by Luigi Ferini Strambi
Reduced sleep time is implicated in increasing cardiovascular risk, but can also affect obesity and diabetes. The hypnotic drug must be chosen by the doctor in a thoughtful manner
I read that, according to a study, those who use sleeping pills have an increased risk of death compared to those who don’t take them: right?
Answered by Luigi Ferini Strambi, full professor of Neurology at the Vita-Salute San Raffaele University and director of the Sleep Medicine Centre, IRCCS San Raffaele Hospital, Milan (GO TO THE FORUM)
I think you are referring to a recent study conducted in Asia on 484 thousand subjects. This study shows several critical points. The main one relates to the total sleep time, which is that perceived by the subjects and not that detected with specific tests. Other weaknesses of the study are the failure to take into account the type and dose of hypnotic drug used, as well as the duration of treatment. So, how to answer your question? We certainly know that insomnia, based not only on subjective data but also on the demonstration of reduced sleep time at night, determines an increased risk of mortality. A reduced sleep time is implicated in increasing cardiovascular risk: in fact, after falling asleep the heart rate and blood pressure begin to decrease, because the release of cortisol is inhibited. In insomniacs, cortisol levels remain high and therefore the dipping phenomenon (i.e. the physiological reduction in blood pressure values) is not observed.
Obesity is diabetes
Then there are other factors that can come into play in the link between sleep reduction and vascular pathologies: obesity and diabetes. By sleeping less we tend to eat more and the reduction in sleep leads to the search for unhealthy, high-calorie food. Researchers at King’s College in London, a few years ago, highlighted that, after a night with less than six hours of sleep, 385 more kilocalories are consumed. Longitudinal studies in the general population have shown that sleeping less than 6 hours per night increases the risk of developing type 2 diabetes mellitus by approximately 50% compared to those who sleep at least 7 hours. Finally, insomniacs have an alteration of the immune response, with a decrease in the secretion of interferon-gamma, a reduced activity of natural killer cells and reduced levels of interleukin 2.
The directions to follow
Returning to the initial question, there are some considerations to make:
1) insomnia in itself increases the risk of mortality;
2) it is important to verify that the hypnotic drug really resolves the sleep disorder;
3) the hypnotic drug must be chosen by the doctor in a thoughtful manner (evaluating the half-life of the drug and the duration of treatment);
4) in case of non-response to various hypnotic drugs, the opportunity of an instrumental assessment must be considered;
5) cognitive-behavioral therapy is still considered the first choice treatment for insomnia.
November 2, 2023 (modified November 2, 2023 | 08:48)
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