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Chronobiol Med > Volume 5(4); 2023 > Article
Lee: Sleeping Pills and Increased Mortality and Suicide
If you suffer from insomnia, it is easy to be tempted by sleeping pills that promise to make it easier to fall asleep. With the advent of Z-drugs, which claim to have fewer side effects than previous sleeping pills, they tend to be over-prescribed. But are they safe? It is well known that many celebrities have died from sleeping pill overdoses in the past. The deaths of Marilyn Monroe, the American actress of the century, Heath Ledger, the Australian-born actor best known for his role as the Joker in The Dark Knight, and Michael Jackson, the pop star of the century, have also been linked to dependence on sleeping pills and drug overdoses for sleep.
When sleeping pills are taken for a long time, their effectiveness gradually decreases and the dose must be increased to achieve the same effect. This is called tolerance. In addition, dependence occurs when a person cannot sleep without sleeping pills. This problem of tolerance and dependence has been known for a long time. Surprisingly, recent studies have shown that long-term use of sleeping pills is not only associated with tolerance and dependence, but also with increased rates of physical illness and mortality. In 1979, Daniel F. Kripke of the University of California, San Diego, published the first study linking sleeping pills to increased mortality [1], and since then a significant number of studies have linked sleeping pills to increased mortality [2]. These studies have reported that prescription sleeping pills increase the incidence of several cancers and infectious diseases, as well as suicide rates. A study conducted in Taiwan using 10 years of National Health Insurance data reported a 2.08-fold increase in suicide or attempted suicide among those taking zolpidem compared with those not taking zolpidem [3]. In Korea, a study analyzing 12 years of data from the National Health Insurance Service reported that zolpidem prescriptions more than doubled the risk of suicide death during long-term follow-up [4], and also reported that the use of sleeping pills increased the incidence of dementia [5]. However, it remains unclear what specific mechanisms increase suicide mortality and increase dementia.
Wouldn’t it be great if there was a sleeping pill that could help you sleep without side effects, tolerance, or dependence? But such an ideal sleeping pill does not exist—in fact, it is impossible. Because sleep is the result of circadian rhythms, we cannot reliably and sustainably get a good night’s sleep every night without sufficient light exposure and activity during the day.
Tolerance and dependence on sleeping pills can eventually lead to a cycle of needing more and more sleeping pills, which can be harmful to the body and mind by having the opposite effect to a healthy circadian rhythm. In addition, erratic behavior under the influence of sleeping pills can lead to problems such as binge eating or suicide. This is why sleep and chronobiology experts stress the dangers of sleeping pills. This is why experts in sleep and chronobiology emphasize the dangers of sleeping pills. Correcting circadian rhythms regularly helps prevent and manage many psychiatric and physical illnesses, not just insomnia [6,7].

NOTES

Funding Statement

This study was supported by the Korea Health 21 R&D Project funded by the National Research Foundation of Korea (2019R1A2C2084158).

Conflicts of Interest

The author has no potential conflicts of interest to disclose.

REFERENCES

1. Kripke DF, Simons RN, Garfinkel L, Hammond EC. Short and long sleep and sleeping pills. Is increased mortality associated? Arch Gen Psychiatry 1979;36:103–116.
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2. Kripke DF, Klauber MR, Wingard DL, Fell RL, Assmus JD, Garfinkel L. Mortality hazard associated with prescription hypnotics. Biol Psychiatry 1998;43:687–693.
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3. Sun Y, Lin CC, Lu CJ, Hsu CY, Kao CH. Association between zolpidem and suicide: a nationwide population-based case-control study. Mayo Clin Proc 2016;91:308–315.
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4. Cho CH, Jee HJ, Nam YJ, An H, Kim L, Lee HJ. Temporal association between zolpidem medication and the risk of suicide: a 12-year populationbased, retrospective cohort study. Sci Rep 2020;10:4875.
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5. Sun TH, Yeom JW, Cho CH, Lee HJ. Association between benzodiazepines and dementia in South Korea: a nation-wide study. Chronobiol Med 2022;4:152–156.
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6. Lee HJ, Cho CH, Lee T, Jeong J, Yeom JW, Kim S, et al. Prediction of impending mood episode recurrence using real-time digital phenotypes in major depression and bipolar disorders in South Korea: a prospective nationwide cohort study. Psychol Med 2023;53:5636–5644.
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7. Yeom JW, Lee HJ. Exploring the relationship between circadian rhythm shifts and postpartum depression. Chronobiol Med 2023;5:53–57.
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