A sleep scientist on the vicious cycle of insomnia and sleeping pills

Maybe you’re one of the estimated 50 to 70 million Americans who suffer from sleep disorders, including insomnia; maybe you’re also among the 4 percent of American adults who rely on prescription medication in order to fall asleep. If so, Matt Walker, a professor of neuroscience and psychology at the University of California, Berkeley, has a bit of bad news for you.

In a section of his new book, Why We Sleep, Walker explores the latest scientific research to show the unfortunate truth about sleeping pills: They don’t work as well as we wish they did. Sleep medications don’t deliver the same restorative benefits as natural sleep, and even though people who take them often swear by them, the research suggests that the drugs don’t tend to increase sleep quality beyond placebos. Currently, Walker says, the best available treatment method for combating chronic sleeplessness is not pharmacological at all; it’s psychological.

Recently, we spoke with Walker about this aspect of his book, including his skepticism over sleeping pills and his enthusiasm for cognitive behavioral therapy for insomnia, or CBT-I. What follows is a lightly edited and condensed version of our conversation.

There’s a lengthy section toward the end of the book that discusses your concerns about sleeping pills. What’s most worrisome about them to you?
The quality of sleep that you have when you’re on these drugs is not the same as normal, naturalistic sleep. They’re classified as “sedative hypnotics,” so the drugs actually just sedate you — and sedation is not sleep.

And you argue that this distinction, between natural sleep and sedation, is why sleeping pills don’t deliver the same benefits of sleep. Right?
That’s right. The way that they work is by targeting a set of receptors, or “welcome sites,” in the brain that are lured to basically stop your brain cells from firing. They principally attack those sites in the cortex, this wrinkle of tissue on the top of your brain, and they just switch off the top of your cortex, the top of your brain, and put you into a state of unconsciousness.

Sleep, in contrast, is this incredibly complex ballet of neurochemcial brilliance that results in numerous areas of the brain both switching on and switching off. We don’t have any good pharmacological approach right now to replicate such a nuanced and complex set of biological changes.

My second problem with sleeping pills: They don’t tend to increase sleep much beyond placebos. People may be fooled into thinking that they’re getting more sleep, but actually they’re not. This was not my conclusion — it was a committee of experts, who reviewed 65 separate drug placebo studies, and their conclusion was simple: There was no objective benefit of sleeping pills beyond placebo. Their summary was that the impact of sleeping pills was small, and of questionable clinical importance.

And my third problem: They are associated with a higher risk of death and cancer.