Are Sleeping Pills Addictive?

Benzodiazepine "Addiction" Leads To New Diagnosis

Coping with Insomnia disorder is hard, but coming off sleeping pills, the types of sleeping pills commonly prescribed by a doctor for insomnia can be even harder. 

Typically called "sleeping pills" by the public, medications & sedative drugs for sleep, also called sedative-hypnotics (sedative = calming, hypnotic = sleep-inducing), are often the first treatment offered to those having trouble sleeping by medical practitioners (pills actually aren't the first line treatment recommendation that GPs should offer for insomnia, find out about CBTi the recommended treatment). 

These drugs act at GABA neuroreceptors in the brain, the primary negative neurotransmission system in the Central Nervous System, and cause sedation and sleepiness.

But could they actually be addictive? Is sleeping pill addiction a real thing?

What Are The Common Side Effects Of Sleeping Pills?

You may know the drugs by their brand names Xanax, Valium and Atvian or by their medical names Alprazolam, Diazepam and Lorazepam. Add to the list sleeping pills like:

• Quazepam (Doral)

• Flurazepam (Dalmane)

• Triazolam (Halcion)

• Estazolam (ProSom)

• Temazepam (Restoril)

• Loprazolam (Dormonoct)

• Flunitrazepam (Rohypnol)

• Lormetazepam (Loramet)

• Nitrazepam (Alodorm)

• Clonazepam (Klonopin)

There are many different types of sleeping medications but these are of a class of prescription medication called benzodiazepines or "benzos", and these s medications have been commonly prescribed since the 1970s for sleep problems or anxiety (interestingly, Valium, Xanax and Atvian are commonly prescribed for sleep but are actually sedative non-hypnotics, all the bullet-pointed drugs are hypnotics) 

Common side effects of this class of drug include:

• drowsiness

• dizziness

• confusion

• next day sedation

• impaired coordination

What Are The Dangerous Side Effects Of Benzodiazepine Sedatives?

But people don't realize that, over the years, researchers have also identified some well known serious problems found in those that take sleeping pills of this class, especially among long term users.

Some of the most serious side effects from using sleeping pills include:

• falls (especially among the elderly);

• health conditions such as respiratory problems;

• cognitive impairments such as problems with memory;

• harmful interactions with other medications (& alcohol);

• increased risk of death

In order to reduce this harm clinicians, including physicians, sleep specialists, and sleep psychologists (including The Better Sleep Clinic), work with patients to taper the use of their prescribed sleeping pills (ask us about a supported medication taper here).

But these tapers have seen a new set of problems: Severe physical withdrawal symptoms such as:

• tremors;

• high blood pressure;

• psychiatric conditions such as depression and suicidal thoughts; and

• recurrence of the underlying conditions of anxiety, insomnia and sleep problems that the medication was originally intended to treat. The underlying conditions often return much worse than before.

This has led to a group of physician-scientists at Oregon Health & Science University to coin a new term for this phenomenon:

Complex persistent benzodiazepine dependence, or CPBD.

Christopher K. Blazes, assistant professor of psychiatry and the director of Oregon Health & Science University's addiction psychiatry fellowship said:

"This is really a dangerous situation, we now know that long-term benzodiazepine prescribing is rarely indicated, but we are still left with the problem of helping those who have been on these medications for years to safely get off them. The process of discontinuation can be very challenging and even dangerous. There may even be some circumstances, when attempts to discontinue fail, that restarting safe doses may be indicated."

Is Dependence On Sleeping Pills The Same As Addiction To Sleeping Pills?

It's important to note that the diagnosis of CPBD is intended to make a clear distinction between dependence and addiction. The distinction is important because addiction treatment differs from treatment options available for dependence.

What Are The Symptoms Of Sleeping Pill Addiction vs Dependence?

The OHSU group notes that addiction tends to result in sacrificing jobs, losing relationships and or personal stability. Whereas CPBD is more a form of physiological or physical dependence to benzos that sometimes includes behaviours consistent with addiction issues, but that only develop during the discontinuation process.

Blazes said:

"You don't want to diagnose addiction if people don't have addiction. People who don't have addictions aren't going to respond as well to psychological, social and behavioural interventions that work for addiction".

The complexity of an addiction can mean an addict must enter a recovery center or similar, but this is not required with dependence.

But Blazes notes:

"many patients who have been prescribed benzodiazepines over months and even years will experience severe repercussions from de-prescribing. It's a conundrum, you're damned if you do and damned if you don't."

But because benzodiazepines are associated with a large uptick in mortality, Blazes said he works with patients to taper off these medications.

Fortunately, benzos are no longer the most popular sleeping pills on the market, with prescription sleep medications known as “z-drugs" (so called because their names often start with a "Z") now the most prescribed medications. These medications include:

Zopiclone (Imovane, not available in the USA);

Zolpidem (Ambien or Stilnox / Stilnoc, not available in some countries e.g. New Zealand, Canada)

Zaleplon (Sonata), and

Eszopiclone (Lunesta).

These medications are typically not thought to be as highly addictive as benzos, but at The Better Sleep Clinic we do see some people have great difficulty when they stop taking these medications.

What Help Is Available To Reduce My Use Of Sleeping Pills?

When should you seek professional help?

If you feel you're either:

• unable to sleep without medications;

• you think you've developed a dependency;

• you worry you'll become dependent on a benzo you are taking;

• you are starting to increase the dosage of your sleep aid;

• you begin using another sleep aid;

• you are prone to misuse of your sleeping pills (e.g. taking extra doses, pills taken in high doses, taken with alcohol or other substances)

• you have a history of substance use disorder already

These are all signs you should seek professional help sooner rather than later. This is because CPBD is associated with long-term use rather than shorter term use. Taking the drug for shorter periods may reduce any symptoms of withdrawal and likely make a supervised taper easier.

I Take A Sleeping Pill: Can You Help Me To Stop Taking My Sleep Medication?

We are able to provide supported and supervised sleeping pill tapers (ideally in partnership with your prescriber).

Over the years we have seen that patients can struggle with coming off:

• Benzodiazepines

• Z-drugs

• Over-the-counter sleep aids (OTC)

• Anti-depressants often prescribed for sleep (e.g. low dosage Amitriptyline, Mirtazapine)

• Anti-psychotics prescribed for sleep (e.g. Quetiapine)

• Alcohol (insomnia is made worse by regular alcohol use)

• Cannabis (generally will make sleep worse over the long-term)

While understandably patients just want to fall asleep or achieve a good night's rest, not only can some pills cause physical dependence (that CPBD is supposed to help differentiate), some patients simply become psychologically dependent (yes, even over-the-counter drugs / behind-the-counter drugs like diphenhydramine and doxylamine, can cause issues, and we have patients taking melatonin even when it clearly is doing nothing).

While we certainly see patients that feel they are "addicted to sleeping pills", we'd say we often see symptoms of sleeping pill dependence rather than signs of sleeping pill addiction (as defined by the OHSU group).

As sleep specialists and sleep psychologists with experience in 1-1 treatment over multiple sessions for insomnia and other sleep disorders and mental health disorders, we're uniquely placed to give patients the support their physicians and GPs are often too busy or unaccustomed to giving.

Our understanding of sleep also means that, for some clients, we are able to help them taper off a long-term medication and have them going to sleep by themselves with little to no disruption to sleep throughout the taper (it does happen!).

Do we get results?

It's not 100% guaranteed, but even where we don't get patients entirely off their medications, we typically get doses reduced by 80-90% and with less frequent use on a weekly basis.

Here's what one client with a 5+year history of nightly medication use had to say:

"I was planning on sending you an update and thanking you for your help. Tapering will be complete next week and it has gone well. The tools you have given me have successfully guided me, and for this I am grateful. Sleep efficiency has been high 95%- 98%. I feel I have the confidence now to manage my sleep going forward. This has been a game changer for me and I can't thank you enough"

So if you're concerned about your sleep and the problems drugs can cause get in touch with us.

Research originally published by Oregon Health & Science University