Evie Summers
Sleeping pills are medications designed to help people fall asleep and treat insomnia. While they can be effective in the short term, they are not intended for long-term use due to associated side effects and the risk of dependency. It is important to consult a healthcare professional before taking sleeping pills, especially when pregnant, breastfeeding, or giving them to children. Mixing sleeping pills with certain substances, such as alcohol or other sedatives, can lead to an increased risk of overdose and other adverse effects. Therefore, it is crucial to follow the prescribed dosage and be aware of potential interactions with other medications.
| Characteristics | Values |
|---|---|
| Purpose | Help people with sleep disorders like insomnia fall asleep and stay asleep |
| Effectiveness | Sleeping pills generally start working within 20 to 30 minutes |
| Side effects | May cause dizziness, fatigue, irritability, and long-term side effects such as depression |
| Safety concerns | Can be addictive, may cause rebound insomnia, overdose, or parasomnia |
| Precautions | Should not be used long-term, should not be mixed with alcohol or other sedatives, should be taken as prescribed |
| Alternatives | Good sleep hygiene, nondrug treatments, and systematic treatment plans are recommended |
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What You'll Learn
Side effects and long-term usage
Sleeping pills can have several side effects and are not recommended for long-term usage. They are designed to help with short-term sleep issues and can be addictive if used continuously over an extended period.
Side Effects
Sleeping pills can cause a range of side effects, including drowsiness, difficulty with balance or motor coordination, impaired focus or memory, and a "hangover" effect the next day. More rarely, they can cause allergic reactions and nocturnal behaviours such as sleepwalking, sleep talking, sleep eating, and even sleep driving. These behaviours can be dangerous and may increase the risk of accidents and falls, especially for older people. Additionally, mixing sleeping pills with other medications or alcohol can increase the risk of injuries, memory problems, and even death.
Some sleeping pills, such as benzodiazepines, can be habit-forming and lead to substance use disorders. They may also cause dizziness, fatigue, irritability, and long-term side effects like depression, especially in patients with liver and kidney disease. Withdrawal from sleeping pills can also cause adverse effects, including rebound insomnia, where insomnia worsens after stopping the medication.
Long-Term Usage
Sleeping pills are generally not recommended for long-term use due to the risk of dependency and adverse health effects. Long-term use of prescription hypnotics (sedatives) and anxiolytics has been associated with increased mortality. Additionally, prolonged use of sleeping pills may worsen insomnia in the long term, as the pills become less effective over time. It is important to consult a doctor before taking sleeping pills for an extended period and to follow their instructions for safe use.
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Addiction and withdrawal
Sleeping pills are addictive and can lead to substance use disorders. Users may not realise they are dependent on the pills until they abruptly quit, causing side effects that impact their daily lives. Withdrawal symptoms can occur when people suddenly stop using sleeping pills. Depending on the specific drug, symptoms can start within a few hours, but they may also start later – sometimes even weeks after you stop taking the medication.
Typical withdrawal symptoms include trouble sleeping, restlessness, anxiety, shivering, circulation problems, seizures, and feeling dizzy and faint. These symptoms are similar to the ones the sedative was originally meant to get rid of, which may cause a vicious cycle where people start using the sleeping pills again to relieve these symptoms. To avoid such relapses, it is important to try to keep withdrawal symptoms to a minimum when stopping the medication. This is why it is common to gradually reduce the dose over several weeks before stopping the medication completely.
The withdrawal process, including its duration, is different for each sleeping pill user. For most, symptoms of withdrawal begin to present within several hours to a few days after quitting the drug. Symptoms generally fade after about a week or two, but the psychological symptoms have been known to last for several weeks after. These persistent symptoms are known as post-acute withdrawal symptoms (PAWS). They include insomnia, anxiety, irritability, agitation, mood swings, and poor concentration.
Benzodiazepines (BZDs) are a powerful class of sleeping pills that can lead to addiction and substance use disorders. To lower this risk, healthcare providers only prescribe these sleeping pills for short-term use. You are more likely to get a prescription for Z-drugs, which are fast-acting sleeping pills that take effect 30 minutes after intake and last up to 8 hours.
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Overdose
While sleeping pills are designed to aid sleep and are generally safe when prescribed, it is possible to overdose on them. Overdose can occur when an individual takes more than the recommended dose or when sleeping pills are combined with other substances like alcohol or opioids, which amplify their effects.
Sleeping pills are central nervous system depressants, slowing down brain activity to induce sleep. However, too much medication can lead to a deep state of sedation, dangerously slowing down critical functions like breathing, heart rate, and even stopping them. Mixing sleeping pills with other central nervous system depressants can be life-threatening.
The physical signs of a sleeping pill overdose include extreme lethargy, confusion, shallow or difficult breathing, decreased heart rate, and loss of coordination. More severe signs include unconsciousness or coma. Some people might also experience nausea, vomiting, or abdominal pain.
Accidental overdose can occur when someone becomes dependent on sleeping pills but gradually needs higher doses to achieve the same effect. Older adults are at a higher risk of overdose due to decreased drug metabolism rates. Additionally, certain antifungal and antibiotic medications can affect the metabolism of sleeping pills, increasing their sedative effects.
If you suspect someone has overdosed on sleeping pills, call emergency services immediately. Keep the person awake and talking if possible, and if they are unconscious, place them in the recovery position until help arrives. Seeking immediate medical attention is crucial, as healthcare professionals can provide life-saving interventions.
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Interactions with other drugs and substances
Sleeping pills can interact with other drugs and substances, and caution should be exercised when taking them alongside other medications. Before prescribing a specific sleeping pill, a doctor will consider the patient's existing mental or physical health concerns and ensure the sleep aid will not interact negatively with any other drugs or substances the patient is taking.
It is important to be transparent with your doctor about all health conditions and drugs being used, including prescription, over-the-counter, and complementary medicines. This is because combining certain medications can introduce the potential for adverse 'drug-drug' interactions. For example, taking sleeping pills with alcohol, even a small amount, can increase the sedative effect and cause confusion, dizziness, or fainting. Mixing sleeping pills with opiates, antidepressants, or antihistamines can also be dangerous, and in some cases, may lead to slowed breathing and even death.
Some prescription sleep medications, such as benzodiazepines, carry a risk of physical addiction and overdose. They are not usually prescribed long-term as patients can quickly develop a tolerance, requiring higher doses over time. Non-benzodiazepine "Z-drugs", on the other hand, have a lower risk of abuse and generally have a more favourable side-effect profile. However, the FDA has recently warned that Z-drugs are more likely to cause complex sleep behaviours, such as sleepwalking or driving while asleep.
Over-the-counter (OTC) sleep aids may also interact with other medications and can have side effects. However, they are not intended for long-term use and have not been shown to improve sleep quality. Examples of common OTC sleep aids include melatonin, valerian, and antihistamines like Benadryl, Sominex, and Tylenol PM.
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Safety for pregnant and breastfeeding women
Sleep disturbances and disorders are common during pregnancy, affecting 5% to 38% of women in early pregnancy and up to 60% in late pregnancy. While sleep aids and sleeping pills can be helpful, the decision to use them during pregnancy and breastfeeding requires careful consideration due to potential risks.
When it comes to taking sleep aids during pregnancy, it is essential to consult with a healthcare provider first. Certain over-the-counter sleep aids, such as Unisom and Benadryl, are generally considered safe for pregnancy. Doxylamine, the active ingredient in Unisom, is an antihistamine that is considered safe during pregnancy and is also used to treat nausea, a common pregnancy symptom. Diphenhydramine, the active ingredient in Benadryl, Tylenol PM, and ZzzQuil, is generally considered safe for occasional use during pregnancy. However, as with any medication, it is important to be aware of potential side effects.
Most healthcare providers caution against using prescription medications such as Valium and Ambien during pregnancy. There is limited research on the safety of prescription sleeping pills during pregnancy, and they may carry a higher risk of negative interactions with the mother and baby. Trazodone, an antidepressant with sedative effects, is sometimes prescribed in pregnancy to help with insomnia, but it is important to discuss the risks and benefits with a healthcare provider.
During breastfeeding, some medications, such as zolpidem (Ambien), have been found to pass into breast milk in small amounts. While one study reported no problems in babies, it is important to monitor for potential symptoms such as sleepiness, trouble gaining weight, low muscle tone, or slow breathing. Non-pharmacological interventions, such as improving sleep hygiene, practising relaxation techniques, and addressing underlying issues like sleep apnea or restless leg syndrome, are generally recommended as the first line of treatment for sleep disturbances during pregnancy and breastfeeding.
In summary, while some over-the-counter sleep aids may be considered relatively safe during pregnancy, it is crucial to consult with a healthcare provider to weigh the risks and benefits of any medication use during this time. Breastfeeding women should also exercise caution and seek medical advice, as some medications can pass into breast milk and potentially affect the baby. Prioritising non-pharmacological approaches to improving sleep can be a safer and effective strategy for pregnant and breastfeeding women.
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Frequently asked questions
Sleeping tablets are generally safe to take in the short term, but they can have side effects and are not suitable for everyone. It is important to consult a doctor before taking sleeping tablets, especially if you are pregnant, breastfeeding, or taking other medications.
Sleeping tablets can cause dependence, meaning that users may find they are unable to sleep without them. They can also interact with other medications, particularly those that affect the central nervous system, and may cause depressed breathing or even death in some cases. Other side effects include dizziness, fatigue, irritability, and long-term effects such as depression, especially in patients with liver and kidney disease.
Sleeping tablets are not recommended for children, and there are currently no prescription sleep medicines available for this age group. People over the age of 65 should also try non-drug treatments first, as there may be safer ways to improve sleep. Pregnant and breastfeeding women should consult a doctor before taking any sleeping tablets, as the medication can be passed on to the fetus or baby.
