2023-05-21 11:00:00
Nearly one in five French people take sleeping pills every year. However, these drugs are not very effective against insomnia and have many side effects.
The benzodiazepine family is the most prescribed to treat insomnia. 13.4% of French people were reimbursed for one of these drugs at least once in 2015, and 117 million boxes were sold (Agence du medicament, April 2017). Twenty benzodiazepines and related drugs are currently marketed in France. All these molecules share the same therapeutic properties: they reduce anxiety (anxiolytics), induce sleep (hypnotics), relax muscles (muscle relaxants) and prevent seizures (anticonvulsants) but at different levels depending on their chemical structure. They are rapidly absorbed in the digestive tract and metabolized mainly in the liver. It is very common for doctors to prescribe an anxiolytic molecule instead of a sleeping pill.
The number
The 2nd row. This is the place occupied by France for the consumption of benzodiazepines in Europe, behind Spain; the least consuming countries are Germany and the United Kingdom.
1/ Why do benzodiazepines cause sleep?
Gaba (gamma-aminobutyric acid) is a neuromediator whose function is to reduce the nervous activity of the neurons on which it binds. In particular, it blocks the arousal systems in the brain. By binding to its receptors, benzodiazepines mimic its effects. “The sleep induced by these drugs is not very restorative because it is similar to a light anesthesia, underlines Dr. Patrick Lemoine, psychiatrist, sleep specialist and author of Doctor, I have trouble sleeping, To sleep naturally (ed. Odile Jacob). The durations of paradoxical and slow deep sleep are reduced. But patients are not aware of this because these molecules have an amnesic effect. In short, under sleeping pills, we sleep badly, but we don’t remember!
2/ Are these molecules useful?
Yes, in the event of transient insomnia whose cause is identified: before an examination, a job interview, a surgical intervention, or even to overcome jet lag. They can also help to overcome an unfortunate event. The fact remains that the treatment must last as short as possible and that its discontinuation must be foreseen and planned as soon as it is prescribed by the doctor.
3/ Do these drugs have many side effects?
The list is impressive: drowsiness during the day which increases the risk of traffic and work accidents, sleep apnea, memory loss, alterations in intellectual performance… They also cause balance disorders and falls, especially in older people whose body takes longer to eliminate these drugs. They are also likely to cause behavioral disorders, even an alteration of the state of consciousness: agitation, delusions, hallucinations, psychotic-type symptoms, disinhibition with impulsiveness, or even coma.
4/ Is their prescription limited in time?
Yes: since 1991, the maximum prescription period for benzodiazepines has been limited to twelve weeks for anxiolytics and four weeks for hypnotics. This is due to several reasons. First, the experts agree that these molecules are useless in the management of chronic insomnia because their hypnotic action decreases from fifteen days of continuous intake. The temptation then becomes great to increase the doses in order to obtain the same effects. The phenomenon of habituation therefore quickly appears: beyond a month of taking benzodiazepines. Then, taking them for a long time exposes them to psychological and physical dependence. This can occur in anyone, even at normal doses… “Temesta and Xanax, two anxiolytics, are the most addictive benzodiazepines”, reveals Patrick Lemoine.
5/ Does their consumption expose you to Alzheimer’s disease?
The medical journal Prescrire has analyzed several studies that have evaluated this link. In 2016, she concluded that benzodiopezines exposed people to dementia. The risk increases in particular in people aged over 65, when their consumption lasts three months or more, revealed a French study published by Inserm researchers in 2014 and published in the British Medical Journal.
6/ Are there benzodiazepines that are less harmful than others?
“Exactly: those with the shortest duration of action because their residual effects are less significant,” says Dr. Lemoine. Physicians use the term elimination half-life which refers to the time after which the initial concentration of the active ingredient in the blood has been halved. It varies from 0.7 to 3 hours for Stilnox and from 17 to 48 hours for Mogadon.
7/ Why is it so difficult to wean off?
For several reasons. First, the abrupt cessation of treatment causes a withdrawal syndrome in the days that follow. It is manifested by headaches, muscle tension and pain, palpitations and irritability. Then it elicits a transient rebound of insomnia and anxiety that is hard to bear. And even, sometimes, seizures or psychotic-type reactions! These symptoms are all the more important with sleeping pills as they are more concentrated in active principles than anxiolytics. Finally, weaning is very difficult because, for many insomniacs, the evening tablet is a contraphobic object, a kind of comforter that reassures them when it comes to facing the night.
8/ Can other medications be taken to treat insomnia?
Indeed, other drugs, which are not sleeping pills but which have sedative properties, are sometimes prescribed. “It is questionable to prescribe neuroleptics to people who are not psychotic,” insists Dr. Lemoine. It is therefore necessary to ban cyamemazine (Tercian) and levomepromazine (Nozinan). Antihistamines like alimemazine (Theralene) and hydroxyzine (Atarax) have far too many side effects. An antidepressant, Laroxyl, may be useful in very small doses for resistant insomniacs. Donormyl, a drug indicated for occasional insomnia and delivered without a prescription, also contains an antihistamine. But it is not very dosed and can therefore be useful.
9/ Is melatonin effective for falling asleep?
In some cases, yes. Melatonin is secreted by the brain when night falls. It is not a sleeping pill, but it tells the body to sleep. It’s a signal. This hormone, in the form of a food supplement (0.5 to 5 g per day), can be useful for adjusting biological rhythms in the event of night work, jet lag, phase delay. The best time to take it? Fifteen to twenty minutes before the desired time of falling asleep. It has no side effects. Melatonin also exists in the form of a prescription drug that is not reimbursed: Circadin. It is indicated for people over 55 in whom melatonin secretion decreases with age. Its efficiency is 60%.
10/ When will there be a new family of sleeping pills?
A new molecule, Suvorexant, which does not act like known sleeping pills, was authorized in the United States in 2014 under the name Belsomra. This molecule blocks one of the neurotransmitters responsible for maintaining wakefulness. Its manufacturer, the Merck laboratory, has filed an application for marketing in Europe. “This molecule seems interesting, but we still lack perspective, warns Dr. Lemoine. It took thirty years to discover the side effects of benzodiazepines. »
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