Prescription Drug Addiction

The use of nonmedical prescription drugs increased dramatically in the 1990s, and remains at a high level. In 2007, approximately 7 million people aged 12 or older reported nonmedical use of a prescription drug. The most commonly abused medications are painkillers or opioids, with 5.2 million users. 1.2 million people use stimulants like methylphenidate and amphetamine. There are over 2 million users of central nervous system depressants like benzodiazepines. Like many illicit substances, these drugs alter the activity of the brain and can cause many adverse consequences, including addiction. For example, opioid pain relievers like Vicodin or OxyContin can cause health risks similar to opioids like heroin. The effects of these drugs depend on dose, route of administration and combination with other drugs. Because of increased use of nonmedical drugs, more people visit the emergency room at hospitals for accidental poisonings and treatment addictions. Treatments for prescription drugs tend to be similar to those for illicit drugs that affect the same brain systems. Thus, doctors prescribe buprenorphine to treat addiction to opioid pain medications. Behavioral therapies help addicts cope with stimulant, but there are no medicinal treatments for central nervous system depressant addictions.

Topiramate

Doctors think that topiramate works by increasing inhibitory neurotransmission and reducing stimulatory glutamate neurotransmission. Scientists do not know the precise mechanism of action of topiramate in treating alcohol addiction. The Federal Drug Administration does not yet approve topiramate. In two randomized controlled trials, studies show that topiramate significantly improves multiple drinking outcomes when compared with a placebo. Over the course of a 14-week trial, topiramate significantly increased the proportion of patients with 28 consecutive days of abstinence or moderate drinking. In both studies, the differences between topiramate and placebo groups were still diverging at the end of the trial, suggesting that patients had not achieved the maximum effects of topiramate. The studies show the efficacy of topiramate in volunteers who were drinking upon starting the medication.

What Does Sleep Do for People?

A number of tasks vital to health and quality of life relate to sleep and these tasks are impaired when people are sleep deprived.

Learning, Memory and Mood

Students who have trouble grasping new information or learning new skills should "sleep on it," and that advice seems well founded. Recent studies reveal that people can learn a task bet­ter by sleeping enough. People can also remember better with a good restful sleep after learning the task. Volunteers had to sleep at least six hours to show improvement in learning. Other studies suggest that all the benefits of training for mentally chal­lenging tasks become apparent after a restful sleep, rather than immediately following the training or after sleeping for a short period overnight.
Many well-known artists and scientists claim to have had creative insights while sleeping. Mary Shelley, for example, said the idea for the novel "Frankenstein" came in a dream. Although not proven that dreaming is the driving force behind innovation, one study suggests that sleep is necessary for creative problem solving. In that study, volunteers performed a memory task and then took a test eight hours later. Participants who slept for eight hours immediately after receiving the task and before being tested were much more likely to find a creative way of simplifying the task and had heightened performance compared to those who were awake the entire eight hours before the test.

No one knows exactly what happens during sleep that improves learning, memory and insight. Experts suspect, however, that while people sleep, the body can form or reinforce the pathways of brain cells needed to perform certain tasks. This process may explain why infants need sleep in order to have proper brain development.
Not only is restful sleep required to form new learning and memory pathways in the brain, sleep is also necessary for those pathways to work up to speed. Several studies show that lack of sleep causes thinking processes to slow down. Lack of sleep also makes it harder to focus and pay attention. Lack of sleep can make people more easily confused. Studies also find a lack of sleep leads to faulty decision making and more risk taking. A lack of sleep slows down reaction time, which is particularly significant in driving and other tasks that require quick responses. When people who lack sleep undergo a test by using a driving simulator, these people perform just as poorly as people who are drunk. (See "Crash in Bed, Not on the Road"). The bottom line is: not getting a good sleep can be dangerous!
Even when days are not mentally or physically challenging, people should still get enough sleep to be in a good mood. Most people report being irritable, if not downright unhappy, when lacking sleep. People who chronically suffer from a lack of sleep, either because there is not enough time spent in bed or because of an untreated sleep disorder, are at greater risk of developing depression. One group of people who usually do not get enough sleep is mothers of newborns. Some experts think depression after childbirth (postpartum blues) is, in part, a result of lack of sleep.

The Heart

Sleep gives the heart and vascular system much-needed rest. During non-REM sleep, the heart rate and blood pressure progres­sively slow as people enter deeper sleep. During REM sleep, the heart rate and blood pressure have boosted spikes of activity. Overall, however, sleep reduces the heart rate and blood pressure by about 10 percent.
If people do not get enough sleep, this nightly dip in blood pressure, which appears to be important for good cardiovascular health, may not occur. According to several studies, if blood pressure does not dip during sleep, people are more likely to experience strokes, chest pain known as angina, an irregular heartbeat and heart attacks. People are also more likely to develop congestive heart failure, a condition in which fluid builds up in the body because the heart is not pumping sufficiently. Insufficient sleep time, an untreated sleep disorder or other factors can result in failure to experience the normal dip in blood pressure during sleep. African Americans, for example, tend not to have as much of a dip in blood pressure during sleep. This difference may help to explain why African Americans are more likely than Caucasians to have serious cardiovascular disease.
A lack of sleep also puts the body under stress and may trigger the release of more adrenaline, cortisol and other stress hormones during the day. These hormones contribute to blood pressure not dipping during sleep, thereby increasing the risk for heart disease. Inadequate sleep may also negatively affect the heart and vascular system by the increased production of certain proteins thought to play a role in heart disease. For example, some studies find that people who chronically do not get enough sleep have higher blood levels of C-reactive protein. Higher levels of this protein may suggest a greater risk of developing hardening of the arteries (atherosclerosis).