The covid-19 pandemic has affected people’s mental health, increasing the number of cases of depression, anxiety and stress and, consequently, problems with sleep have increased in Brazil. This can be seen in the rise in the sale of prescription-controlled sleeping pills.
According to data from Anvisa (National Health Surveillance Agency), the purchase of the drug with the drug zolpidem hemitartrate, one of the most popular, has grown since the beginning of the health crisis in every state in the country. In 2019, 8.16 million boxes or vials of the drug were sold. In 2020, the number went to 8.73 million and, in 2021, there is already a record of 4.85 million sold.
The pandemic increased a trend that had been happening since 2011, since from that year until 2018, zolpidem sales grew 560%. “The dynamics that the pandemic brought and still brings affected people’s sleep. The causes range from social isolation, change in routine, fear, uncertainties, to increased work, increased use of screens, television, on cell phones, which worsens the sleep condition. In addition to the increase in alcohol consumption, what hinders the quality of sleep are stimulating drinks to be able to produce more and more”, explains psychologist Ksady Sousa, responsible for the start up SleepUp.
For Dr Dalva Poyares, a researcher at the Sleep Institute of São Paulo and a professor at Unifesp (Federal University of São Paulo), the use of medicines for people who started to present the problem during the pandemic may represent more damage to health than solution to the difficulty of sleeping.
“Many of these insomnia are not really insomnia. They are related, for example, to sleep rhythm disturbance. The idea of a person saving that time when she took the transport to sleep an hour more, she tends to sleep and wake up more But when she wants to go back to sleep at the right time, she has trouble falling asleep, for example. It’s actually a complaint of insomnia, but it’s not the disorder. And it’s being treated with sleeping pills, when it should be treated with a rhythm regulator,” alerts the doctor.
Experts make it clear that sleeping pills are advisable in cases of sleep disorder, but close monitoring by professionals is necessary, who will control the side effects, the amount of medication and the time of use required.
“People who have a chronic insomnia disorder need medication, especially if the patient is suffering, with impairment due to lack of sleep, or if associated with other illnesses. There is an arsenal of drugs, but they should be used sparingly. with the lowest possible dose and keep observing the effects. But in the pandemic, the abuse of medicines also increased a lot,” laments Dalva.
Ksday adds that the remedies cannot be seen as villains. “Medications are important, necessary, especially in acute conditions or when there is an associated psychiatric condition. They have a period of use. When they are used with a medical prescription, with follow-up, respecting the dosage, it is safe. We do not need to put it on. them as a bad thing”, emphasizes the psychologist.
88.4% started with medication more than 3 months ago
In February, SleepUp, a startup focused on treating insomnia, conducted a survey of 533 people to assess how good their sleep was. More than 13% of respondents said they took sleep medication, 71% women and 29% men. Of those currently using it, 88.4% had started taking it for more than three months, and 44.2% had been taking it for more than a year. Of the people who used the drugs, 35% did it without a doctor’s prescription.
Medications have side effects ranging from drowsiness, which is the most common, to changes in consciousness, memory, dependence and tolerance, which is when the medication is not enough and the person is increasingly using it for sleep. Use without medical supervision can aggravate problems.
“There is also the chance of creating a psychological dependency. The patient with insomnia often finds he is no longer able to sleep alone and starts using medication as a safety behavior for him,” notes Ksady.
Doctors suggest that the best treatment for sleep problems is cognitive behavioral therapy, which will uncover the causes of insomnia. “This therapy includes measures that are adequate for the person to function well during the day and sleep better at night. You will learn to deal with the anguish of not sleeping, what to do if you wake up at night and, most importantly, learn to regulate sleep,” says Dalva.
“Until two years ago, it was only possible to do this therapy with a professional and at a cost that was not accessible to the majority of the population. Today it is possible to do it by digital means. But it is not just any application. The ideal is to ask the doctor for the application or treatment available on the internet that is validated and is serious,” adds the doctor.
The psychologist adds: “The digital format facilitates access because of the cost and accessibility, since everyone has a cell phone. It has been an outlet for managing cases of insomnia, especially the most chronic ones associated with some comorbidity.”
But the Instituto do Sono doctor emphasizes that the same conduct does not apply to everyone. “About 20% of people do not respond well to cognitive therapy. The use of any treatment must be studied, it is necessary to know what type of insomnia is, if you have depression with it, age, if you have any other illness. treatment for everyone. Today, with the evolution of science, we are moving towards precision medicine. It is a treatment for each person”, adds Dalva Poyares.