Both prescription and over-the-counter sleeping pills commonly result in dependence, anterograde amnesia, altered sleep architecture, and a residual daytime hangover. Long-term use, which is increasing, is associated with significant rebound insomnia upon discontinuation. Furthermore, reliance on sleeping pills disregards the critical role of lifestyle, as well as personal responsibility, in sleep problems. Some sleep specialists believe that long-term use is also associated with increased mortality.
In fact, sleeping pills have limited effectiveness. Recent analyses suggest that, at best, they result in no more than 25 minutes of additional sleep per night, often less. They function in large part by producing amnesia for nighttime awakenings, leaving users with the impression that they're sleeping better than they actually are. All over-the-counter sleeping pills with the designation "PM" contain benedryl, which has a long half-life and suppresses dreaming. Those that contain acetaminophen can lead to liver damage.
I don't mean to suggest that taking something to sleep is never an appropriate response to insomnia. The short-term, periodic use of effective sleep-inducing substances can be helpful in managing personal and medical crises. But the idea of "taking something to sleep" is deeply rooted in our collective consciousness: it's associated with a sense that we don't have direct control over falling asleep, and it's conflated with the misguided notion that we need to be knocked out by some outside force.
Ultimately, cultivating nightmindedness is less about getting to sleep than letting go of waking intention—learning to untether oneself from one's daytime consciousness. To help clients achieve this, we need to explore their personal sleep stories, evaluate their daily habits and activities, and help them become aware of the ways in which they unknowingly import waking consciousness into their night worlds, or undermine their ability to sleep in other ways.
Rest and Rhythm. As part of my evaluation of Christina, I asked what she believed was causing her insomnia. Although I knew the question was as tired as she was, I believe it's helpful to understand the attributions clients make about the causes of their sleeplessness. She paused and said, "I'm really not sure. At different times, I've thought it might be caffeine, stress, my mattress, my antidepressant, and on and on. I have to admit, I don't really know. What I do know is that when night comes, I'm just not sleepy enough."