June 26, 2016

Resting easy?

Why some students are turning to alcohol, sleeping pills and a slew of other unhealthy sleep aids to get a full eight hours

A person may develop an increased tolerance to sleeping aids within a week of initial use.
A person may develop an increased tolerance to sleeping aids within a week of initial use.
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When Shakespeare called sleep “nature’s soft nurse,” he was right about the restorative effects of a phenomenon often given a low priority in students’ busy lives.

According to Dr. Suzanne Billing, medical director at Queen’s Health, Counselling and Disability Services, sleep is a mysterious but necessary phenomenon.

“We know a lot about what happens to our bodies and minds when we don’t sleep adequate amounts, but we do not actually know or understand the real role sleep plays in our life,” she told the Journal in an e-mail.

Billing said sleep’s most prominent function is physical restoration.

“Some process during sleep restores tissues and prepares the body for the next day,” she said. “This theory certainly appears to have validity [at] face value, as a night without sleep does not leave one prepared for the next day.”

Billing suggested sleep might also have some unexpected functions.

“The Adaptive Theory of Sleep proposes that sleep increases survival,” she said. “Sleep immobilizes animals during the most dangerous time of the day, decreasing their chances of becoming another animal’s prey.” Billing said sleep might also have a role in conserving energy by lowering the body’s metabolism for an extended period of time.

Despite all this, Jenn Owen, ArtSci ’10, said sleep isn’t always easy to come by.

“University changes sleeping habits,” she said. “The pressure of being a student definitely has something to do with it. Assignments take longer, studying takes longer, and not having parents around means it’s up to you to choose your own bedtime.”

Owen said sleepless nights were part of her transition to university.

“I remember in first year being awake until four in the morning thinking, ‘This is cool.’ Now, I realize getting to have a good night’s sleep is better for me than staying up until four in the morning and being a zombie the next day.”

Owen said despite her best intentions to get to sleep, the stresses of school often make getting a full night’s rest difficult without the help of medication.

“I’ve been taking Gravol to help me get to sleep,” she said. “Gravol is not technically a sleeping pill, but everybody has it. It’s relatively inexpensive and soon after you take it, you start getting fatigue symptoms. Once you get into bed, you’re out like a light.”

Owen said she takes medication to help her sleep a couple of times per week, although it depends on the season.

“Especially during exam time, I need to counteract the effects of all the caffeine I’ve been drinking during the day,” she said. “I also use it more often during exams because of anxiety. If I don’t take it, I’ll be up all night and just worry.”

Billing said students can easily improve their sleep quality by making small behavioural changes, like exercising for at least 20 minutes during the day and trying not to go to bed hungry. She also encouraged students to minimize emotional stressors that might hinder sleep quality.

“Deal with your worries before bedtime,” she said.

Billing said difficulty sleeping is prevalent among the population at large.

“Insomnia is one of the most common medical complaints,” she said, adding estimates of prevalence rates vary, but probably close to 50 per cent of primary care patients experience occasional insomnia, while 19 per cent suffer from chronic sleep trouble.

Billing said complaints of insomnia are common among students as well.

“It is quite common, but fortunately in most cases it is not a chronic problem,” she said.

“Behavioural therapy is often recommended as the initial treatment for people with insomnia,” Billing said, adding that this includes counselling about sleep strategies and relaxation. Sleep medication is seen as a later step down a long line of options.

Billing said many varieties of drugs are used as sleeping aids in addition to prescription medication, including herbal products, antihistamines and over-the-counter pills.

This can make it difficult to estimate how many students are actively using sleeping aids at any given time.

James Owen, a professor cross-appointed to the departments of psychiatry and pharmacology and toxicology at Queen’s, said over-the-counter sleeping medications all act in similar ways.

“They all affect brain activity in a way that enables you to fall asleep,” he said, adding that most sleeping medications affect a neurotransmitter called gamma-aminobutyric acid (GABA).

“Most sleep aids will enhance the actions of GABA,” Owen said. “GABA is an inhibitor, so to enhance its action can effectively suppress other actions in the body. Primarily, it suppresses the action of wakefulness areas in the brain.”

A different class of sleeping medications contains anticholinergic drugs. Owen said these produce an effect by blocking the neurotransmitter acetylcholine, reducing its excitatory actions.

“Many of our antihistamines, like Benadryl, are in the anticholinergics class,” Owen said, adding that this is why allergy or cough and cold medications often induce drowsiness.

Owen said many medications like sleeping aids, cough and cold preparations and anti-nauseants share the same active ingredient, called diphenhydramine.

Although Gravol isn’t marketed as a sleep aid, Owen said it has virtually the same function as drugs designed to target wakefulness.

“You can use Gravol and actually get the same effect. It suppresses those areas responding to motion,” he said.

Owen said sleeping medications are potentially addictive.

“You have to be cautious with anticholinergic drugs. With these, you develop tolerance over the course of a week,” he said.

“If you stop a drug, you will get the opposite effect. So if you stop a sedative—like a sleep aid—abruptly, you may become more anxious. So you take more, and it continues to perpetuate the use. Then, there’s also the psychological dependence. People enjoy the effects of a drug—they like that feeling of euphoria and the release of anxiety.”

Owen said people can’t overcome tolerance to sleeping medications by simply switching brands.

“It has to do with the class of drugs you take,” he said. “It’s just like allergies. If you’re allergic to one brand of a particular drug, you’re allergic to all of them.” Owen said sleeping medications present few threats besides dependency issues.

“You could become delirious, but that’s only with extreme use. With normal doses that most people would take, sleeping medications are not terribly dangerous.”

Nonetheless, Owen said students should be aware of the side effects.

“These drugs have effects on other systems, too—they are not selective. One of the most significant effects is cognitive impairment. Sleep aids can decrease your cognitive ability, so these are not the drugs to take if you are studying for an exam.” Owen stressed the importance of reading the labels of any over-the-counter sleep aids carefully, as the drugs can have interactions with other medications.

“The sedating effect of these drugs will have an additive effect with other things,” he said, adding that people taking sleeping medications should watch their alcohol consumption.

Challenging the myth that alcohol promotes rest, Owen said students should avoid using alcohol as a sleep aid.

“Alcohol is unique in that it produces a withdrawal syndrome shortly after you take it. Withdrawal from alcohol’s depressant effects involves insomnia, so you may find you wake up at two or three in the morning,” he said.

Although herbal sleeping aids like valerian root exist, Owen said they are best avoided.

“There have been two recent analyses of these natural sleeping aids: one that suggests there might be a sleep-inducing effect, and one that says not at all. A main concern with these products is that they’re poorly regulated, and all contain different amounts of the active ingredient. It’s probably a good idea to stay away from them.”

Lifestyle changes students can improve students’ sleep quality.

“Having regular sleep habits is important—try to keep the same hours every night. Also, limit the consumption of caffeine, especially in the evening,” Owen said, adding that although students sometimes resort to caffeine or other stimulants for energy after sleepless nights, this can actually interfere with healthy sleeping patterns.

“People should monitor their use of stimulants,” he said. “Amphetamines will cause anxiety. It’s probably a good idea to consider stopping the use of stimulants, including recreational drugs, to see if sleep problems go away.”

Owen said there’s also some value to the old wives’ tale that posits milk and cookies before bedtime.

“One way to aid sleep is to increase the amount of tryptophan in your diet. Milk is a source of tryptophan, and there is evidence [that] warm milk has a sleep-promoting effect,” he said. “You also need a good deal of insulin to usher tryptophan into the brain. Carbohydrates produce an insulin response, and cookies are an excellent source of carbohydrates.”

Owen said there are many ways people can improve their sleep quality.

“Yes, there are sleeping medications. But the milk and cookies is, I think, my favourite,” he said.

Sarah Pekeles, ArtSci ’12, said she prefers using behavioural methods to help deal with insomnia out of a concern for developing dependence on sleeping medications.

“I frequently have trouble sleeping and I’ve suffered from a degree of insomnia for my entire life,” she said. “I have been tempted to take medication for it, but the whole idea of sleeping pills scares me. Their dependency factor is a huge deal.” Pekeles said she takes a more natural approach to control her sleep schedule.

“I know my insomnia is directly related to stress—both social and academic—so I try to deal with these stressors during the day,” she said, adding that she tries not to be anxious about hours spent lying awake.

“The way I see it, if my body does really need sleep, sleep will happen. If it’s still early and I can’t sleep, I’ll get up and read. Otherwise, I’ll lay in the dark and enjoy the fact that I don’t have to be doing anything at that time.”

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