When sleep is hard to come by, some pop a pill. But it can be addictive over time and the habit can harm you.

Madam Lin (not her real name), a housewife, had always suffered from insomnia but did not resort to sleeping pills.

That changed a decade ago when her world fell apart.

Her young son's teachers had complained about his behaviour, and she became highly stressed because of this.

A doctor had previously prescribed some sleeping pills, which she had not taken. 'But now I just wanted to sleep my problems away, so I took them,' said Madam Lin, 50.

That was the first step towards her addiction. She regularly took Dormicum, which falls under the class of benzodiazepine drugs. They work by lulling activity in the brain.

To get more pills, she began lying to general practitioners.

'All I had to do was to tell the GPs I needed them or I would faint,' she said.

Madam Lin, who managed to wean herself off the habit about three years ago, is one of many Singaporeans who take or have taken such pills excessively.

In fact, Singaporeans pop a whopping seven million sleeping pills every year, not counting the supply from the black market.

Sleeping pills are taken to facilitate sleep. In Singapore, benzodiazepine is the more commonly used class. Dormicum and Erimin, for example, are the brand names of different types of benzodiazepines that produce different levels of sedation. Other common brand names of benzodiazepines are Valium and Ativan.

In the past four years, at least 20 doctors have been disciplined for prescribing the pills inappropriately. One reason for this is that doctors buy the pills cheaply but sell them at a higher price, allowing them to make quick profits.

In October, the Ministry of Health (MOH) issued updated guidelines on how benzodiazepines should be prescribed.

Under the revision, doctors must take extra precautions such as indicating the dosage, duration of use, and reasons for prescribing the pills.

They also must look out for any physical signs of illicit use and alert the ministry and the Central Narcotics Bureau (CNB) if they suspect that a patient is abusing the use of sleeping pills.

A ministry spokesman said: 'Where necessary, MOH may conduct audits in selected clinics to assess doctors' compliance with the guidelines.'

Doctors here are, however, not the only source of sleeping pills, since people have been known to bring them in from countries such as Malaysia and Thailand.

Apart from drugs like Dormicum, smugglers have sneaked in banned sedatives like Erimin-5.

Drug abusers can get their high from a cocktail using drugs such as Dormicum and Erimin-5, and Subutex, another banned substance which causes sedation and is sometimes used as a painkiller.

Such drug cocktails are usually taken intravenously.

CNB figures show that 24,926 Erimin-5 tablets were seized last year. In the first half of this year, about 12,000 Erimin-5 tablets were seized, about the same as the corresponding period last year.

In April, a man was caught trying to smuggle in 15,000 Dormicum pills at the Woodlands Checkpoint. He was sentenced to eight months' jail.

The unwitting addicts
Hard-core abusers, however, make up only a small portion of those who use sleeping pills. The key worry is still the potential of addiction for ordinary folk like Madam Lin.

Because they are also muscle relaxants or have anti-anxiety properties, such drugs are used to treat not only insomnia but also anxiety, seizures and as an anaesthetic agent, said Dr Tan Hwee Sim, a registrar from the Addiction Medicine Department, Institute of Mental Health.

Insomnia and anxiety seem to be on the rise.

Dr Stephen Lee, a specialist in Ear, Nose and Throat (ENT) Surgery at Raffles Hospital, said a Singapore general practice survey on insomnia found that one in 10 patients surveyed had the condition.

He added that a separate elderly population survey found that 25 per cent of those interviewed had problems with insomnia.

Dr Kenny Pang, an ENT consultant and sleep specialist at the Pacific Sleep Centre, said: 'In general, insomnia and related anxiety are on the rise because of high stress levels.'

Not surprisingly, the bleak financial outlook has had an impact. 'Since the economic crisis, attendance at my clinic has doubled because people are stressed about the economy,' he said.

Doctors said that insomnia can affect anyone. But Dr Pang pointed out that many doctors avoid prescribing sleeping pills. If they do so, it is only after easily treatable diseases such as thyroid conditions or sleep apnoea - which also result in insomnia - have been ruled out.

'The pills only provide light sleep and people still wake up feeling groggy. They should only be used in the interim to provide rest while the individual's sleep habits are improved,' Dr Pang said.

Dr Nicholas Chew Wuen Ming, consultant, psychological medicine at Tan Tock Seng Hospital, noted that transient insomnia is normal due to life stresses and people may require less sleep as they age.

The bottom line, he said, is that benzodiazepines can be addictive.

Some patients become dependent on them over time and require increasing doses.

He has also heard of odd experiences. 'A patient of mine took his first tablet of Dormicum only to wake up the next morning to find that he had lit candles all over the bedroom floor,' he said.

And, while relatively uncommon here, sleeping pill addiction can become a stepping stone to harder drugs like heroin, said Dr Tan. There are always those who will do anything to get their fix.

Dr Pang once saw a young, well-spoken man who asked for sleeping pills. The doctor refused, saying sleeping pills were used only as a last resort and he would have to try other methods first.

The man agreed to come back for a second session and paid for the consultation with a credit card.

But before the second session, the police came by and told Dr Pang that the credit card had been stolen.

'The man was probably hoping to coax a big prescription out of me the second time,' he said.

A Straits Times Forum letter writer, Ms Joline Ng, wrote in recently to relate how her 16-year-old daughter had been prescribed sleeping pills because she was depressed over a broken relationship.

The girl now has problems withdrawing from the pills, and the mother is urging doctors to exercise more caution in giving them out for psychological problems like stress.

Because of problems of abuse and addiction, GPs and even those who depend on the pills support the new rules.

Dr Kelvin Phua of Clarke Medical Centre can tell if someone who comes to him for pills is an addict: The person knows the name of the medication and asks for it directly.

'Greater awareness of the problem has led to the ministry clamping down harder on it and I think this is good.'

Added Dr Lily Aw of Lily Aw Pasir Ris Family Clinic and Surgery: 'I generally don't prescribe sleeping pills in case of abuse. I think it should be controlled and the new guidelines are good for this.'

Perhaps the most telling reaction comes from former addict Manimaran Murugayan, 40.

Once addicted to Subutex and Dormicum, the former property agent said: 'Some doctors don't even ask questions except for 'how much do you want?'. I wasted my life on drugs. Everything should be done to prevent others from experiencing the same.'