Colin Snow
Sleeping pills are available over the counter or by prescription, and they can help people fall and stay asleep. However, they are not without risks. Sleeping pills can cause side effects and are associated with addiction and overdose, especially when combined with opioids or alcohol. Opioids, on the other hand, are prescription medications that act on the brain's orexin neurotransmitter system, impacting wakefulness and sleep. While they are used to manage pain, they can also alter sleep quality and contribute to daytime sleepiness. With nearly 92 million Americans using opioids, understanding their interaction with sleeping pills is crucial for patient safety.
| Characteristics | Values |
|---|---|
| Are sleeping pills opiates? | No, they are not. Opioids are prescription painkillers. Sleeping pills are available over the counter or by prescription. |
| Types of sleeping pills | Over-the-counter (OTC), natural supplements, or prescription. |
| Over-the-counter sleeping pills | Often contain antihistamines, which can make you drowsy. |
| Prescription sleeping pills | Stronger than over-the-counter pills. They are not a cure for insomnia and carry a risk of dependence and addiction. |
| Side effects of sleeping pills | Can cause uncomfortable withdrawal symptoms. May lead to addiction. |
| Sleeping pills and opioids | Taking prescription opioids with sleeping pills increases the risk of overdose. |
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What You'll Learn
Opioids and the orexin neurotransmitter system
Opioids directly affect sleep through the orexin neurotransmitter system, which is responsible for wakefulness. When orexin is overactive, a person may experience difficulty falling or staying asleep, and cravings for drugs or other substances may increase. The orexin system has been implicated in the regulation of motivation, arousal, and stress, making it a promising target for treating substance use disorders.
The non-medical use of prescription opioids has become a major concern due to the dramatic increase in abuse and overdose cases. While medications for opioid use disorder (MOUD) such as buprenorphine and methadone are frontline treatments, they have limited effectiveness due to restricted access, the need for a maintenance regimen, the risk of overdose, and the social stigma associated with OUD. This highlights the need for novel pharmacotherapies, and the orexin system has emerged as a potential target.
Research suggests that the orexin system plays a role in regulating the high motivation to take and seek drugs of abuse. Studies have shown that targeting the orexin system, specifically OrxR1 and OrxR2 receptors, may effectively reduce the motivation for and craving of opioids. For example, SB334867 can selectively decrease drug-seeking behaviour without interfering with regular food intake. Additionally, medications like suvorexant, a dual-orexin receptor antagonist, have been found to improve sleep disturbance, opioid withdrawal, and craving during opioid tapering.
A Phase 3 clinical trial is currently underway to assess the effectiveness of suvorexant in treating insomnia in individuals with OUD. This trial aims to enrol 300 participants with insomnia and stable doses of buprenorphine or methadone for OUD. Participants will be randomised to receive suvorexant or a placebo once daily for eight weeks, undergoing polysomnography sleep studies at the beginning and end of the treatment to evaluate sleep improvement. The results of this trial will provide valuable insights into the role of the orexin neurotransmitter system in OUD and guide future medication development.
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Over-the-counter sleeping pills
Sleeping pills are available over the counter (OTC), as natural supplements, or by prescription. Anyone over the age of 18 can buy OTC sleep medications at drugstores or other retail outlets without a prescription. It is important to exercise caution when taking sleeping pills, as they can cause side effects such as constipation, muscle weakness, digestive problems, and worsened snoring and sleep apnea. Additionally, there is a risk of dependence and addiction with long-term use.
Some people opt for natural remedies such as melatonin or valerian supplements to aid sleep. Melatonin is a hormone naturally produced by the body that promotes sleep, while valerian is an herb that is believed to aid relaxation and sleep. Although easily accessible, it is recommended to consult a healthcare provider before taking any OTC sleeping pills or supplements, as they can interfere with other medications or aggravate existing health conditions.
For extreme insomnia, a healthcare provider may prescribe a short-term sleep aid. Prescription sleeping pills are stronger than OTC options and are typically recommended for short-term relief due to the risk of dependence and addiction. Types of prescription sleeping pills include antidepressants, barbiturates, benzodiazepines (benzos), and Z-drugs such as zolpidem (Ambien) and eszopiclone (Lunesta). Benzodiazepines, in particular, carry a risk of addiction and are therefore usually prescribed for short-term use, with Z-drugs being a more common alternative.
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Prescription sleeping pills
Sleeping pills are available over the counter (OTC) or by prescription. Prescription sleeping pills are stronger than over-the-counter ones and are only recommended for short-term relief. They are not a cure for insomnia and there is a risk of dependence and addiction.
Z-drugs like zolpidem (Ambien) and eszopiclone (Lunesta) are non-benzodiazepine benzodiazepine receptor agonists, which means they act on the same brain receptors as benzodiazepines but have a different molecular makeup. These medications can also produce hallucinatory effects if an individual fights the urge to sleep after taking them. They also have dangerous interactions with alcohol, increasing the likelihood of a fatal overdose.
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Opioids and sleep-disordered breathing
Opioids are commonly used for acute and chronic pain management. However, they are highly vulnerable to abuse, and opioid use disorder (OUD) is a chronic and relapsing brain disease characterised by loss of control over opioid use and deficits in cognitive function, mood, pain perception, and autonomic activity.
OUD can lead to sleep deficiency, and opioids have been associated with an increased prevalence of sleep-disordered breathing (SDB), ranging from 42% to 80% in certain clinical referral populations. This prevalence is challenging to define due to the complex bidirectional interactions among sleep, OUD, and breathing control, as well as the different manifestations of SDB.
The effects of opioids on breathing during sleep are influenced by a range of physiological factors, including concurrent central nervous system depressant use. Opioids can cause breathing to slow and become irregular, leading to hypercapnia and hypoxia, especially with high doses. Central sleep apnea is very common with high-dose opioid use and is associated with impaired psychomotor vigilance performance. The respiratory patterns associated with opioids are distinctive, including ataxic, Biot's or cluster breathing, and periodic breathing with short cycle times.
The opioid crisis has brought to light the link between opioid use and SDB. To address this, researchers at Johns Hopkins Medicine are conducting a three-year, multisite, Phase 3 clinical trial of the sleep medication suvorexant (Belsomra) for people in treatment for OUD. The trial aims to enrol 300 participants with insomnia and OUD who will take suvorexant or a placebo once daily for eight weeks. The participants will undergo polysomnography (PSG) sleep studies at the beginning and end of the treatment to assess improvements in total sleep time and time spent awake after falling asleep.
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Opioids and overdose risk
Opioids are a class of drugs that includes compounds extracted from the poppy plant (*Papaver somniferum*) and semisynthetic and synthetic compounds with similar properties that can interact with opioid receptors in the brain. These drugs have analgesic and sedative effects and are commonly used for pain management. Examples include morphine, codeine, and fentanyl.
Opiates are a subset of opioids that refers specifically to compounds derived from the opium poppy plant. While opioids act on opioid receptors in the brain, they can also have pharmacological effects that lead to breathing difficulties and, in the case of an overdose, death. Opioid overdose is a significant and growing problem, with drug overdose being the leading cause of accidental death in the United States, and opioids being the primary cause. Worldwide, in 2019, about 600,000 deaths were attributed to drug use, with close to 80% related to opioids and about 25% caused by opioid overdose.
There are several risk factors that increase the likelihood of an opioid overdose:
- Mixing opioids with other substances, such as alcohol, benzodiazepines ("benzos"), or other respiratory depressants.
- Using opioids with stimulants, such as cocaine or methamphetamine.
- Having chronic health conditions, such as HIV, hepatitis C, lung disease, heart disease, or other health concerns.
- A history of past overdoses or changes in tolerance due to periods of less or no opioid use.
- High prescribed dosages of opioids or using prescription opioids without medical supervision.
- Severe medical and psychiatric conditions, such as depression, HIV infection, and lung or liver disease.
- Resumption of opioid use after an extended period of abstinence.
To reduce the risk of opioid overdose, it is important to increase the availability of opioid dependence treatment and prevent irrational or inappropriate opioid prescribing. Additionally, those at risk of overdose should carry naloxone, an antidote to opioids that can reverse the effects of an overdose if administered in time. However, access to naloxone is generally limited to health professionals, and its availability varies across countries.
While sleeping pills are available over the counter and by prescription, they are not opioids. However, they can interact with opioids and increase the risk of overdose. Benzodiazepines and zolpidem (Ambien), which are sometimes prescribed for people with opioid use disorder, can increase the risk of opioid overdose. Additionally, off-label antidepressants or antihistamines prescribed for sleep may not be effective and could potentially interact with opioids to increase the risk of overdose. Therefore, it is important to exercise caution when using sleeping pills, especially in combination with opioids.
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Frequently asked questions
Opiates are powerful painkillers derived from the opium poppy plant. They include drugs like heroin, morphine, and prescription painkillers.
No, sleeping pills are not opiates. Sleeping pills are available over the counter or by prescription and work by changing how the brain functions to help you fall and stay asleep. Opiates, on the other hand, are a type of drug that directly affects sleep through the orexin neurotransmitter system responsible for wakefulness.
It is not recommended to take sleeping pills with opiates. Taking strong prescription painkillers together with sleeping pills increases the risk of overdose. Additionally, opioids can interfere with sleep, leading to changes in sleep architecture and reduced sleep quality.
