Every night, I take .05 milligrams of Ativan.
This represents my dose, recommended by a licensed doctor. At first, the prescription gave me pause: Did I want to end up a slave to benzos like Janice Dickinson, forced to sweat it out on Celebrity Rehab? No, thanks. But because research shows that women need more sleep than men, and that our health suffers without enough sleep, my doctor wasn’t worried when I asked her about it. “Yes, you’ll probably get addicted, but I think the pros outweigh the cons,” she said.
Not everyone in my life feels this way. “Do you really want to be addicted to something for the rest of your life?” asked my sister-in-law, when I told her about my daily habit.
Yes, actually, I do. But when it comes to sleep and sleeping pills, there’s a world of conflicting information. There’s one revolving door of research that tells us women who lack sleep are at an elevated risk for heart disease, type 2 diabetes, depression, and sagging skin. Then there’s another door, research about how sleeping pills are dangerous for women and how we’re over-medicated and how there’s been a dramatic rise of emergency room visits for women who take sleep medication.
Sleeping might seem like the most natural of human behaviors; but to at least 9 million of us, who, according to the Centers for Disease Control, use sleep aids, it’s the anvil that rides on your shoulders once the sun goes down. There’s that nagging fear of the insomnia question: What will happen tonight? When it hits, and it does hit for twice as many women as it does for men, the CDC says, it’s impossible to ignore. But before I scare you into thinking that this is another article about how sleeping pills are our personal Armageddon, and how we should all embrace meditation and toss our pills, let me clarify that I love my pill. I love being able to sleep. I love being able to sleep through the night.
When you’re a middle of the night waker, not waking up is a blessing, as a friend, a mother of three who takes Klonopin nightly, told me. “When I wasn’t taking it—it would take me a very long time to fall asleep, I woke up multiple times. I didn’t really wake up and stay up, I just woke up a lot,” she said. Now, that’s not a problem.
But what to make of all the contradictory info about staying medicated to sleep? According to Katherine M. Sharkey, a sleep-medicine expert at the Sleep for Science Research Lab at Brown University, my doctor was right about the harm in sleep aids—if the benefits clearly outweigh the risks then prescription sleep aids can really help people. “We all in our busy lives are cramming things in, expecting to put kids to bed and then do a couple of hours of work. And it’s hard to switch gears,” she explains. She puts it this way: Most of us aren’t giving ourselves enough downtime. “You expect to go to bed because that’s the next thing on your schedule. You’re scheduled to sleep between 11 p.m. and 5 a.m. And if you don’t, then you think you’re going to have a terrible day tomorrow.” (That’s when I realize that maybe it’s one of the reasons I take Ativan every night, because it keeps me on schedule. It’s the one thing I can control.)
On a nightly basis, the millions of us taking a pill are mostly likely fighting a lot of the behavioral foundations for good sleep. Some of this can be managed, for instance, by not checking emails after 8 p.m., but because women report a higher sleep disturbance than men for biological reasons or depression or menopause, explains Kelly Glazer Baron, a sleep researcher and neurology instructor at Northwestern University’s Feinberg School of Medicine, the process takes more work.
Baron’s core research shows that cognitive behavior therapy (CBT-I)—which is very different than tell-me-about-your-childhood therapy—has an 80% success rate. “It’s a highly effective, non-drug treatment that keeps working over time and that you don’t need refills on. It’s certainly worth a try,” she says. CBT-I is a brief therapy—about five or six sessions where you learn to break bad sleep habits, relaxation techniques, and sleep restriction (e.g., spend less time in bed or cut out naps).
But Baron says the real problem isn’t someone like me who is perfectly happy with my little half a pill—it’s women who have sleeping problems despite taking medication. Probably the biggest complaint about sleeping pills is that groggy morning-after feeling, which a friend of mine in her mid-30s who has been religiously taking Ambien every night for five years, tells me is her biggest problem with it. “It’s horrible. It’s so hard for me to get up in the morning,” she says. “Once I get up, I’m fine, but I definitely feel drugged. The nights I don’t use it, it’s easier for me to get started.”
It’s also why one woman I spoke to wanted to wean herself off medication all together. Sara (not her real name) took sleeping pills on a nightly basis for at least three years for all of the reasons you might expect—she traveled a lot for work, she was flipping back and forth between time zones, she was exhausted. “At first, it let me to catch up on my sleep. But then it just became a habit. I couldn’t sleep without it and then I got nervous that I was going to be on it forever.” Weaning herself off it took a couple of months; now she pops an Ambien only if she’s stressed—on an as-needed basis—which is how Shelby Harris, director of the Behavioral Sleep Medicine, Sleep-Wake Disorders Center explains that sleep aids should be used. “We just simply don’t have enough data on long-term usage of sleep aids,” she explains.
For the meantime, for those of us who sleeping aids do work for, we can rejoice in knowing that taking them isn’t such a bad thing. Until our pills wear off—or when we creep into the category of being an older adult (65 and above) when sleeping pills have more serious downsides like falls, fractures, and car accidents—I’m going to relish my magic pill.