[Dr. Chen Yongzhan] On the Treatment of Insomnia

Have you ever had insomnia? According to research in the United States, about one-third of adults experience some form of sleep disorder or sleep problem at some point in their lives, with insomnia being the most common issue. In Taiwan, about one-third of adults also suffer from insomnia. Patients suffering from insomnia are easily and significantly affected by insufficient sleep in terms of mental health, emotions, memory, concentration, physical health, and workplace performance.

Because the insomnia population is so large and its impact so widespread, most insomnia patients who seek treatment at psychiatric clinics begin by saying, "Doctor, I can't sleep." Following this, besides concerns about potential liver and kidney damage from medication, the most common question is, "Will I have to take this medication for the rest of my life?" This conflicting desire for quick results often leads to excessive physical and psychological dependence on medication. Therefore, if insomnia patients wish to take sleeping pills, it is strongly recommended that they use them appropriately and cautiously under the guidance of a medical professional, and strictly follow medical advice. Only in this way can sleeping pills be effective and safe.

Although most psychiatrists treat insomnia primarily with medication, when patients have concerns about medication, doctors may recommend cognitive-behavioral therapy or sleep education to improve their sleep problems.

Common sleeping pills

Traditional benzodiazepines (BZD)

Developed starting in the 1960s, barbiturate-derived sleep aids (BZDs) have largely replaced traditional hypnotics due to their high safety profile. However, despite their safety, concerns remain regarding drug tolerance, addiction, and dependence. Both barbiturates and BZDs generally possess anti-anxiety, sleep-inducing, muscle-relaxing, anti-epileptic, and central nervous system depressant effects. However, the effectiveness of each BZD varies; some are better suited for sleep aids, while others are more suitable as anti-anxiety agents. Based on duration of action, BZDs are categorized into short-acting, intermediate-acting, and long-acting types. BZDs can easily cause memory loss, poor concentration, and confusion. Therefore, elderly individuals taking them may fall and fracture bones at night when using the toilet due to confusion. Long-acting drugs may also lead to poor daytime attention and alertness, increasing the risk of traffic accidents and workplace accidents. Short-acting drugs are more likely to cause drug tolerance and dependence.

Non-benzodiazepine sleeping pills

These types of drugs often have a "Z" in their English scientific names, such as Zolpidem, Zaleplon, and Zolpiclone. Compared to benzodiazepines (BZDs), non-benzodiazepines are less likely to cause daytime sleepiness because they induce sleep quickly, have a shorter half-life, and are less likely to cause daytime fatigue. They are also less likely to cause daytime decreased attention and alertness like long-acting BZDs, making them safer. However, because they are fast-acting and effective, insomnia sufferers may take one after another, leading to physiological and psychological dependence in a short period. Furthermore, some patients report side effects such as sleepwalking or morning headaches, so extra caution is needed when using them.

[Note]: Sleeping pills are effective for insomnia quickly, while non-drug treatments show significant effects after 3-4 weeks of treatment. Long-term use of sleeping pills carries the risks of dependence (unable to stop taking them) and tolerance (requiring more and more to be taken), and the long-term risks to the body are currently unclear. Therefore, choosing a treatment method is also a matter of weighing the pros and cons.

Article source: Dr. Yung-Chan Chen, Department of Psychiatry/Sleep Disorders Clinic, Shuang Ho Hospital