How Addictive Are Sleeping Pills?

“Insomnia was my gateway to drug addiction”

“It took me years to beat my sleeping pill addiction, and another year before I beat my insomnia”

Approximately ten percent of Americans suffer from long-term insomnia, with up to thirty percent experiencing short-term bouts. If you have suffered from insomnia, you know how distressing it can be. Lying in bed for hours, worried about how you’ll feel the next morning, is a horrible prospect every night. As such, you might be wondering whether it is worthwhile trying sleeping pills.

But you may have also heard that sleeping pills can be addictive. How addictive are sleeping pills? Are they worth trying or should you look for alternative options?

Here is what you need to know about how addictive sleeping pills are.

Insomnia and Addiction

Before discussing sleeping pills in particular, we should mention the connection between insomnia and addiction. The CDC estimates that half of people suffering from sleep disorders develop an addiction.

This development follows a familiar sequence. An individual struggles to sleep every night. They try alcohol or a narcotic that helps them “turn off.” It works the first few times, until the individual fears going to bed without the substance. However, the effects of the substance begin to wear off as the body builds a tolerance. The individual can no longer function without the substance, and it is no longer helping them sleep.

The substances that figure in this addiction cycle are generally:

• Downers or tranquillizers
• Tolerance building, i.e. the person requires more and more for them to continue being effective
• Dependence building, i.e. the body starts to depend on them to continue functioning normally
  subject to withdrawal symptoms

Let’s take a look at sleeping pills and whether they are likely to cause an addiction cycle.

Types of Sleeping Pills

The main types of sleeping pills are of the benzodiazepine or z-drug class.

Benzodiazepines, such as Valium, were popularly prescribed for insomnia until the 1990’s. They work by depressing the nervous system to induce sleep. However, they proved to consistently cause tolerance and dependence, with severe withdrawals, leading to addiction.

Z-drugs, such as Ambien, were developed as a non-addictive alternative to benzodiazepines. Initially, they seemed like a good long-term option. However, over the following years it became clear that, while tolerance and dependence develop more slowly with z-drugs, and withdrawals are less severe, they are still habit-forming and addictive.

Today, benzodiazepines and z-drugs are still the most well-known sleeping pills. However, they are no longer prescribed for long-term use. Responsible prescription practices recommend that they are not used for longer than two weeks.

Benzodiazepine and Ambien addiction are still very common. More than half a million Americans abuse Ambien. Benzodiazepine use is on the rise, with an estimated six hundred thousand Americans addicted.

These types of sleeping pills are therefore addictive and are not viable long-term solutions to insomnia.

Are there sleeping pills that are non-addictive?

Non-addictive Drugs and Supplements For Insomnia

There are a few non-addictive sleeping pill alternatives for insomnia.

• Ramelteon (Rezenor): this sleeping aid targets the sleep-wake cycle rather than the nervous system and is not tolerance-building or dependence-forming. It is safe for long term use. Studies indicate that Ramelteon reduces the time it takes to fall asleep, but the amount of research so far is limited
• Doxepin (Silenor): doxepin is an antidepressant that has been shown to help individuals stay asleep. It is not tolerance-building, but can have serious withdrawal effects if not done safely
• Quetiapine (Seroquel): an antipsychotic prescribed for depression, bipolar, and schizophrenia, quetiapine (Seroquel) may work in small doses as a long-term treatment for insomnia. It is not tolerance-building but can have severe withdrawals. Long-term use is safe, but it can have problematic side effects and can damage liver function in individuals with a disposition to liver problems. There has been some controversy surrounding its over-prescription for sleep issues, with some experts considering it as a dangerous option

There are a number of over-the-counter products available as sleep aids. These generally include antihistamines, and melatonin-based supplements. While there is anecdotal evidence for their efficacy, there is not a lot of substantial evidence that they are effective in treating long-term insomnia.

Therapy for Insomnia

Cognitive behavioral therapy (CBT) has been effective at treating insomnia without the use of narcotics. CBT for insomnia (CBT-I) trains patients to identify thoughts and behaviors that lead to sleep problems and to challenge them.

As anyone suffering with insomnia knows, the more you think and worry about it, the worse it becomes. CBT-I helps the individual learn to restrict the impact of these thoughts.

CBT-I also provides “sleep hygiene” instructions, that are implemented around at night-time to improve the chances of falling asleep and sleep quality. Certain behaviors, including limiting social media use and other kinds of stimulation before bedtime can have immediate impacts on insomnia.

Insomnia is a distressing sleep disorder that can have significant consequences on your mental health. Unfortunately, most sleeping pills are habit-forming and stop being effective after a few weeks of use. Consult your psychiatrist about non-addictive options and about therapy for insomnia.

References:

• https://www.cdc.gov/sleep/data_statistics.html
• Brower, K. J., Aldrich, M. S., Robinson, E. A., Zucker, R. A., & Greden, J. F. (2001). Insomnia, self-medication, and relapse to alcoholism. The American journal of psychiatry, 158(3), 399–404. https://doi.org/10.1176/appi.ajp.158.3.399
• Brandt, J., & Leong, C. (2017). Benzodiazepines and Z-Drugs: An Updated Review of Major Adverse Outcomes Reported on in Epidemiologic Research. Drugs in R&D, 17(4), 493–507. https://doi.org/10.1007/s40268-017-0207-7
• Chiappini, Stefania & Schifano, Fabrizio & Corkery, John & Guirguis, Amira. (2019). An insight into Z-drugs abuse and dependence: an examination of reports to the European Medicines Agency (EMA) database of suspected Adverse Drug Reactions (ADR). International Journal of Neuropsychopharmacology, pyz007.. International Journal of Neuropsychopharmacology. 22. 10.1093/ijnp/pyz007.
• Rozerem (ramelteon) tablets. Product information. Lincolnshire, Ill.: Takeda Pharmaceuticals America, Inc., 2005. Accessed online January 24, 2006, at: http://www.rozerem.com/PI_1.aspx.
• Cognitive behavioral therapy for insomnia. National Sleep Foundation. https://www.sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomnia