November 17, 2014 by Shawn Smith
Last week I had the honor of speaking with about 200 wonderful students at Northeastern Community College here in Colorado. We discussed important things, like why the mind is willing to jump through too many hoops for a free cookie. During a lively Q&A, one student asked my opinion on sleeping pills. How does a person know when medication is the proper way to treat sleep difficulties?
I gave the answer that you might expect from a shrink: psychiatric medicine can be a life-saver, but interventions like sleeping pills should be a last resort. The side-effects can be awful. Try exercise, good sleep habits, and behavior therapy first.
It was a standard, correct, and boring answer. Here’s what I wish I had said: more often than not, sleep medication is a duct-tape solution. There are many problems in life that can be fixed with duct tape, but very few that should be.
Like sleep medication, duct tape is a modern miracle. It is the all-purpose, quick and dirty repair for anything from broken taillights to ripped jeans. (Ironically, you shouldn’t use duct tape on air ducts. Any reputable psychologist will recommend foil tape for that.) Duct tape will get you a little further down the road, but it rarely fixes the real problem.
Sleep medication, along with antidepressants and anxiolytics, are wonderful inventions. I’m truly thankful for them. But they should be treated like duct tape for the mind. In most cases, they are temporary fixes that calm the underlying problems but don’t cure them.
For example, lots of people have difficulty sleeping because they worry at night. That’s not a sleep problem, that’s an anxiety problem. Sleep meds may mask the worry at bedtime, but anxiety has a way of creeping back into the driver’s seat eventually.
Another example. Some people have difficulty falling sleep, unaware that the caffeine they drink all day has a half-life of roughly five hours (more or less, depending on the individual), and so there is enough stimulant in their bloodstream at bedtime to make sleep impossible. That’s a caffeine problem, not a sleep problem.
Others have difficulty staying asleep, not realizing that the alcohol they drink after work each day metabolizes in the wee hours and—BING!—they’re wide awake at 2:00 AM. That’s not a sleep problem, that’s an alcohol problem.
I could continue with examples ranging from exercise to work schedules, but I’ve probably made my point.
It’s easy to apply the duct-tape solution to any of these problems, but there’s a big cost involved. As soon as we apply duct tape, we become disinclined to actually fix the problem.
Duct tape merely holds things in place. It makes life bearable while the real problem lurks beneath the surface, waiting to return at the first opportunity. When it does, there’s a good chance we’ll be blindsided because we’ve been lulled into a false belief that the problem is under control. Worse, duct-tape solutions almost always come with ugly side-effects.
Unfortunately, duct-tape solutions to mental health problems are alluring for both patients and clinicians, especially with agonizing problems like sleep-deprivation. Exhausted patients, who may be at their wit’s end, just want the problem to go away. Clinicians, who are busy and who want to help, are motivated to provide quick relief.
There’s nothing wrong with the motivations on either side. The only real mistake is accepting the illusion that a temporary patch is as good as a permanent repair. That belief will bite us in the ass every time, if you’ll pardon the clinical jargon.
Whether the problem is a broken taillight or a disrupted sleep cycle, the key to stop-gap measures is to think of them as the first step in solving a problem, not the last.