Insomnia: unwanted side effects of sleeping pills

Sleeping pills are not as effective and are a source of significant adverse effects, recalls 60 million consumers on November 8, 2018. Most of the drugs and products indicated to treat insomnia have actually shown an effect only when a very short term (less than a month), after which side effects may take precedence over benefits.

According to Santé Publique France, 45% of French aged between 25 and 45 believe they sleep less than necessary. Insomnia can cause fatigue, distress, daytime running problems and a reduction in quality of life. No treatment is indicated against chronic insomnia, recalls the High Authority of Health (HAS) in its latest best practice recommendations. Regarding the management of "occasional and transient insomnia"she is resting"especially on non-pharmacological measures (respect for the basic rules of hygiene and sleep, psychological support, cognitive-behavioral techniques)". Thereby, "drug therapy is not normally recommended unless insomnia occurs in a predictable way (occasional insomnia during a trip for example)"OR"transitory", for example"during the occurrence of a very disturbing eventIn these cases, a treatment may be prescribed respectively "only for 2 or 3 nights", or"From 2 to 4 weeks at mostThe main treatments are the benzodiazepines and related molecules, anxiolytics called "hypnotics" (on prescription) In some cases, doctors are turning to sedative antidepressants, which are not addictive, or antihistamines H1, some of which are D & # 39; part, herbal or melatonin products are available in pharmacies, with claims against insomnia.

Benzodiazepines / hypnotics: limited efficacy, risk of addiction and drowsiness behind the wheel

Regarding the benzodiazepines or related molecules, such as Nuctalon (estazolam), Noctamide (lormetazepam) or Stilnox (zolpidem), doctors and health authorities have known for a long time that they should only be prescribed sparingly and for a very short period of time . Treatment should not exceed one month by counting the period of gradual decrease of the dose, to avoid creating dependence on the patient. However, according to ANSM, 35% of the first treatments with benzodiazepines last longer than 28 days and 10% more than 3 months. Durations that reverse the risk / benefit ratio of these products, since their effectiveness "it was essentially evaluated over short periods (between one night and 6 weeks)", according to the HAS, while"the maintenance of long-term efficacy has not been demonstrated"But also in the first month of employment"the amount of effect is low, of the order of an hour of sleep gained from Furthermore, the effect eventually vanishes when patients become tolerant to the action of the drug and will therefore be tempted to take a larger amount to achieve the same effect. rebound effect ": sleep may be worse quality than before taking them if they are stopped too abruptly or after too much time.

Among the side effects, drowsiness is the most common. Therefore, 23% of the serious side effects reported with benzodiazepines are disorders of the nervous system: drowsiness, coma, convulsions, even, more rarely, amnesia. According to ANSM, "also the consumption of benzodiazepines expands (…) From 60 to 80% of the risk of road accidents, this risk is multiplied by 8 in case of concomitant consumption of alcoholTherefore, they are classified as having a greater incompatibility with the guide from May 2017.

Antihistamines: moderate short-term effects

Some sedative antihistamines known as H1 may be of interest if behavioral measures and benzodiazepines fail, particularly to get rid of their dependence on them. Phenergan (promethazine) or Donormyl (doxylamine) belong to this category. "Antihistamines have only a weak to moderate efficacy in the treatment of insomnia ", However, European recommendations are mitigated, especially when the body gets used to it "quickly"These substances lose their effect, and antihistamines can cause dizziness, dry mouth and disturbances in concentration.studies have shown that these drugs are taken too long: more than six months instead of the five days indicated", explains 60 million consumers.

Antidepressants: short-term profits, with potentially deterrent side effects

Sedative antidepressants, widely used also against insomnia "although they are not registered for this use and proof of their effectiveness is not definitive", explain the authors of a recent review of the knowledge available in the Cochrane review: This important use of antidepressants outside their initial indication"It could be related to concerns about hypnotic drugs"and their side effects.they are effective in the short-term treatment of insomnia"according to the European recommendations, but not"long-term (…) due to lack of evidence and the risk of side effects"Because antidepressants can cause inhibition peaks with risk of suicide, constipation, sweating or weight gain.

Phytotherapy and melatonin: little evidence

As for self-medication, herbal medicines (valerian, linden, passion flower …) and melatonin (sleep hormone) are available in pharmacies. However, there is currently little evidence of their effectiveness, which remains controversial. According to ANSES (Agency for Health Safety), melatonin can "mitigate the effect of jet lag" or "Reduce time to fall asleep". But it is not without risks. Therefore, the agency received 90 reports of adverse effects (gastroenterological, neurological and general) from 2009 to May 2017 following the intake of food supplements based on melatonin. Data that led to discouraging these products to different categories of people, including asthmatics, pregnant and nursing women, children or people to perform an activity that requires sustained supervision. Regarding the European recommendations, the level of evidence is considered insufficient to be able to recommend phytotherapy such as melatonin.

WHAT TO DO IN THE CASE OF INSOMNIA? Before moving on to pharmacological treatments, lifestyle rules could be safer to implement.

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