Sleep, Sleeping Pills, and the Zeez Sleep Pebble
A brief outline of how sleeping pills affect our sleep, and using them alongside the Zeez Sleep Pebble
In the UK, insomnia / sleeplessness is the most common psychiatric complaint,¹ affecting 30–40% U.K. adults in any year, 10% severely. There were 5.3m diagnoses of sleep disorder in 2010.² Although NICE only recommends sleeping pills (hypnotics) as a short-term treatment for severe insomnia, with cognitive behavioural therapy (“CBT”) as a first-line treatment for long-term insomnia,³ 15.3m prescriptions were written for sleeping pills in 2010, at a cost of £15m.⁴ In the short term, sleeping pills can break a poor sleep habit. In the long term, their use is problematic. The use of hypnotics to treat poor sleep increases risk of death⁵ — a US analysis of 10,000 patients who had been prescribed hypnotics and 20,000 controls concluded a greater than threefold risk of death. 42% of those taking sleeping pills surveyed in the Great British Sleep Survey in 2012 had had sleeping problems for more than a decade — the survey concludes a lack of efficacy,⁶ but despite all the recommendations, many people have been taking sleeping pills for years, sometimes decades.
Our technology, used in the Zeez Sleep Pebble, is designed to retrain the brain to sleep well. It is an extremely low power device, intended to prompt the brain to adopt good patterns of relaxation and deep sleep. I am often asked whether it can be used alongside sleeping medication and whether sleeping pills diminish its efficacy.
The first question is easy to answer: yes (see comment on benzodiazepines below). The second is really difficult:
Each drug is different
Drugs can have many different effects
The knowledge of their pharmacology may be imperfect
Sometimes, very little is published, either because it isn’t known, or is being kept confidential.
Here’s my best stab at a brief summary. I am not a doctor or a pharmacist. I am an ex-insomniac, and this is written for ordinary poor sleepers and those who care about them.
First, let’s look at some of the commonly prescribed drugs used to help insomnia. There are around 20 drugs that are labeled for the treatment of insomnia in the UK. Others, such as amitriptyline, are used off-label.
Z- drugs, (Zopiclone, Zolpidem)
The ‘Z’ drugs were designed to try to overcome some of the problems associated with benzodiazepines, but they act in a very similar way. Users can become dependent on them and stopping them can produce withdrawal symptoms such as rebound insomnia.
The NHS says “‘Z’ drugs should be given:
for severe problems only
at the lowest effective dose
for the shortest possible time
they should be withdrawn gradually”.
I have not seen a really satisfactory description of their pharmacology — maybe it isn’t known. In practice we have found that people taking Z-drugs respond well to the Zeez, although I would expect them to have some lessening effect on the ability of the Zeez to help, especially with deep sleep.⁷
Anti-depressants can have a positive effect on sleep, and unlike most insomnia drugs, aren’t limited in their indication to short-term use. Amitriptyline, in particular, is often prescribed off-label to help overcome poor sleep. It has many different modes of activity, and seems to have a sedative effect as well as stopping serotonin reuptake.⁸ The former would probably work against the Zeez (render its effect less powerful). Some people find them hard to tolerate (Bettina).
Benzodiazepines. (e.g. temazepam, diazepam, lorazepam)
Benzodiazepines block neuronal activity (hyperpolarise the cell) and reduce communication between neurons.⁹ We expected Benzodiazepines to stop the Zeez from working altogether and told people using them regularly that we couldn’t help them. Some people didn’t listen, and used the Zeez anyway — and found that it helped. We would expect it to lessen the efficacy of the Zeez, but it is definitely worth a try, given the risks of using benzodiazepines.
Melatonin is a hormone involved in regulating our sleep/wake cycles. It is created from serotonin at dusk by the pineal gland. We naturally produce less as we age, and if we don’t produce enough we are likely to find it difficult to fall asleep or stay asleep, at least at the right time of day. A melatonin supplement may help with circadian rhythm issues such a jet lag. Where there is a long-term issue we think it preferable to improve the body’s own ability to make melatonin naturally. The Zeez can be used for jet lag too, (Louis) (Tom)and alongside melatonin, and the lifestyle and dietary changes that enhance melatonin production.
The Zeez has worked well for people taking every kind of sleep med other than benzodiazepines. Very few people using benzodiazepines regularly have used the Zeez, and we don’t know what response they would have. People using benzos occasionally have successfully used the Zeez. In the future, we will suggest that people try (we sell on sale / return). Overall, in our testing, the number of people taking sleeping medication who have responded to the Zeez Sleep Pebble is the same as those who haven’t been taking any medication — around 80%, and almost all of those users who have been using sleeping pills have stopped them completely, eventually. (Jim).
We think that people using sleeping pills with the Zeez Sleep Pebble should come off long-term medication in the same way as others — slowly, patiently and carefully, to minimise the risk of rebound insomnia and withdrawal symptoms. And we would expect them to succeed.
Singleton N, Bumpstead R, O’Brien M, Lee A, Meltzer H. Psychiatric morbidity among adults living in private households, 2000. London: The Stationery Office,2001.