Day 265 of 365 - Sleep Aids
I know, I've written a number of times now about sleep issues and strategies. But, an article I just read, was troubling enough that I'm back on the topic of sleep again. The issue at hand is a controversial one, that of drug prescriptions for sleep. The focus of the article was on a drug called Seroquel, which is actually an antipsychotic, for schizophrenia, bipolar disorder and major depression. However, prescriptions for it have risen dramatically in recent years, and they are for sleep.
The scary part is, that this is a drug with known risks and potential side effects. These include Parkinson's type tremors, dizziness, heart arrhythmia and sleep apnea, to name some. Why have family doctors been prescribing it? They have justified it as a last resort treatment and when patients are also dealing with anxiety and depression. They also prescribe it in low doses which are presumably safer. It has become a commonly requested drug by patients, as well as frequently recommended by medical colleagues, oddly enough, without knowledge of the adverse effects.
It's very understandable that doctors want to help their patients who may have been struggling to get good sleep for months or years. It seems logical, however, that before drug prescriptions, patients try strategies to improve the likelihood of sleep, such as what I've described in other posts and will not repeat here. There are also behavioral interventions which can help, like mindfulness based stress reduction and cognitive-behavioral therapy. Psychiatrists may go this route before prescribing sleeping pills, but family doctors are less likely to do so.
No prescription sleep aids are without side effects, ranging from increasing tolerance requiring higher doses, to memory issues. It is reported that 10 percent of our population now relies on prescription sedatives, with the highest numbers being women and adults over 65. Prescribing pills has become the path of least resistance when it comes to sleep. It's a concern that neither doctors nor patients may be well informed about the drugs and their effects. Doctors need more training in evaluating insomnia and a greater variety of options for patients.
Prescription monitoring for off-label use, when a drug is given for other than its intended purpose, is not well monitored. There is more surveillance now for use of opioids and benzodiazepines, but not antipsychotics or antidepressants.
This sleep prescription issue may have arisen in part due to the limited time family doctors have available to spend with their patients to get at root causes of problems, along with their lack of training in doing so, Making better use of family practice team members like nurses, nurse practitioners, social workers and therapists might be a better support for patients in the long run. I'm also aware that some of the adjunct strategies, such as those offered via therapists or psychiatrists may not be covered by government plans, and thus unaffordable for many people. This also makes the case for increasing what can be offered via family practice teams which are covered by insurance.
Believe me, I have heard it first hand from friends, how desperate they can be for a good sleep. I am sometimes too. But, we need to think beyond the short term when considering our options. At the very least, if you are going to ask your doctor about a prescription drug for sleep, make sure you are informed of the risks versus the benefits.
The scary part is, that this is a drug with known risks and potential side effects. These include Parkinson's type tremors, dizziness, heart arrhythmia and sleep apnea, to name some. Why have family doctors been prescribing it? They have justified it as a last resort treatment and when patients are also dealing with anxiety and depression. They also prescribe it in low doses which are presumably safer. It has become a commonly requested drug by patients, as well as frequently recommended by medical colleagues, oddly enough, without knowledge of the adverse effects.
It's very understandable that doctors want to help their patients who may have been struggling to get good sleep for months or years. It seems logical, however, that before drug prescriptions, patients try strategies to improve the likelihood of sleep, such as what I've described in other posts and will not repeat here. There are also behavioral interventions which can help, like mindfulness based stress reduction and cognitive-behavioral therapy. Psychiatrists may go this route before prescribing sleeping pills, but family doctors are less likely to do so.
No prescription sleep aids are without side effects, ranging from increasing tolerance requiring higher doses, to memory issues. It is reported that 10 percent of our population now relies on prescription sedatives, with the highest numbers being women and adults over 65. Prescribing pills has become the path of least resistance when it comes to sleep. It's a concern that neither doctors nor patients may be well informed about the drugs and their effects. Doctors need more training in evaluating insomnia and a greater variety of options for patients.
Prescription monitoring for off-label use, when a drug is given for other than its intended purpose, is not well monitored. There is more surveillance now for use of opioids and benzodiazepines, but not antipsychotics or antidepressants.
This sleep prescription issue may have arisen in part due to the limited time family doctors have available to spend with their patients to get at root causes of problems, along with their lack of training in doing so, Making better use of family practice team members like nurses, nurse practitioners, social workers and therapists might be a better support for patients in the long run. I'm also aware that some of the adjunct strategies, such as those offered via therapists or psychiatrists may not be covered by government plans, and thus unaffordable for many people. This also makes the case for increasing what can be offered via family practice teams which are covered by insurance.
Believe me, I have heard it first hand from friends, how desperate they can be for a good sleep. I am sometimes too. But, we need to think beyond the short term when considering our options. At the very least, if you are going to ask your doctor about a prescription drug for sleep, make sure you are informed of the risks versus the benefits.
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