According to the Brazilian Sleep Association (ABS), about 73 million Brazilians suffer from insomnia. During the worsening of the pandemic, a survey by the Instituto do Sono indicated that the situation has become even more recurrent – about 70% of the population had difficulties falling asleep. This meant that many individuals had to seek medical help, starting to use sleeping pills. To be safe during use, however, it is necessary to understand in which cases the medication is recommended and what precautions should be taken.
According to the psychiatrist at the University Hospital (HU-UFJF/Ebserh) and professor at UFJF Alexandre de Rezende, insomnia occurs when the pattern or quality of sleep is not able to make the individual rest. “It’s what we call unrefreshing sleep. The person still wakes up tired and has repercussions of this throughout the day, with difficulty concentrating, changes in mood, appetite and tiredness”, he explains.
In this sense, the psychiatrist warns that most cases are related to psychiatric disorders, the so-called secondary insomnia. “Depression and anxiety, for example, generate insomnia as a symptom.” The pandemic caused by the coronavirus, he evaluates, contributed to the reduction in the quality of sleep. “The pandemic scenario has increased stress, causing concerns such as fear of contamination and job loss,” he explains.
For psychiatrist Glauco Corrêa de Araújo, director of Vila Verde Saúde Mental, there are other reasons that may be causing the increase in reports of insomnia. “In current times, there is an intense growth of demands and responsibilities in the job market, in terms of performance and financial commitments, causing the individual to be increasingly exposed to an excessive overload in different areas of life”, he says. For him, this causes a framework of excessive self-demand, which can cause damage to mental health, including making the individual reluctant to seek help.
Before prescribing sleeping pills, experts highlight the importance of sleep hygiene, which, according to Glauco, “is a behavioral practice that includes a change in daily habits to prepare the body and mind for sleep”. To achieve this goal, the psychiatrist explains that it is necessary to adopt habits, such as maintaining a sleep routine, not ingesting caffeine at the end of the day and creating a comfortable environment to sleep (quiet, dark and with a pleasant temperature). In addition, it is very important to avoid the consumption of alcoholic beverages, napping during the day, going to bed before the usual time, not using screens before bed and avoiding heavy meals at night, among other precautions.
In Rezende’s view, this care usually generates great results. “Physical activity, for example, is one of the best treatments for insomnia. It is also very important to have contact with sunlight, because our brain can identify what is light (day) and absence of light (night).” He explains that when the brain perceives that light is falling, it has a series of sleep-inducing reactions.
Recommendations for using sleeping pills
According to psychiatrist Alexandre de Rezende, treatment with sleeping pills is indicated when sleep hygiene measures are not sufficient. And insomnia begins to have a negative impact on a person’s physical and mental health. At this point, it is important to look for a specialized professional, such as a psychiatrist or neurologist, to identify the reason for the difficulty in having restful sleep. “When this diagnosis is made, it is possible to treat the cause of the condition. If it’s a depression, let’s treat the depression; if it’s anxiety, let’s treat anxiety,” he says.
Currently, the main drugs indicated are those with the ability to reduce arousal and with sedative properties, with the potential to induce and/or maintain sleep. Of these, there are benzodiazepines, non-benzodiazepine hypnotics and drugs of other classes that have sedative potential. Among them, the specialist explains that the most specific and safe for inducing sleep are those in the hypnotic category. In addition, he adds that benzodiazepine medications, known as “pam” medications (such as diazepam, clonazepam, and bromazepam), are less recommended because of their addictive potential.
Rezende emphasizes that the prescription must be made by a professional, and that the patient “should not use the medication on his own”. The specialist points out that the well-indicated medication is safe and can be used without major problems. “Logically, the drugs should not be used for a very long time,” he warns.
Adverse effects and medication abuse
Psychiatrist Glauco explains that the main remedies used for insomnia can cause sedation. It is perceived by psychomotor slowing, cognitive impairment, memory impairment and respiratory depression. The loss of balance with greater predisposition to falls, tinnitus, dizziness, tolerance and dependence are also symptoms.
He also points out that all these effects can be felt by any patient in use. But he says: “they are not even more frequent in the elderly, and therefore, a population that should avoid their use”. Medicines should also be adopted with caution by pregnant women, people with kidney, liver, lung disease and individuals who abuse alcohol.
In addition, the specialist says that it is essential to evaluate the routine, especially work, of each patient. “Being risky in those who work with activities that require quick decision-making and attention, such as drivers, machine operators and firefighters, for example”.
Glauco also highlights that inadequate prescription, without medical supervision, and abusive use can cause several complications for patients. Among them, it is possible to mention acute intoxication, when overdose occurs, and can even be lethal – especially if associated with the use of other substances. A small portion of patients may also have withdrawal syndrome. This occurs when severe symptoms of hallucinations and seizures and substance dependence syndrome are observed. In this case, the adverse effects mentioned can be serious, “causing irreversible complications”.