Slashdot Mirror
Those Sleeping Pills May Be Killing You
dstates writes "A recent article in in BMJ Open reports a strong association between the use of prescription sleeping pills and mortality. The study used electronic health records for 2.5 million people covered by the Geisinger Health System to find 12 thousand who had been prescribed sleeping pills and a matched set of controls. Death rates were much higher in the patients taking sleeping pills and the risk increases with age. Kudos to the authors for publishing this in an open access journal."
Most of the people I know who take sleeping pills are not necessarily the most stable people in the world to begin with. Sorry to all you Ambien fans.
SJW: Someone who has run out of real oppression, and has to fake it.
The people taking the medications might be dying sooner because they have insomnia which is not fixed by sleeping pills easily. The study should not compare with the general populace since they are, by definition, better sleepers than the group that isn't able to get good sleep.
This space for rent.
How often is healthcare data used for these sorts of studies? Not that I have a problem with it, quite the opposite, so long as the data is sanitized. To me it makes more sense to data mine existing records than set up and conduct expensive studies, am I missing something or is this actually commonly done?
Morphine is also naturally sinthesized by our organism.
-- --
Neat, but not surprising.
Taking pills to help/force you to fall asleep on a consistent basis can't be good for you. That said, neither can not sleeping on a consistent basis. Even with the risks in mind, I imagine in many cases it still makes sense to keep taking the pills?
Luckily I sleep like a log.
Ahh those overlapping confidence intervals.
Seven puppies were harmed during the making of this post.
I strongly suspect a lot of people with chronic pain issues are on some kind of sleeping pills. These people may have skewed the study because they already have health conditions that are leading to increased mortality.
After reading the full study report, the headline for this post is more than a bit sensational (disappointing for /.). This was a longitudinal study comparing a set of data from a certain time period and can't be used to determine causality. Also, the control were only matched on a few data points, making this difficult to apply to a general population or even interpret if there was an actually difference in mortality given that table 3 showing differences in co-morbid diagnoses shows large disparity in key areas like cardiovascular risks, hypertension, heart failure.
This point underlies why this study is not helpful. Many serious medical illnesses have insomnia has a symptom, and often treated with a sedative hypnotic. This DOES NOT mean that the sedative hypnotics are "killing" people. I hate studies like this.
Drug companies spend more on marketing than they spend on research. Is it any surprise that these stories keep coming up? SSRIs were going to cure everyone's depression. Now we find out that they're addictive, and only effective in the very worst cases of depression. Vioxx was going to usher in a new age of pain relief for arthritis, turns out it killed tens of thousands of people. Hormone replacement therapy was considered essential to prevent osteoporosis in women. Turns out it also causes bone remodeling that makes certain types of fractures even more common. Don't be surprised if we find out in the future that wonder drugs like statins carry risks we haven't been made aware of.
Pharmaceutical companies should not be allowed to market. Not to the general public, and not to doctors either.
Give me Classic Slashdot or give me death!
#1 has been my experience as well. I have a few friends who mention having constant problems sleeping. They're also the most inactive and eat like hell. Inactive to the point of refusing anything that might cause activity. :/
Sure, cardio isn't necessarily as fun as playing Xbox but sleeping awesome is totally worth it. I "trick" myself into exercising by just picking up a sport and sticking with it. Treadmills are boring, but sport can be fun with the right crowd.
Big Pharma kills, period! :-/
http://nathanlindsell.blogspot.com/
Before you kneejerks get going ("it don' apply causality naw, ya'here?"), please read a couple excerpts:
"Receiving hypnotic prescriptions was associated with greater than threefold increased hazards of death even when prescribed 18 pills/year. This association held in separate analyses for several commonly used hypnotics and for newer shorter-acting drugs. Control of selective prescription of hypnotics for patients in poor health did not explain the observed excess mortality."
And regarding the limitations of the study:
"Cohort studies demonstrating association do not necessarily imply causality, but the preferable randomised controlled trial method for assessing hypnotic risks may be impractical due to ethical and funding limitations."
There is obviously cause for concern here, but not panic. People on sleeping medication should talk to their doctors about this.
Not screaming in terror, like his passengers.
Have gnu, will travel.
A recent post to /. pointed to several articles that brought up the fact that a solid 8 hours of sleep may not be normal.
http://www.bbc.co.uk/news/magazine-16964783
http://en.wikipedia.org/wiki/Segmented_sleep
http://www.history.vt.edu/Ekirch/sleepcommentary.html
http://www.nytimes.com/2006/02/19/opinion/19ekirch.html
Our brains may very well be wired to a distrupted sleep and taking pills to 'correct' this is not a good idea!
Did you consider: Even if this study is flawed, it might do something about the approach of providing benzos to people who have trouble sleeping. Maybe the actual reason why they aren't sleeping will be investigated. It's probably something completely treatable: overstress, uncontrolled diabetes, nutritional deficiencies, abuse of some other substance like caffeine, etc.
HBI's Law: Frequency of calling others Nazis is directly correlated with the likelihood of the accuser being Communist.
What if the higher death rates are because they aren't getting enough sleep!?!
These pills are supposed to put you to sleep, waking up again was never promised.
I stopped taking sleeping pills because they had an unintended side affect for me. They kept me awake.
Caffeine has no affect on me- but taking a sleeping pill keeps me awake all night. I have some odd body chemistry no doubt.
"That's the way to do it" - Punch
Urgent bulletin. A new study has found that people having extended stays inside hospitals have a much higher mortality rate than people who don't. Avoid hospitals at all costs.
...it could be the fact that those who have trouble sleeping are pre-dispositioned to having lower mortality. The fact that they also taking sleeping pills is a side issue. I'm just sayin...
Melatonin is fine and I highly recommend its use, opposed to traditional sleep aids (I use it). Melatonin is a sleep aid, in that it aids you in falling asleep... but it is different from traditional (prescription) sleep aids such as Ambien, in that it is a hormone supplement.
Melatonin is a non-benzodiazepine, while traditional sleep aids are benzodiazepines. Melatonin (N-acetyl-5 methoxytryptamine) is a compound naturally created in the pineal gland of the brain which triggers sleep. This should not be confused with the feeling of being tired, depleted of energy, or "heavy eyes." Traditional sleep aids act more like an anesthetic, actually making you feel tired and/or knocking you out.
Melatonin is non-habit forming, nor does the body develop tolerances for it, as in drugs like Ambien. It's kind of like a "passive" sleep aid, while Ambien/Benadryl/Lunesta/etc would be "active" sleep aids. There's a reason why it is available over-the-counter.
Note- while you can get Melatonin over-the-counter, you'll likely find nothing higher than 1mg doses (sometimes up to 3mg). You CAN, however, get a prescription for it. Then you can get a higher dose (up to 5mg?), in larger quantities (bottle of 40 as opposed to over-the-counter pack of 14ish), and your insurance will likely cover it.
Warning- with higher doses, especially if your body is already producing it's own, it may take a while for your body to expel the excess in the morning. This could make you feel groggy, make it hard to wake up, and make it too easy for you to fall back asleep (i.e. while driving). Take it 20-60min before sleep, sleep for at least 8 hours, give yourself 20-60min to wake up before driving.
Hope this helps! :o]
I'm glad they discovered that death risk increases with age.
Did you ever wonder how they come up with death rates that are less than 100%?
You never really know how close to the edge you can go until you fall off.
The patients did not know they were being monitored (blind.) The doctors/nurses who entered the charts didn't know their patients' data would be used for this research (double-blind.) The people who analyzed the data, however, had everything upfront to poll and draw whatever conclusions they were looking for. "Using a query into the EHR..." "A further query of this subset..." "For each hypnotic user, we attempted to identify two controls with no record of a hypnotic prescription..." Sounds like they need a triple-blind experimental design.
The stats are for Zolpidem and Temazepam, drugs which have a high therapeutic index ration, in other words, several time a one month supply, which is all that a pharmacy is allowed to dispense at the same time. I highly doubt anyone is using these drugs to kill themselves.
There's no need to shill for a specific brand. I don't know what's in your selection Anything with chamomile in it will tend to make you sleepy unless it's counterbalanced by some other herb. YMMV. Chamomile works for me. I'm sure there are plenty of people who have a cup and it does nothing. Perhaps there are even people kept up by it. I know that some people can be kept up by sleeping pills because they're nervous about what the pill might do. I'm sure herbs are no different.
Isn't that the entire reason to "shill" for a specific brand? He has a specific brand that works for him so that's what he's recommending. He doesn't know what's in every "sleepy time" tea on the market, and probably doesn't even know what's in his specific brand of tea that makes him sleepy, all he knows is that it works. For him.
And the authors recognize this - from TFA:
"Cohort studies demonstrating association do not necessarily imply causality, but the preferable randomised controlled trial method for assessing hypnotic risks may be impractical due to ethical and funding limitations."
It's well-known that sleep disturbances are correlated with higher mortality. This study could simply be uncovering that people who have sleep disturbances (and who are therefore in a higher mortality group) are more likely to ask for meds to help them sleep. Can't see that there's any big news here.
I just lived through six years of chronic insomnia and went down the whole path of doctors and pills. What it turned out to be was a undiagnosed heart arrhythmia caused by a untreated infection which was exasperated by fluroquinalone which almost killed me. It just shows that Doctors just collect a paycheck and push what ever pills big pharma claims works.( it took 6 years and about $300,000 in medical bills and completely wiped out my financials and credit) After getting on propafenone for the arrhythmia for 1 year my insomnia went away and my arrhythmia has went away. I had to revamp my diet and get rid of all stress from work and sleep 8-10 hours a night and I have about made a complete recovery. A recent medical paper has shown that a messed up circadian rhythm can cause all kinds of heart problems. This study just shows how little doctoring and how much pill pushing is done. They should be trying to find the root cause of the problem instead of trying treat the symptoms so you can get back to your slave to the grind job that is killing you.
I'm pretty healthy. The Doc put me on byetta to get my borderline glucose down. Everything else was fine until 8 months on byetta! I had a scare, microalbumin was at 1586! Microalbumin/Creatine ratio was at 800! I thought I was gonna loose the kidneys. I didn't wait for my Dr. to say stop taking it. When I got the results I didn't know it was the byetta. I did a search on the fda.gov website and found a warning about byetta. So I stopped taking it, stopped working out hard for a little. Bought some urine test strips and in a a few days it appeares that it healed since now I can't measure it. I told my wife that if the strip was blue or purple then we should look at selling the house. well.. at least the strip was only beige/pink ... normal.
I get an official test this weekend. I hope the sticks are accurate and that the problem I was experiencing is gone.
I'm going to workout hard this weekend to see if the reading goes up a little.
I'm still scared actually. I'd rather be borderline diabetic. The risk of taking byetta isn't worth it.
Apparently cars sold in the US will be required to have rear-view cameras starting in 2014, because this will prevent about 200 "back-over" deaths/year.
TFA puts the low estimate of "excess deaths per year" at 320,000.
Clearly, Big Pharma can afford better lobbyists than Big Auto.
cue the mass tort lawyers - perhaps Big Pharma already knew about the problems and kept quiet, wouldn't be the first time that's happened.
I listen to both RIAA and non-RIAA stuff if I like the music, tangential business/politics nonwithstanding.
My own 0.02 suggests that Big Pharma probably isn't completely blind to some of the problems behind sleeping medications. Addiction side effects no withstanding, there are thoughts that these medications could have diliterious effects on the brain's neurochemistry. The trouble with Big Pharma is that it has little or no interest in curing disease because there is no profit in it. The profit is in long term symptom mitigation and sleep medications are simply just that - mitigations. Sleep needs to be more throroughly researched, specifically in the areas of cellular repair which happens during said event. Maybe the cure is really diet, exercise, and learning techniques for stress control. Since starting Yoga, I've found I am naturally sleeping better.
I "trick" myself into exercising by just picking up a sport and sticking with it. Treadmills are boring, but sport can be fun with the right crowd.
Nailed it on the head.
Back when I embarked on getting into better shape.. I struggled to force myself to do the recommended weekly exercise. It was 30 minutes I really would rather spend doing something else. Then I got into a floor hockey thing some guys at work had going and it literally changed everything. I saw the light. Not only was I getting way more exercise than I was doing jumping jacks in my basement.. but I actually _looked forward_ to it.
From there I got into badminton, then squash, then skiing.
I feel great now (I didn't buy it when others told me, but doing more exercise really does give you more energy) and exercise has gone from something I have to do if I don't wanna have a heart attack in 20 years, to something I do purely for enjoyment, with the health benefits a side benefit.
Also a side benefit I look much more attractive. I never thought I cared about my appearance, but I guess deep down I kinda did. I feel a certain confidence that I never new was missing.. if that makes sense (and I get if it doesn't, because I barely understand it).
And no one really understands why most mammals sleep. You monkey around with such a core function and you may effects side-effects.
... but it also prevents new bone from growing. Progesterone - the natural kind (progesterone USP), NOT the kind in birth control (Provera) that was studied in the Women's Health Initiative - is what helps new bone get laid down.
Progesterone is good on all counts. It's a hormone on its own, and the body converts it into other hormones, like testosterone and cortisol. This is why birth control takes away women's libido - fake progesterone ("progestins") CANNOT be converted into other hormones, which leads to a testosterone deficiency and low libido.
If you have puffy veins when you stand and raise your hands 30-degrees from your legs, or have varicose veins in your legs, you're probably progesterone-deficient... There are lots of symptoms that respond nicely to progesterone therapy.
Learn the rules so you know how to break them properly.
www.teslabox.com
I talked to a 60-something woman who used to have extreme fibromyalgia problems last weekend. Estrogen came up, and she said her doctors had put her on it years ago. She was in the hospital within a week.
There's a PDF floating about the Estrogen Scam... Let's see... Ah, here it is:
The Rise and Fall of Estrogen Therapy: The History of HRT
This was written by a harvard law student, and basically finds that the estrogen hucksters are criminally negligent.
My most recent blog post is the start of a series about problems with chemical birth control pills. I thought it'd be good to start out with why they're so expensive, but I've since realized that staying baby-free is much more important to most women than the cost, or the side effects...
Learn the rules so you know how to break them properly.
www.teslabox.com
uses sleeping pills every night. Darn.
I showed your post to an MD, who said that while everything you asserted is more or less true, what you failed to assert far outweighs the value of the information you did provide. Melatonin has documented negative interactions with Coumadin, Warfarin, and Aspirin, which are widely prescribed anti-coagulants. Melatonin will also nullify the effects of any corticosteriods you happen to be on. So -- do us all a favor, eh, and don't leave off the bad parts just because you are a fanboi of the good parts.
I don't use them because I'm scared of something that puts me to sleep against my system's "will".
I am vindicated.
You know I track this stuff as my father died of cancer, so I am rather keenly aware when new cancer treatments pop up.
However, over the past 2 years I have noticed a trend that just about every major medication from cholsterol pills, to sexual disfunction to vaccines, have 3-5 times the elevated risk factors for people to die of cancer.
If I didn't know any better the industry is astroturfing for patients to increase profits.
-Hackus
Got Geometrodynamics? Awe, too hard to figure out? Too bad.
...such as alcohol addicts, it could have a great deal of effect on the study.
Addicts, are, by nature, totally dishonest about their use. I have known many folks that took sleeping pills, and drank (even one beer is enough) on them.
Very, very dangerous.
Those of a "certain age" may remember this unfortunate young lady.
"For every complex problem there is an answer that is clear, simple, and wrong."
-H. L. Mencken
"Also a side benefit I look much more attractive. I never thought I cared about my appearance, but I guess deep down I kinda did. I feel a certain confidence that I never new was missing.. if that makes sense (and I get if it doesn't, because I barely understand it)."
Makes perfect sense to me. It's kind of a positive feedback loop. It's kind of the same thing I went through - "wow, you look really good" suddenly meant I somehow turned into a viable candidate in the dating meat market. Granted, I'm out of that market now it still sets the bar in a neat way. The more fit I get the less my wife feels inclined to let herself go and vice versa so it's kind of a team thing now. And heck, no one can complain about their wife still being hot throughout the years.
The prescription "sleep aids" I was prescribed didn't so spit! I kept asking and I kept getting bupkis! Nothing works like diphenhydramine (benadryl), works every time, but takes a while to kick in.
I killed da wabbit -Elmer Fudd
Does that ratio change much when combined with alcohol?
...the future crusty old bastards are already drinking the Kool-Aid.
Considering that, that combo has no official use there is no ratio. I'm not a doctor, but that combo seems risky. You could vomit up the drugs, you could sleep it off, or you could die.
What surprised me about the study was *which* sleeping pills the subjects were taking. #1 was Ambien, #2 was temazepam (which is a benzodiazepine-- same category as Valium, Ativan, Xanax, Klonopin etc.) And looking in the "supplemental data" section, it turns out that the other sleeping pills were either a) more benzodiazepenes, b) antihistamines like Benadryl, or c) barbiturates (which you'd have to be nuts to use for sleep).
As someone who prescribes sleepers all the time, I was wondering why none of my preferred sleeping pills-- which would be trazodone, melatonin, doxepin, and maybe low-dose quetiapine-- were included. (I prefer them because I think they're the safest ones). It turns out that they excluded most of these because they were "dual use" medications. (E.g. trazodone is technically an antidepressant, doxepin is an antidepressant, quetiapine is FDA-approved as both an antidepressant and an antipsychotic). And melatonin was excluded (I guess) since it's technically considered a food supplement rather than a medication.
So, in short, they excluded all the best choices and studied a bunch of sleeping pills that many would consider to be relatively problematic. It's not the only problem with the paper (or even the only serious problem), but it's a biggie.
Lets assume, hypothetically, that we substitute the drugs in this study with medications used for the treatment of bipolar disorder. Assuming the aforementioned, we could reach exactly the same conclusions as this study did. So does that mean patients with bipolar disorder should stop taking their medications to live longer?
It doesn't even factor in the fact that a large portion of patients suffering from neuropsychiatric conditions also have sleep disorders, whether it be treatment induced, co-morbid, or other reasons. It's also been conclusively proven that lack of sleep will inevitably kill a person, Fatal familial insomnia as the name implies is terminal.
You can look at the data ten ways till Sunday, but no matter what you won't have enough to determine causality or even speculate why.
Melatonin not only aids sleep, but inhibits a number of types of cancer. L-Trytophan is a naturally occurring amino acid found in warm milk and turkey, and it will help you fall into a very nice natural sleep with virtually no ill effects. So why is it, that instead of safe, effective inexpensive solutions to sleeplessness, all we have is poison provided by Big Pharma?
Oh yeah... profit. Never mind!
The "best that we can do" is give people choice: Let them migrate to territories shared by mutual consent that operate under the hypotheses in human ecology they believe in -- rather than ramming down their throats the considered opinions of top men, let alone the crazed inquisitions of morally vain church ladies of political correctness.
Seastead this.
Careful with that terminology -- Ambien, Lunesta, and other "Z-drugs" are commonly referred to as "non-benzodiazepines"
Incorrect. Ambien and Lunesta are actually atypical benzo's. They are not referred to as non-benzodiazepines.
Ambien = Zolpidem = Atypical benzodiazepine
Lunesta = Eszopiclone = Atypical benzodiazepine
Melatonin is a non-benzodiazepine because it's not a benzodiazepine, but still a "hypnotic" because it is a hormone which activates the melatonin receptors in the pineal gland of the brain (it's also an antioxidant and some other stuff).
Benzodiazepines are habit-forming and tolerance-building drugs. Ambien/Lunesta are definitely that.
That being said, I'm still not going to take a prescription sleeping medication when I can just take a cheap and safe melatonin pill.
I don't know of a single prescription sleeping drug that has a normalizing effect, helps prevent cancer, and makes you more healthy.
I do know too many unhealthy people that can't read and comprehend a PDR listing that take any drug their told.