The Health Blog

It is now believed that benzodiazepine exerts an inhibitory effect on the transmission of signals between nerves, so that there is a slowing down in the relay of signals between nerve cells and hence the person becomes less excitable and more relaxed. Benzodiazepine competes with a naturally occurring chemical in the nerve endings known as GABA (gamma amino butyric acid).

It appears to displace GABA off these nerve endings, which increases the amount of freely available GABA. GABA is known to inhibit transmission of impulses between nerve cells.

There are two main kinds of benzodiazepine, the long acting and the short acting. By long action, we mean that once the drug is absorbed into the body it stays active for a long time and can be detected in the body after many days. The drug is eliminated from the body by two mechanisms, either destroyed by metabolism in the liver or excreted by the kidneys in the urine. The faster the metabolism, the shorter the half-life of the drug, which is the time taken for half of the drug in the body to be eliminated. This elimination phase can be much longer in older people than in younger people because their kidneys are not normally so efficient. The long acting hypnotic drugs have a long half-life and can sustain sleep longer, but they may give a hangover feeling the next morning;

people who take these drugs often complain that they feel like a zombie the following morning. If this drug is taken nightly and regularly, it tends to accumulate in the body. One of the longer

acting drugs is Flurazepam, commonly known as Dalmane, and its half-life is nearly 80 hours. This is rarely prescribed in Australia now.

The short acting benzodiazepine has a short half-life and is eliminated from the body much more quickly, usually within a few hours. It can initiate sleep more easily, but may not be as effective in sustaining sleep. There is very little hangover feeling in the morning and accumulation of the drug in the body is less likely even if taken regularly. A common short acting drug is Temazepam, which is marketed in Australia as Euhypnos or Normison; its half-life is 5.8 hours.

Health authorities all over the world have now recognized the abuse of benzodiazepines. They have found that they are addictive. As the number of deaths from barbiturates fell, it became apparent that quite a large number of people suffer from the distressing effects of dependence on benzodiazepines. In Australia alone there are about 6.5 million prescriptions for benzodiazepines written each year, and there are only 15 million people here.

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Some degree of sleeplessness is a fairly constance feature of anxiety conditions. The main problem is that insomnia is such a disturbing symptom that we turn to sleeping tablets far too quickly. Most people can learn to use this relaxing technique to put themselves to sleep I have recently been treating a doctor with chronic anxiety who had been taking sleeping capsules every night for twenty-five years. He learned the relaxing method of putting himself to sleep in three or four sessions, and since then has taken no sedative at night at all. But it does not come quite as easily as this to everyone. Give yourself a little time to get into the swing of it, and be patient when it does not all come at once.

When you have mastered the relaxing mental exercises, it is quite a simple matter to put yourself to sleep. You will have been practising the exercises in relatively uncomfortable positions. Now do them when you go to bed, and with the added warmth and comfort they will seem very easy indeed. Just lie flat on your back and proceed with the exercises in the ordinary way:

Relaxed.

Legs are relaxed.

Utterly relaxed.

All I feel of them is their weight on the bed.

Heavy relaxation.

Heavy drowsy relaxation.

It comes all through me.

Heavy, drowsy, sleepy.

My body is heavy with it.

It is in my face.

Eyelids are heavy with it.

So drowsy, so sleepy.

It is all through me.

When you really feel the heaviness, and the sleepiness, and weight in your eyelids, you just turn over on to your side into a sleeping position and you are asleep.

If you wake during the night, you just repeat the same procedure. It is important to do it systematically and in a relaxed fashion. Do not allow yourself to get restless or irritable with yourself. Do it systematically and you will soon be off to sleep again.

A feature of this approach is that it is effective not only with insomnia which is caused by anxiety, but with insomnia resulting from almost any cause. Those who are kept awake by pain find it very effective. Elderly persons can use the method with success provided their mind does not wander too much during the exercises.

Improvement in sleep is the general rule for anxious persons once they start to practise the exercises.

A rather outstanding example was a professional man who had been taking sleeping capsules every night for more than twenty years, since he was a student. He came seeking help for general anxiety, and his difficulty in sleeping was hardly mentioned, as he had assumed he would be taking sleeping capsules for the rest of his life. It was only afterward that he told me he had been so impressed with his calmer state of mind that he had experimented, and had gone to bed without his usual capsule, and was surprised to find that he could sleep quite well. He said that he felt that his sleep was lighter but at the same time more refreshing.

I can give a further example from my personal experience. The incident occurred just recently, after my first submission of this manuscript to the publishers. I developed an abscess on a tooth. My face was swollen right up to the eyes. In spite of the pain I found I could put myself to sleep in two or three minutes by the relaxing exercises. However, in about half an hour, when I was deeply asleep and off guard, the pain woke me. But I was able to put myself asleep again quite quickly only to be awakened by the pain again in half an hour or so. This sequence was repeated several times during the night, so that I actually had a reasonable amount of sleep. Next morning I had the tooth extracted without anaesthetic and without discomfort.

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