This post links to Bob Fiddaman’s Forty Winks last week.
Insomnia is one of our all time biggest problems. We all need Kind Nature’s Chief Restorer to knit up the ravelled sleeve of care. There is all sorts of health advice out there about how you owe it to yourself to get a good nights sleep, that its dangerous not to, and that whatever is today’s hypnotic of choice is a lot safer than the pills like Doriden we used to use but now recognize as dangerous.
Today is no different to the 1950s – perhaps even worse. Turning to one of today’s pills can make the original problem a lot worse.
Katinka Newman’s book The Pill that Steals Lives brings out how stress leading to a poor sleep can lead to a pill that triggers an earthquake – volcano – avalanche – pick your word for something that sweeps the person away.
The disaster that struck her once she figured on helping herself by getting something to help her sleep to tide her over a stressful situation comes through very clearly also in a compelling Medicating Normal Interview she gave recently.
Miranda Levy’s Insomnia Diaries tells a very similar story of a very normal, more competent than average woman, having a Descent into Pills – something to rival Dante’s Descent into Hell.
Another book telling this story all too well is Laurie Oakley’s Crazy and It Was, which outlines a similar dynamic and in particular how doctors are almost completely blind to the havoc they are causing. This led to a further series of 5 posts by Laurie in January and February 2016 on Pharmaceutical Rape.
Several of the compelling narratives in Medicating Normal begin from the same point – normal people who have had a sleep problem which is rabbit-hole through which they slip, like Alice, into a crazy underworld.
Its normal to have broken sleep with stress. Its also common for a lot of women to have broken sleep in their fifties – perhaps caused by a changing physiology or perhaps linked to taking stock of a life. (It’s easier blame hormones). An innocent sleeping pill taken for a few days looks like it will be and often will be no worse for many than having a drink.
Katinka and Miranda’s cases though bring out that even this simple and seemingly harmless move has an element of roulette linked to it.
Taken for longer than a few days the problems really start. A doctor may want to change you over to something that is not habit-forming like an antidepressant, an SSRI in all probability or perhaps a sedative antidepressant like Mirtazapine – Remeron, Trazodone, or to Quetiapine – Seroquel.
Or if you have been put on a short acting hypnotic like Zopiclone, or Zolpidem you may tell her/him you are falling asleep quite well but not staying asleep and s/he may add something in to help with this. Always adding.
Many doctors are now petrified to prescribe benzodiazepines – these include the Z-drugs used as hypnotics. The guidelines tell them not to give them for more than four weeks. Many doctors dish out opioids a lot more freely than they given benzos and figure Benzos are more dangerous than Heroin.
They have been told that poor sleep is a cardinal symptom of depression and have been encouraged to treat the underlying problem rather than the superficial symptoms of insomnia or anxiety.
This led Don Schell’s doctor to give him paroxetine, when he came complaining about poor sleep. Forty eight hours later he put three bullets through the head of his wife, his daughter and his grand-daughter before killing himself.
This is where you risk entering the weird dystopian world of antidepressants and sleep.
Most of the posts on RxISK that have attracted the most comments have been by contributors (like you), and in particular posts about sleep. Its not just the posts from people descending into Hell, like those above, there are also those whose sleep was okay to begin with but who wake up to find themselves in a Sleepless Hell.
Bob’s Forty Winks made me aware of sleep paralysis and sleep apnoea, and before it Night of the Living Cymbalta made me aware of the horrific nightmares many SSRIs can cause both while on them and on coming off them. In the same way Sleep Problems after Stopping Antidepressants has changed my clinical practice completely.
Some of the problems antidepressants cause like nightmares and sleep walking or paralysis are totally predictable. We know that these drugs act on the mechanisms that control our cycling through the various stages of sleep and this means they can cause nightmares – or perhaps an awareness of nightmares we would not otherwise be aware of – and other things that happen on the borderland between sleep and wakefulnes like paralysis, hallucinations and sleep walking (somnambulism in the Table below).
The nightmares can be particularly horrific and can lead to dangerous sleep behaviours – Night of the Living Cymbalta. The comments afterwards are worth reading in addition to the post. The disturbances to sleep can endure for years after stopping – this is something no doctor ever tells a patient. See Sleep Problems on Stopping – and particularly the comments afterwards.
There are other things though that I would never have guessed. Until Forty Winks if you’d asked me can antidepressants cause Sleep Apnoea, I’d have said no. Not an easy matter to tell Bob Fiddaman he’s wrong though – especially as it turns out he’s right. Sleep Apnoea turns up very commonly on all SSRIs.
Sleep Apnoea is even commoner than the reports below suggest in that FDA let people report Sleep Apnoea, Obstructive Sleep Apnoea and Apnoea so this breaks up the numbers – just as people are let report sedation, lethargy, malaise, sluggishness etc which may well be all the same thing. And both nightmares and abnormal dreams which again are likely the same thing.
We are told we have to get our sleep problems treated because we won’t be able to function, or will be dangerous when doing things during the day if we don’t. When Prozac was being sold to us, Lilly told employers that it would reduce presenteeism – workers who were there in body but not able to work efficiently and in fact dangerous.
Well the reports to FDA in the Table suggest the effects of these drugs may be just the opposite – they cause presenteeism. People are reported as less functional at activities of daily living and as having impaired work abilities,
|Abnormal Dreams||0.6%||0.6%||0.4%||0.7%||0.5%||1 %||0.4%|
|Home Function Impaired||0.4%||0.5%||0.3%||0.3%||0.35%||0.3%||0.3%|
|Work Function Impaired||0.3%||0.5%||0.2%||0.24%||0.2%||0.3%||0.25%|
|Poor Sleep Quality||0.3%||0.3%||0.25%||0.3%||0.3%||0.25%||0.2%|
Bob generated the figures for the Table below and the Images below that. In terms of interpreting this Table, every 1% equates to 1000 reports. This is rough and ready rather than absolutely accurate.
The actual figures are in the images below – with the Paroxetine figures in Forty Winks.