat longer sleep; they can also be good to help you through a rough patch if, for example, you have just lost someone.’ Lipsitz adds that prescribed medication is preferable to the over-the-counter pills you may find on the drugstore shelf. ‘Most of those sleep aids are sedating antihistamines [the same type of medication used to relieve allergy symptoms],’ he says. ‘Yet they don’t necessarily give you a good or refreshing sleep and they may not have been tested’rigorously or at all’for their effect or their safety as sleep aids.’

The trouble with sleeping pills

Lipsitz cautions that Canadians relying on sleeping pills rarely stop at short-term use. ‘Even the sleeping pill manufacturers state that their products are for acute insomnia only, which is generally defined as insomnia lasting three weeks or less. Yet millions of people take them for years.’

In addition to grogginess and elevated anxiety, which are common side effects of benzodiazepines, you can develop a tolerance to the medication after just two to four weeks. ‘If you don’t take the medication, you may have severe insomnia, but you also need more of the medication to have the same [sedating] effect,’ Davidson says. ‘The risk of dependence is high.’ During one particularly miserable night, Kishi swallowed four pills in a single gulp to ensure a decent sleep. ‘I was definitely freaked out after that happened,’ she admits. ‘I didn’t want to keep putting that in my body. I didn’t want to be hooked.’

Understanding your insomnia

It’s crucial to remember that insomnia is a symptom of an underlying cause, and not a diagnosis unto itself. Although Kishi still takes the occasional sleeping pill, she acknowledges that it is ‘the stress of this job that keeps me out of this bed. I’m trying to make shifts in my lifestyle and not take so much of that stress home.’ As desperate as everything may seem at four in the morning, no one is condemned to eternal sleeplessness. ‘There is a physiological basis for this problem, one that can be treated, corrected and generally improved upon,’ Lipsitz confirms. ‘It doesn’t have to be merely papered over with a prescription.’

Contact the Canadian Sleep Society to find a sleep clinic in your area.

For tips on how to get the sleep you need, check out:

‘ 6 ways to improve your sleep hygiene
‘ 5 sleep mistakes and how to avoid them
‘ 10 sleep mistakes and how to avoid them

* Name has been changed.

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