How much temazepam could kill you

The news wakes you wide awake. It particularly frightens those who can no longer sleep soundly anyway: Completely normal sleeping pills seem to drastically increase the risk of imminent death, researchers from the Californian Scripps Clinic Sleep Center report in the medical journal British Medical Journal Open. "Sleeping pills are obviously harmful to health," concludes Daniel Kripke, one of the scientists, from his data.

His team had evaluated the medical records of 34,000 Americans. Of the 10,500 among them who had been prescribed sleeping pills, around four times as many died in the following two and a half years as of those without such prescriptions. The groups were largely comparable in terms of age, gender, lifestyle and underlying diseases. In any case, it is worthwhile "to think about alternatives to sleeping pills," emphasizes Kripke. After all, 24 other studies before him had indicated an increased risk of death from the drugs.

According to the new analysis, this is even true for younger people under the age of 55 - and for all kinds of sleeping pills, including the newer "Z-substances" like zolpidem. The Z-substances imitate the natural messenger substance GABA, which dampens the activity of the brain. Compared to the older barbiturates or benzodiazepines such as temazepam, the Z-substances are considered gentler and more tolerable. Nevertheless, the risk of death was increased for them even if only prescriptions were available for less than 18 nights a year, says Kripke.

The only question is: why is that? Is it really because of the pills or is it because of bad sleep? There are numerous ways in which sleeping pills can lead to death, says Kripke. "The direct lethality is probably rather low." However, the remedies often triggered depression and increased the risk of suicide. Sometimes they also impaired their users in traffic during the day. Finally, some pills increase short-term breathing stops during sleep, which can affect the heart; others mess up the digestive tract, causing food debris to rise and attack the mucous membranes, which can result in infections.

It is also possible that the poor effect of the pills is to blame for the increased risk of death. "Only in 20 percent of patients do we really achieve a comfortable sleep with the tablets, in more than 70 percent sleep is disturbed," says Ingo Fietze, CEO of the German Sleep Foundation. "And it has long been known that too little sleep reduces life expectancy."

Although the interpretation of the current data is so difficult, one should see them "as a signal, but not panic," recommends Wolfgang Becker-Brüser from pharmakritischen Drug telegram. The Regensburg sleep researcher Jürgen Zulley also sees it as a "warning to be more careful with sleeping pills than before". The first choice should always be non-drug methods anyway, according to Zulley - behavioral therapy, for example, or sleep hygiene measures. This also includes not watching TV until the last minute, giving up alcohol in the evening and writing down problems on a piece of paper first - so that you can wallow through them the next day instead of at night.

© SZ from 02/28/2012 / beu / gba