Neuroscience and Society

The Right to Restfulness

Jacob Mesina


Abstract

How people get their rest at night and stay awake in the morning is constantly changing. Good sleep has always been a necessity; however its true purpose has largely been misunderstood. In recent years, the number of people who have reported difficulty in sleeping and being alert has increased rapidly. This has caused medications alleviating conditions such as insomnia and drowsiness to gain immense popularity in society {1,2]. These medications, however, have the potential to harm as they have to heal. Medications such as benzodiazepines and antidepressants have been shown to be effective in helping people fall and stay asleep, but they also have adverse side effects and various levels of success that suggest further exploration. Likewise, the use of amphetamines to stay awake has caused controversy in the medical community. Therefore, it is clear that the concept of sleep is a highly beneficial and necessary natural process that needs to be understood in greater depth.


 

Treatments to Stay Asleep

    The necessity of sleep and restfulness is universally recognized. Humans cannot function properly without an adequate amount of sleep, which is known to have various functions in maintaining the body, such as boosting wakeful cognition and promoting physical well-being [3]. Thus, not having enough sleep has the possibility of being  detrimental to one’s health. Insomnia, or the condition of having difficulty sleeping, affects many people around the world. In fact, about

    30% of adults from various countries have reported suffering from some form of insomnia [4]. Advancements in technology have led to new treatments for insomnia. From sedatives to hypnotics, the world of sleep medication has grown tremendously [5]. However, these medicines come with their own risks.

    One of the earliest and safest solutions developed for insomniac patients was benzodiazepines. Prior to the development of these drugs, sedative drugs known as barbiturates were used to help people rest. Unfortunately, these drugs were very addictive and susceptible to overdosage, making them unfit for the general population to use [5]. With benzodiazepines, which act upon GABA neuroreceptors, REM-sleep is reduced.  Since REM is associated with memory processing, using benzodiazepines may inadvertently affect REM-related memory consolidation [5]. Benzodiazepines have been found to have particularly strong sleep inducing effects. These substances also have considerably long half-lives, with medication remaining in the system for upwards of 11 days [5]. Common benzodiazepine medications include temazepam and estazolam [5], which have been found have been found to reduce  the length of sleep stages 1, 3, and 4 in patients [6]. Non-benzodiazepines can also influence benzodiazepine receptors. However, these substances do not significantly shorten the sleep stages like temazepam and estazolam do. If benzodiazepines are suddenly discontinued, then withdrawal symptoms tend to occur. These symptoms arise in various stages, starting from day one and leading all the way to day fourteen and beyond, depending on the medication’s half-life. Some of these withdrawal symptoms include weight loss, nausea, anxiety, and restlessness [7]. Hence, the use of benzodiazepines to prevent insomnia is cautioned.

    Other hypnotic medications such as zolpidem and zaleplon have seen a rise in popularity [5].  Having fewer known side effects and less abuse potential than benzodiazepines [5], zolpidem (Ambien or Edluar) and zaleplon (Sonata) are both designed to help users fall asleep. Some rare side effects of zolpidem include hallucinations, amnesic symptoms, and somnambulism (sleepwalking) [9].  Therefore, doctors are advised to take in various factors such as the gender of the patient and dosage when prescribing this medication [9]. Eszopiclone (Lunesta) is another popular medication prescribed for sufferers of insomnia [8]. This drug is considered special for its selectivity on certain GABA receptors. It has decent tolerance and has been shown to lengthen total sleep time and sleep quality for patients of all ages. In conjunction with fluoxetine, eszopiclone has been found to be more effective in helping patients get rest [10]. However, there is still the possibility of eszopiclone leading to dependence [8]. Ramelteon (Rozerem) helps its users fall asleep and is intended to be non-dependent [8]. It is unique in that it is a melatonin receptor agonist and does not have an active sedative effect. Rather, it operates through mechanisms in the suprachiasmatic nucleus, the part of the hypothalamus that helps to control our sleeping patterns. Ramelteon has a relatively low potential for abuse [11]. Antidepressants including the tricyclic family have helped to alleviate  insomnia in patients, but their side effects and overdose potential render them relatively unfit for prescription in these cases[5]. Selective serotonin reuptake inhibitors (SSRI), a type of antidepressant, have been found to paradoxically cause insomnia and daytime drowsiness [12]. Ethanol, an alcohol, is also used to help insomniacs find rest; this helps to explain the phenomenon of drowsiness experienced by heavy drinkers [5].

    Patients who are considering taking sleeping medication are advised to be well researched on the medication that they consume. For example, people 65 and older are advised to not use diphenhydramine and doxylamine. In one study, however, 52% of the medications used by older participants contained these two substances, and 59% of participants reported taking these medications with these potentially harmful substances [13]. Diphenhydramine can be found in common medicines like benadryl and can lead to daytime drowsiness and dry mouth, while doxylamine can be found in unisom sleeptabs and has similar side effects [14]. Drugs like zolpidem have been linked to an increased risk of fainting (4 times greater occurrence in one study) and can impair people’s driving skills, both of which could result in serious injury and even death [15]. Next-day drowsiness is common in sleeping-pill users and should be taken seriously.

    Overall, sleep medications have various strengths and weaknesses which should be explored by potential users. The potentially detrimental effects of sleep medications have led scientists and doctors to start suggesting more cognitive ways of inducing tiredness, such as hypnosis and relaxation training [5]. Research continues in the field of sleep medication to further understand why certain drugs perform the way they do.


 

Treatments to Stay Awake

    While the best course of staying awake during the day would be to have a good night’s rest the night before, this is not an option for everyone for various reasons. Insomniacs who struggle to sleep at night may experience daytime drowsiness, and as a result, may need to take substances to stay alert. This daytime sleepiness has been recorded in nearly 15% of the population  of the U.S. [5].

    In addition to substances found in everyday items, such as caffeine, various medications are used to stay awake including amphetamines and pemoline. In one study in Brazil, 456 truck drivers provided urine samples when stopped by police officers, and  9.2% tested positive for drugs in their system. Over 60% of these drugs were amphetamines, which the drivers were using to stay awake on their long trips [16]. In another study, 4% of surveyed students on a college campus recorded that they had taken stimulants in recent memory, with 34% of those students recording that they had taken stimulants to stay awake [17]. Amphetamines, which work by increasing extracellular dopamine levels [18], can be easily abused and are known to cause physical changes in the brain such as lower cortical grey matter and white matter abnormalities, such as gliosis.

    Another drug known as modafinil has been explored in achieving wakefulness. It has been found to have less adverse side-effects than amphetamines and the potential for use by patients in high pressure situations, such as soldiers in the middle of a battle. Consequently, modafinil has been eyed by the US government. Modafinil still has the potential to become addictive, meaning patients should be cautious when consuming it [19].

    Remaining awake continues to be an ongoing struggle for many people, but the medications used to reach this state can hurt as well as harm.

 

Conclusion

    While restfulness has the potential of being achieved by everyone, this achievement unfortunately is not realized by many. Sleep medications are still being used to promote rest. Some medications, such as ramelteon, show the potential of using the body’s natural sleep cycles to induce sleep. Other medications take advantage of different biochemical pathways to invoke rest, or rather, they try to promote wakefulness during the day. Most medical options come with side effects, compelling scientists and physicians to promote a more natural, pill-free approach to obtaining rest. Knowing the effects of medications is essential for every potential medicine consumer, regardless of what symptoms they exhibit, be it insomnia or daytime sleepiness.


References


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Jacob Mesina

Jacob Mesina


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