Sleeping Pills: What To Do When They Don't Work

Sleeping pills are a common treatment for insomnia, but they don't always work. Insomnia is a sleep disorder that makes it difficult to fall or stay asleep. While sleeping pills can be effective in the short term, they may become less effective over time as the body builds a tolerance. This is known as tachyphylaxis or tolerance, and it can lead to an increased dosage or the need to switch to a new medication. Additionally, sleeping pills may not address the underlying causes of insomnia, such as stress, anxiety, or depression. Other factors that can interfere with sleep include room temperature, alcohol consumption, caffeine intake, and certain health conditions.

Tolerance and tachyphylaxis

Sleeping pills can be a welcome relief for those who suffer from insomnia. However, this relief can be short-lived as, over time, sleeping pills can become less effective. This change in effectiveness may be due to a process called tachyphylaxis, a form of tolerance.

Tachyphylaxis and tolerance refer to the body's gradually diminished response to the same dose of medication. In the case of sleeping pills, this means that over time, a person may find that their usual dose is no longer as effective, and they may need to increase the dosage to get the same impact. This can be dangerous if not done under medical supervision, as it can lead to an increased risk of overdose, especially when combined with alcohol.

Tachyphylaxis and tolerance occur due to the body's natural process of developing a tolerance to a medication. This process is related to metabolism, which can be influenced by factors such as genetics, age, sex, and body type. In the brain, nerve cells can change the number and responsiveness of receptors, reducing the impact of the drug over time. This can happen quite quickly, leading to tachyphylaxis, or more gradually, resulting in tolerance.

To avoid the issues of tachyphylaxis and tolerance, it is recommended to use sleeping pills only for a short period, typically less than two weeks. It is also important to not combine multiple medications or use them with alcohol. If sleeping pills are no longer effective, it is best to consult a healthcare provider, who may recommend alternative treatments such as cognitive-behavioural therapy for insomnia (CBTi).

Dependence and addiction

Sleeping pills are easily accessible and often seen as a blessing for those struggling with sleep. However, they can be incredibly addictive, and many become dependent on them without realizing it. Dependence and addiction to sleeping pills can have severe consequences and lead to significant health problems.

Dependence

Sleeping pills can cause physical dependence, especially when taken for more than two weeks. This is due to a natural process called tolerance, where the body gradually becomes less responsive to the same dose of the medication. As a result, individuals may find themselves increasing their dosage without medical advice to achieve the desired effect. This can be dangerous and lead to an overdose, especially when combined with alcohol or other drugs.

Addiction

Addiction to sleeping pills is a serious problem and is considered a public health concern. It often goes unnoticed as many do not consider these medications to be addictive. However, sleeping pill addiction can easily develop and even lead to more dangerous drug use. The American Psychiatric Association does not have specific criteria for sleeping pill addiction, making it challenging for medical professionals and law enforcement to identify true addiction.

Signs of Addiction

• Increasing Dosage: The need to increase the dosage is a classic sign of addiction, as the body builds tolerance and requires more of the drug to achieve the same effect.
• Inability to Quit: Long-term use of sleeping pills is not recommended, and the inability to stop taking them, despite trying, is a sign of addiction.
• Doctor Shopping: Visiting multiple doctors to obtain prescriptions for sleeping pills, also known as "doctor shopping," is a red flag for potential addiction.
• Withdrawal Symptoms: Sleeping pills, especially benzodiazepines, can lead to withdrawal symptoms similar to alcohol withdrawal, including increased heart rate, sweating, shaking, and anxiety.
• Neglecting Obligations: Spending more time using the substance than typical and neglecting social, professional, and familial obligations are signs that the drug use is impacting daily life and relationships.
• Cravings and Psychological Dependence: Constantly craving sleeping pills and believing that one cannot sleep without them indicates a psychological dependence that can lead to addiction.

Treatment

If you recognize any of these signs, it is crucial to seek help. Substance use treatment and medical detox are available to safely taper off sleeping pills and minimize withdrawal symptoms. Therapy, such as cognitive-behavioral therapy (CBT), can also help individuals address the underlying causes of their addiction and improve their sleep without medication.

Side effects

Sleeping pills can have a variety of side effects, ranging from mild to severe. Some common side effects include:

• Daytime drowsiness, dizziness, and confusion: These effects can impact your ability to drive, work, or perform daily tasks.
• Digestive problems: This includes constipation, diarrhea, gas, heartburn, and nausea.
• Worsening of snoring and sleep apnea: Sleeping pills can interfere with breathing and pose risks for people with certain lung conditions.
• Parasomnias: These are complex sleep behaviours, such as sleepwalking, sleep eating, or driving while asleep.
• Rebound insomnia: When you stop taking sleeping pills, your insomnia may return or worsen.
• Dependence and tolerance: Over time, you may need higher doses to achieve the same effect, and it may become difficult to sleep without them.
• Memory and attention issues: Sleeping pills can cause mental slowing, problems with attention, and memory difficulties.
• Dry mouth, constipation, and urinary problems: These are more common in older adults.
• Allergic reactions: Allergic reactions to sleeping pills can include blurred vision, difficulty breathing or swallowing, throat closing, and swelling of the face, lips, tongue, or throat.

It is important to note that side effects can vary depending on the type of sleeping pill and individual factors. If you are experiencing side effects from sleeping pills, consult your doctor or healthcare provider for advice and to explore alternative treatments for insomnia.

Lifestyle changes

If sleeping tablets are not working for you, there are many lifestyle changes you can make to improve your sleep.

Maintain a sleep schedule

Stick to a sleep schedule by going to bed and waking up at the same time every day, even on weekends. This helps to regulate your body's sleep-wake cycle.

Relax before bed

Relax at least one hour before bed. Take a bath, read a book, listen to soothing music, or practice meditation. These activities can help you wind down and prepare for sleep.

Create a comfortable sleep environment

Make sure your bedroom is dark, quiet, and cool. Use curtains, blinds, an eye mask, or earplugs if needed to create a comfortable environment. Ensure your mattress, pillows, and bedding are comfortable and inviting.

Exercise regularly

Engage in regular physical activity during the day, preferably outdoors. However, avoid exercising within four hours of bedtime, as it may interfere with your sleep.

Avoid stimulants and heavy meals close to bedtime

Refrain from consuming caffeine, alcohol, tea, or heavy meals at least six hours before going to bed. These substances can interfere with your sleep and make it difficult to fall or stay asleep.

Limit screen time before bed

Avoid watching television or using electronic devices such as smartphones or tablets right before going to bed. The blue light emitted by these devices can make you more awake and disrupt your sleep.

Avoid napping during the day

Resist the temptation to nap during the day, even if you feel tired. Napping can disrupt your sleep schedule and make it harder to fall asleep at night.

Practice cognitive behavioural therapy (CBT)

Consider seeking help from a therapist trained in CBT. CBT can help you change the thoughts and behaviours that keep you from sleeping. Techniques such as mindful breathing, visual imagery, muscle relaxation, and stress reduction can improve your sleep quality.

Alternative treatments

If sleeping tablets are not working for you, there are alternative treatments you can try. Sleeping tablets are not a cure for insomnia and are only recommended for short-term use. Here are some alternative treatments to consider:

Lifestyle Changes

Doctors often recommend making lifestyle changes to improve your sleep. This includes practising good sleep hygiene, such as creating a sleep-friendly environment, maintaining a consistent sleep schedule, and limiting caffeine and alcohol intake.

Talk Therapy

Talk therapy, such as cognitive-behavioural therapy (CBT), can be an effective treatment for insomnia. CBT can help change behaviours and thoughts that disrupt sleep. It is often recommended as a first-line treatment option and can be done face-to-face with a therapist or through an online self-help programme.

Alternative Therapies

Alternative therapies such as electroacupuncture are also being explored as potential treatments for insomnia.

Herbal and Traditional Medicines

Herbal and traditional medicines, such as valerian, lavender, and Chinese herbal medicine, have been used to treat insomnia. However, their safety and effectiveness may not be scientifically proven. Always check with your doctor or pharmacist before taking any herbal or traditional medicines.

Other Prescription Medicines

In some cases, doctors may prescribe medicines typically used for other conditions, such as epilepsy or depression, that can also help with sleep. It is important to follow your doctor's advice and be cautious when taking any medications for sleep.

Frequently asked questions