Sleeping pills are medication used to help people with sleeping problems, either caused by stress, anxiety, or a sleeping disorder. In fact, they’re one of the most common prescription medications in the United States. The CDC states that 5% of women and 3.5% of men have a prescription for sleeping pills. And, that usage is not counting the millions who abuse these drugs for recreational or self-medication purposes. Sleeping pills are popular. Unfortunately, they’re also addictive and dangerous.
At the same time, sleeping pills aren’t necessarily bad. They solve a valuable purpose for many people, improving health and quality of life. For those of us with major problems sleeping, sleeping aids like Zolpidem enable rest and recovery. But, if you or a loved one is using them, it’s important to understand the history, risks, and abuse potential of these drugs. That’s even more true if you’re using them outside of a prescription, which means you don’t have the benefit of medical management or a Risk Evaluation and Mitigation Strategy.
Sleeping pills comprise a class of drugs known as hypnotics, which can include one of several types of medication. In fact, there are over a dozen medications used to induce sleep approved by the FDA. Here, the most popular include Zolpidem/Ambien, Zaleplon/Sonata, Eszopiclone/Lunesta, and Triazolone. While each has a slightly different mechanism of action, they all result in muscle relaxation, normally through the central nervous system, allowing the body to relax into sleep. Some also affect other parts of the brain and body through Gabapentin, dopamine, and serotonin, but most function primarily as muscle relaxants and hypnotics. So, you relax and fall asleep but potentially lose some muscle control and may talk or act as though inebriated if you stay awake.
Here, many create a “high” feeling of relaxation, drowsiness, and light euphoria. In high doses, zolpidem can cause euphoria, hallucinations, and relaxation. In addition, most people experience effects similar to alcohol of reduced coordination and motor skills as well as dizzy spells. This makes it dangerous to operate machinery or to combine with alcohol – which can increase the effects of both and result in an increased risk of hospitalization.
Sleeping pills, in the simplest form of sleeping aids, date back almost as far as human history. However, the modern form dates back to the mid-1800s with chloral hydrate. This drug was used to suppress the body, providing an intoxicating effect. It was quickly adopted as a sleeping aid. By the early 1900s, barbiturates were used to replace chloral hydrate, as they had both a stronger sedative effect and resulted in fewer risks to health. By the 1970s, modern drugs like quinazolinones and benzodiazepines were introduced.
Today, those drugs are still popular. However, most doctors prefer to prescribe drugs like zolpidem, sonata, eszopiclone, triazolam, mirtazapine, clonidine, and even diphenhydramine instead. In most cases, these drugs are prescribed in short periods of a few weeks – offering users the chance to sleep while hopefully getting therapy or another form of treatment for sleeping issues. In fact, in most cases, sleeping medication in combination with cognitive behavioral therapy is considered the most effective way to treat sleep issues caused by anxiety, depression, and many other mental health disorders. This means that for non-sleep-disorder issues, sleeping aids are often prescribed for as little as 8 weeks. That’s vastly different from as little as 10 years ago, when sleeping aids might be prescribed for years or even decades at a time with little oversight.
Those shifts in approach largely tie into the increasing understanding that sleeping aids are addictive and often dangerous. In fact, in 2010, some 64,000 people were hospitalized from a single medication used for sleeping pills (zolpidem), with over 1/3rd because of overmedication. This, plus increasing crackdowns on unregulated prescriptions means that it’s now more difficult than ever to abuse a sleeping aid prescription. Yet, many people still do. In fact, an estimated 0.2% of the U.S. population abuses or is addicted to a prescription tranquilizer or sleeping aid.
Today, an estimated 4% of Americans have a prescription for sleeping medication, with 9 million prescriptions for Zolpidem alone. While many of these prescriptions are short term, many more have been running for years – and doctors don’t have oversight or options to offer therapy and treatment to help people off them. In many cases, those sleeping aids are vital to quality of life for the people who take them.
In addition, sleeping pills are linked to abuse for both recreational and self-medication purposes. Here, users often combine sleeping pills with alcohol to get a stronger high. Others buy sleeping pills to relax or to destress. Drugs are often bought and sold for a few dollars a pill, stollen from friends or family, or acquired through means like doctor shopping.
In addition, self-medication, or the process of using a drug to treat issues like not being able to sleep, can result in addiction. Here, users often feel anxiety about not sleeping. After all, you have responsibilities, things to do, and want to feel and do your best. Being unable to sleep prevents that. This can result in a self-defeating cycle of being anxious that you won’t’ sleep without sleeping aids, and then the anxiety keeping you awake, so you have to take the sleeping pills every day to sleep. This is one way that people with prescriptions can become hooked on the drug.
At the same time, most sleeping pills are incredibly habit forming. That relates to both stress and the incredibly negative impact of being unable to sleep and the fact that the drugs themselves quickly form physical dependencies. In fact, drugs like zolpidem score higher than both heroin and methamphetamine on the scale of forming physical dependence. In most cases, Ambien can result in physical dependence, or withdrawal symptoms on cessation, in as little as 7 days of daily use.
If you or a loved one is struggling with sleeping pills, you’re far from alone. While often necessary for health, many of these drugs are addictive, habit forming, and dependence inducing. People who use them end up with both physical and mental dependencies, resulting in behavioral changes including addiction. That’s true whether you have a prescription or started taking sleeping pills for recreational purposes or even to self-medicate.
Unfortunately, it’s never safe to simply quit these drugs. Most sleeping medications interact with the central nervous system. You can go into withdrawal which might include seizures. It’s always important to seek out medical attention and taper off the drug or seek out medication to help you detox safely. In addition, addictions are also about behavioral addictions. This means that if you simply quit taking a sleeping medication, you’re only solving one part of the problem. The mental addiction is still there, meaning risk of relapse is high. That puts you at increased risk of overdose if you do relapse, because tolerance goes down quickly.
Addiction treatment including detox, behavioral therapy like CBT and DBT, and counseling can help you to recover safely and fully. Treatment involves detoxing under medical supervision. It also means assessing behavioral problems and motivations, working on underlying problems and treating the reason for initial use, and finding solutions and coping mechanisms for underlying problems and cravings. That means you get the best possible chance at building a new life, where you don’t need sleeping medication to cope.