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Alcohol, drugs and sleeping pills

"If the whole existing formulary of drugs and potions available to them were sunk to the bottom of the sea, it would be all the better for mankind—and all the worse for the fish". Oliver Wendell Holmes, M.D, in a speech before the Massachusetts Medical Society in 1860

What is a sleeping pill?
A « hammer on the head », an «anaesthetic», a « remedy », an « artificial paradise »?
The ideal sleeping pill (able to induce a true state of -normal, thus reversible- sleep « on demand ») doesn’t exist yet.
The consumption of so-called new generation sleeping pills, often claimed to be « occasional » in fact increases steadily.
These molecules, introduced as « harmless », have recently been warned against because of the risk of confusional sleepwalking which they may cause. Cf. Risks of the new sleeping pills

A psychoactive medication has the property of acting on the brain level of vigilance or sleepiness, in accordance with four kinds of effects, which must be well defined.

  • "Hypnotic or Somnogene": puts to sleep, induces sleep (pro-sleep);
  • "Sedative": sedates, diminishes arousal (anti-arousal);
  • "Exciter": excites, makes nervous, blocks out sleep (anti-sleep);
  • "Psycho-stimulating": wakes up, maintains arousal (pro-arousal).

Some drugs have a well-known « sedative » effect...

The use of alcohol as a « sleeping pill » goes back to Antiquity and can often be found in literature:

To lull their laziness and drown their rancour,
For storm-tossed wrecks a temporary anchor,
God, in remorse, made sleep. Man added Wine,
Child of the Sun, immortal and divine!
Roy Campbell, Poems of Baudelaire (New York: Pantheon Books, 1952)

The first testimonials about the use of opium as a sedative go back to the Antiquity, as early as 4000 BC in Sumerian and European

In China, there is an old legend which says that Buddha (?563-483 BC)
slit his eyelids off in a struggle to stay awake. They fell to the moist
ground below, from which grew a red flower, the opium poppy.

The great French scientist Louis Pasteur (1822-1895) praises its action (“taken in moderate amounts, wine is the healthiest and most hygienic of all beverages”).

Not so long ago, insomniac babies received « massages » with a local alcohol (marc, rhum, calvados, brandy, vodka ... ). The very fast cutaneous penetration of alcohol conforted tradition...but not science.

In Greek mythology, Hypnos, the god of sleep holds a poppy flower in his hand to put the mortals to sleep before his son Morpheus, the god of dreams, transforms reality by providing dreams to the sleepers.

Alcohol, Opium, Marijuana, Datura...and so on
The search for a perfect sleep is perhaps one of mankind’s oldest quests.

... but the ideal « sleeping » pill does not exist.

In its absence, medications, issued more recently from the pharmaceutical companies, have been very clumsily called « sleeping pills » (or "hypnotics") and offered for sale on the market for their « anti-arousal » properties.
The sadly reputated barbiturates are no longer used in that context, because they have been supplanted by benzodiazepines (Lexomil°, Valium°, Xanax°, Noctamine° ...) and some neuroleptics or antihistaminics.
« New sleeping pills » (Imovane°, Stilnox°, Ivadal° and their generics) have brought little really significant enhancement in terms of tolerance, dependency or unwanted side effects, compared to those which were used before.

All these molecules induce a decrease of cerebral activity. During the night, they diminish the power of sleep (slow wave activity, REM sleep...).
That deleterious effect on sleep adds itself up, the next morning, with the direct remaining effect of the product, carrying with it a risk of sleepiness and of an important reduction of performances. (Cf. "Know how to sleep")

... The "good" (ideal) sleeping pill does not exist (yet)!

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Cognitive and pharmacological trap

Under some very exceptional circumstances, it may be necessary to use the « least bad » sleeping pill.
It must though be kept in mind that their use in the « treatment » of insomnia is, by definition, illusory and even rather counter-performing.

Despite what the ancient Greek thought about it, poppy and its derivates (opium, codeine, morphine, heroin) are powerful « anti-sleep » drugs.
The consumer is put into a lethargic state but he/she sleeps very little and the slow wave sleep stage is crashed.

Alcohol :

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"Alcohol is an ennemy"

Alcohol has long had -wrongly- a good reputation regarding sleep. Not so long ago, as mentioned above, children with sleep difficulties received « massages » with a little alcohol (rhum, brandy, calvados ...) ! (It is now known that it exposed the child to serious dangers, but nowadays, unfortunately, the « little lexo » takes the same part...).

In fact, alcohol exerts apparently contradictory effects on the states of consciousness.
In a small amount, alcohol is an exciter which disturbs judgement ability and reflexes. It is not truly sedative.
Because of its properties, alcohol is no good « sleeping pill ».
«Lever matin n’est point bonheur Boire matin est le meilleur.» (Get up in the morning, no happiness - Drink in the morning, that is the best).
(François Rabelais). It may have been Pantagruel’s intuition like that of the old Caribbean who « start off» in the morning with a little rhum (sic).

It is sleepiness which is the first cause of traffic accidents in the middle of the night. Alcohol mainly has an aggravating effect because vigilance is very low at the time.

With a strong dosage, the subject gets into a state close to coma (he/she can no longer be woken up normally).
Despite its apparently sedative effect; alcohol blocks out slow wave sleep (stages 3 and 4) in the start of the night. A « compensatory rebound » will occur in the end of the night, when blood alcohol is low enough. That rebound of deep sleep, and sometimes of dreams in the end of the night, gives the excessive drinker a wrong feeling of « good » sleep.

That sleep rebound in the second part of the night is not as efficient as the sleep of the first part of the night (rich in slow wave sleep : Cf Iconography) and the alcoholic subject gets into the situation of lacking sleep.

Benzodiazepines :
It is (unfortunately!) the same for the sleeping pills and tranquillizers which millions of people take in the evenings «in order to sleep » (« just a little quarter of a bar»).
That type of products possesses, in fact, an effect duration which is very much longer than the night and it makes a silent toxicomania, dreadful with its diurnal effects (remaining sleepiness, memory and balance disorders). They are also extremely addictive (strong dependency and withdrawal syndrome).
In both cases, that sleep lack adds itself up with the remaining effect of the product in a true vicious circle, where the medication, taken « in order to sleep and to be performant », reveals much more harmful than insomnia itself.

The « new » products, similar to BZs...
Their effect cannot be denied... as far as the sales curves of the pharmaceutical companies, which produce them, are concerned!
The first-off of a (new) big French pharmaceutical company has become a leader on the European and North-American market in 15 years.
Despite the force of marketing and the intense lobbying made by the companies, it is obvious, by the light of sleep medicine, that a bad sleeper can only worsen his/her problem by using these products, claimed to be less harmful than their predecessors (because they are taken « on demand » ).
Cf. The vicious circle of insomnia).
NB. One of the reasons which makes people take a sleeping pill comes from a misunderstanding that exists between tiredness and sleepiness. Insomniac subjects feel tired and think that, if they sleep more, they will be more performant, while sleeping pills advertisement relies on statistics which confirm that the lack of sleep (sleepiness) is the cause of many accidents...
We think that the use of sleeping pills must be called into question..

The use of a « help for sleep » quickly induces a state of tolerance .

After the « honeymoon » phase, which justifies the initial intake, a state of « tolerance » will appear, more or less quickly, when the brain manages to adapt itself to the presence of the product (24 hours a day).
Very quickly (from 2 to 4 weeks, according to the different studies), the objective effect of the substance can no longer be measured.
The user continues to think that he/she sleeps « thanks to » the product which first satisfied him/her, but, at that stage, the product itself has no more effect (other than behavioural or « psychological »).
Most of the long duration users are in that phase of balance («marriage of convenience »). They admit not to sleep well but live with the fear of it getting worse and are ready to increase the dosage if necessary.

Withdrawal is as difficult to achieve as tolerance is strong.
The fruitless «divorce» attempts lead to the vicious circle of performance anxiety and of insomnia with, in case of failure, the need to increase the dosage.

Phytothérapie ?

Notes :
1°/ An acute alcohol intoxication can amplify the effects of sedative and hypotic drugs in their sites of action in the brain. An occasional drinker is in danger if he/she makes « mixes ».
Chronic alcohol intoxication can diminish their effect, by the acceleration of their hepatic elimination. An alcoholic subject has developed a « pharmaco-dynamic » resistance to sleeping pills.

2°/ Molecules of the future ?

--- Important investigations are made on "endocannabinoids", following several promising lines which corroborate, in our opinion, the "somnicological" approach of functional disorders (see the links at the bottom of the page).
--- Their first uses concerned overweight problems and, in some countries, they were used in the context of tobacco withdrawal (rimonabant).

Despite a triumphal launch in Europe, the FDA recently refused their sale on the American market (because they were poorly tolerated).
We hope that this promising system will offer the possibility of being used, some day, in sleep disorders like insomnia, CFS or fibromyalgia), in food balance and maybe even in the context of immunity.

3°/ Marijuana?
Sick people associations (AIDS, multiple sclerosis, cancer, dystonia, Parkinson’s disease...) militate in favour of its therapeutical use, in particular as an aid for the sick people’s sleep.
Switzerland, Germany, Canada, and some other countries have legislations which sometimes authorize its consumption in particular circumstances.

Marijuana review

The impact of marijuana on sleep is still discussed.
Recent research on endoCBs seem to be in favour of a positive effect of marijuana on sleep. But, as experiments with rodents show ("pop corn" effect at strong dosage), it may behave as an exciter in some circumstances.
Whatsoever, a bad sleeper will remain one as long as he/she firmly believes that he/she « needs » a sleeping pill.
The cognitive and behavioural trap of insomnia leads, as such, to a form of very strong « psychological » dependency, whatever be its support (« I am unable to sleep without a book... ».

Then to us, Marijuana does not seem less legitimate or more harmful (on memory and performances) than benzodiazepines, which are consumed by more than one quarter of the Western people.
On the other hand, the extreme toxicity of smoke for the respratory tracks (bronchitis, respiratory insufficiency and cancer) is undeniably much higher than that of pure tobacco.
(And the social toxicity linked to the early exclusion from the law of an important part of the population which consumes, and thus possesses illegal products, must be underlined).

According to somes studies (see the links below) "For an equal amount (weight), smoked marijuana provides 50% more tar than strong tobacco from a popular brand".
The inhaling technique of marijuana, the fact that its smoke is usually not filtered and the greater amounts of benzopyrene and benzanthracene (two cancerogenic agents) contained in the tar of marijuana, all that explains why heavy marijuana smokers risk, more than others to suffer from pharyngitis, rhinitis, asthma, bronchitis, emphysema and lung cancer on the long term.
Thus, a cigarette of marijuana can theoretically cause as many lung disorders as 4 to 10 ordinary cigarettes. "
(van Hoozen, B., & Cross, C. (1997). Marijuana: Respiratory tract effects. Clinical Review of Allergy and Immunology, 15, 243-269.).

The mix between tobacco and marijuana amplifies addiction.

Cerebral dependency for tobacco is amplified by the intake technique (deep inhalation) and by the effect of marijuana on the brain pleasure areas, thus creating an addictive conditioning (behavioural addiction).
It is extremely difficult to have to manage the two addictions and marijuana smokers are particularly addicted to tobacco (Nicotine patches are strongly recommended here, at a high dosage).

In our opinion, the true danger of the « joint » penalization consists in its inefficiency to stop its consumption (and in the additional value it provides to the big dealers).

In our opinion, the true danger of the « joint’s » banalization consists in the fact that it largely favours the intake of tobacco in the youngest people.

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Auteur | Contact | Copyleft | Traductions | derniere modif 9 June 2008.