Sleeping Pills Should Be Used Judiciously

May 16, 1990|By Dr. Allan Bruckheim.

Q-Can you comment on the constant use of pills to achieve a decent night`s sleep? Isn`t possible to get results without taking dangerous medication? Please put your answer in the column so I can show it to my husband.

A-During the last decade, there has been a great deal of research into sleep disorders and sleep-promoting medications. There is a new class of drugs called benzodiazepines involving lower risks than previous sleeping pills, which included drugs such as barbiturates and non-barbiturate hypnotics.

Although benzodiazepines are prescribed by many physicians when medication is necessary, most doctors are trying to use methods other than drugs to help their patients get a decent night`s sleep.

The National Institutes of Health discovered that one-third of the U.S. population reports some degree of insomnia. A recent survey found that half of those with insomnia considered their problem serious and said it caused emotional distress.

To treat insomnia, doctors begin by assessing the medical, psychiatric or other factors that cause it. Most doctors agree insomnia is merely a symptom of another problem.

When prescribing sleep-promoting medication, doctors divide insomniacs into categories: those with transient insomnia, short-term insomnia, or long- term insomnia. People with transient insomnia are generally normal sleepers who are in a stressful situation that may last a few days. Such situations may include travel to a new time zone or hospitalization for elective surgery. Some sleep experts say that in these situations, sleep-promoting medications are fine.

But other doctors believe such patients should either just tolerate the sleep loss or observe good sleep hygiene, reducing caffeine intake and regulating one`s time in bed.

Doctors use caution instead of simply writing out a prescription because there are side effects to almost all sleep-promoting pills. The most common risk associated with medications is that the patient`s daytime performance will be diminished as a result of carry-over effects. People who have jobs requiring high levels of visual motor coordination must be extremely cautious when using any medication, even on a short-term basis.

When patients are found to have a short-term insomnia problem, doctors may employ sleep hygiene or suggest extra exercise for the patient. A relaxing walk after dinner or before bedtime helps the digestion and removes some of the stressful thoughts occupying our minds. Add a glass of warm milk before bedtime (milk contains the natural tryptophans that can help induce peaceful slumber) and the problem may be solved without unnecessary medications.

If those methods fail, sleep-promoting medications are usually an option. Short-term insomnia may last up to three weeks. It is related to situation stress arising from work, family life or a serious personal loss. The trick is to abandon the medications once a normal sleep pattern has been restored.

Taking medications when they aren`t needed ranks well up on my personal list of no-no`s; it`s always something to be avoided.

Q-Can a seizure by a chronic alcoholic develop while he`s actually drinking? We are faced with an emergency room diagnosis that claims this is so, but we always thought that the shakes were prevented when the alcoholic is drinking. Could you please explain?

A-It`s an unfortunate truth that an alcoholic can become accustomed to very high levels of alcohol. Withdrawal sets in when an alcoholic drinks less than his usual intake. Symptoms of alcoholic withdrawal are seizures, hallucinations, elevated temperature, agitation, impaired coordination, and/or racing heartbeat. The shakes, as we call delirium tremens, or DTs, usually begin within 24 to 48 hours of lessened alcohol intake and usually subside within 72 hours.

Pity the poor emergency room physician who receives a patient in alcohol withdrawal! The doctor first has to rule out head injury, epilepsy, hypoglycemia, psychiatric disorders and intoxication, all of which can mimic some of the symptoms of alcohol withdrawal. In the hospital, the alcoholic undergoing withdrawal can expect to be given intravenous glucose,

acetaminophen if temperature is elevated, a sedative or tranquilizer if agitation is acute, and a blood alcohol test. Later, the doctor may administer thiamine and folic acid, since these are often deficient in chronic drinkers. This emergency medicine is also preventive medicine. The idea is to head off the potentially fatal DTs. I can give you no better reason for getting an alcoholic experiencing withdrawal to a hospital right away. Remember:

Alcoholism is a disease, and the people who suffer it have the right to the best medical care we can give them.