Can I Just Have a Pill to Help Me Sleep?

Sleep is essential for maintaining emotional and physical health. Insomnia often occurs as an indicator of an underlying problem. When it is not the result of a medical condition or related to lifestyle habits, insomnia can lead to significant medical problems.

Insomnia is a symptom, not a syndrome

A symptom is a subjective perception that a person notices regarding a specific bodily sensation or experience. Symptoms are often nonspecific and common examples include headaches, itchiness, fatigue, pain and nausea. Symptoms can serve as warning signs of an underlying disease, but are not a diagnosis in and of themselves. For example, headaches can be caused by migraines, caffeine withdrawal, alcohol hangovers, hormonal shifts or a bleed in the brain.

A syndrome refers to a condition in which multiple symptoms and objective findings exist together. For example, irritable bowel syndrome (IBS) can be diagnosed when multiple signs and symptoms related to gastrointestinal dysfunction occur together. Cushing syndrome occurs when certain bodily changes result from abnormally high levels of cortisol.

If a patient consulted with an orthopedic surgeon for knee pain the surgeon would not simply recommend surgery without an assessment of what was causing the problem. That is because knee pain is a nonspecific symptom that can be related to multiple underlying medical issues. Maybe there is an infection that requires antibiotics. Perhaps the pain is related to inflammation from an autoimmune illness such as rheumatoid arthritis or lupus. Or maybe there is a torn ligament that needs surgical repair. The point is that the treatment for the knee pain is dependent upon what has caused it. The same is true for insomnia.

Insomnia is often a catalyst for seeking medical treatment

Although insomnia is a symptom, it is frequently conceptualized as a syndrome or diagnosis. Too often patients are simply prescribed sleeping pills without a thorough exploration of the context in which the insomnia occurs. Underlying causes of insomnia are often glossed over or are not addressed at all. Without addressing and treating the causes of insomnia, underlying medical conditions can become worse. It can also increase the risk of chronic use of sleeping pills or addiction.

Insomnia is one of the most common reasons that patients seek out psychiatric treatment. It often causes significant distress and quickly leads to spiraling anxiety about not sleeping, which can worsen the cycle of sleep disruption. It can make people feel desperate for sleeping pills.

Insomnia can worsen physical and emotional health

Poor sleep leaves people exhausted, irritable, and less focused. Chronic insomnia increases the risk of medical problems including hypertension, cardiovascular disease, weight issues, metabolic syndrome, type 2 diabetes, and colorectal cancer (Medic et al, 2017). There is a relationship between poor sleep and risk of cancer. Melatonin, a hormone involved in regulating circadian rhythm, has a role in DNA repair and inhibition of tumor growth (Medic et al, 2027). The use of electronic devices such as iPhones, televisions, and computers before going to sleep inhibits the natural production of melatonin. Disrupted sleep can affect the immune system and may lead to worsening of inflammatory bowel disease as well as irritable bowel syndrome and gastroesophageal reflux disease (Medic et al, 2017).

In 2020, 6.3% of adults in the U.S. took daily sleep pills in the previous 30 days with an additional 2.1% using them most days and 10% using them sometimes (Centers for Disease Control and Prevention, 2023). Risks associated with the use of sleeping pills include cognitive problems, impaired driving, and addiction.

Common causes of disrupted sleep

Here are some questions that can help determine the nature and causes of insomnia, therefore leading to the best chances of effective treatment.

• Is the sleep disturbance new or has it been chronic? How long has it been going on?
• How long does it take to fall asleep or fall back asleep?
• How many hours do you sleep per night?
• Is it trouble falling asleep, waking during the night, or awakening extra early in the morning for the day?
• Are substances such as caffeine, alcohol, or cannabis affecting sleep?
• Is it related to medications such as prednisone, Adderall, or over-the-counter cold medicines?
• Is your sleep schedule inconsistent with going to sleep at different times, frequent travel with jet lag, or changing work shifts?
• Is ambient noise, warm temperature, or a pet waking you?
• Do you feel anxious or conflicted leading to obsessing at night?
• Do you have a history of depression or bipolar disorder? Insomnia is often an early sign of an episode.
• Is pain or restless legs keeping you awake?
• Is there an underlying sleep disorder present such as obstructive sleep apnea or narcolepsy?
• Is sleep hygiene problematic such as using screens within an hour of going to sleep or napping late in the day?

Conclusion

Determining the cause of insomnia allows for more effective treatment. Insomnia can not only result from medical problems or lifestyle issues, but it can also lead to a worsening of physical health.

If you suffer from insomnia, it is critical to examine the whole picture and not just put a bandage on it. Sleeping pills can be part of the treatment but for true health and wellness, try to elucidate the syndrome and not only treat the symptom.

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