Sleeping Pill Addiction

Sleeping pills are categorized under sedative-hypnotic drugs. Although this category also includes drugs such as benzodiazepines and Xanax, sleeping aids are non-benzodiazepine hypnotic medications. They are commonly referred to as Z–Drugs due to their ability to induce sleep.

The three most popular sleeping pills are:

• Ambien (zolpidem)
• Sonatas (zaleplon)
• Lunesta (eszopiclone)

While most non-benzodiazepine sleeping pills differ in molecular structure, they do, however, cause similar effects. These medications function by decreasing activity in the central nervous system. Although sleeping aids bind to the same GABA receptors in the brain as benzos, they produce less severe side effects than benzos.

Sleeping pills are prescribed as a short-term solution for severe insomnia. These drugs are fast-acting medications that are generally consumed under PRN situations. PRN medications are drugs that are consumed as needed without a specified dosage schedule. Unfortunately, more and more people now use sleeping pills as a quick fix for sleep issues and anxiety. The use of sedatives in any way beyond a prescription is considered abuse. At high doses, sleeping pills can cause similar effects to that of benzodiazepines.

Other effects of sleeping pills include:

• Lack of co-ordination
• Dizziness
• Light-headedness
• Dreamless sleep
• Decreased anxiety
• Hallucinations

Sleeping pill abuse is now common among high school and college students as a recreational drug. When consumed along with alcohol, sleeping pills can heighten the effects of a buzz or trigger the same effect when consumed in high doses.

Typical signs of drug abuse may include:

• Inability to focus
• Impaired memory
• Unsteady gait
• Unusual euphoria
• Slurred speech

Many wrongly assume that sleeping pills are not as addictive since they were prescribed by their doctor. However, patients may find themselves forming a dependence and tolerance upon the drug after prolonged consumption. This can result in patients unable to naturally fall asleep on their own and requiring higher and higher doses to achieve the desired effects. These formations often lead to addiction.

Many patients form a dependence on sleeping pills while trying to overcome short-term insomnia. The extent of sleeping pill abuse was brought to light when over 38 million prescriptions for Ambien (a popular sleeping pill) were recorded between 2006 and 2011.

“When sleep does not come easily or is interrupted, patients may take more of their [sleep] medication than is prescribed. This may occur even though the medication guides…contain clear instructions to the patient to take the product exactly as prescribed.”

–Drug Abuse Warning Network, August 2014

Mixing sleeping pills with alcohol can lead to adverse consequences as they can increase the sedative effects of both. As a result, this can heighten the risk of an overdose that can be fatal. Although the effects of this combination may slightly vary depending on the sleeping pill consumed, it still remains dangerous.

Other drugs often consumed along with sleeping pills, may include:

• Benzodiazepines
• Antidepressants
• Painkillers

Both the immediate and long-term effects of sleeping pill misuse are sufficient for most individuals to exercise caution. Nevertheless, the biggest issue faced by patients who consume sleeping ill is their lack of awareness of its dangers. Some sleeping pills can cause allergic reactions such as trouble breathing, nausea, chest pain, and swelling.

Typical side-effects of sleeping pill abuse include:

• Dry mouth
• Daytime drowsiness
• Unusual dreams
• Depending on the drug to fall asleep
• Itching
• Preoccupation with bedtime to take medication
• Consumption of the medication to feel its euphoric effects
• Not experiencing the expected results from the prescribed dose
• Having desires to use sleeping pills during the day
• Running out of prescription early

• 21 Percent: According to a report in 2012, around 21% of the individuals who misuse sleeping pills also experienced suicidal thoughts.
• 30,149: About 30,149 emergency room visits were recorded as a direct link to non-medical Ambien’s use in 2011.
• 9 Million: About 9 million US citizens rely on sleeping pills to induce sleep.

The first step in overcoming this powerful addiction is to recognize the symptoms of abuse. The Diagnostic and Statistical Manual of Mental Disorders outlines the full criteria for the clinical diagnosis of sleeping pill addiction. These parameters include behavioral, physical, and psychological effects that arise from excessive drug use. Many who are addicted to their sleeping aids may have symptoms such as:

• Repeated failure to stop sleeping pill consumption.
• Seeming confused or frequently detached.
• Isolating oneself from friends and family.
• Ignoring social, educational, professional, and familial obligations.
• Engaging in unsafe acts while under the influence.
• Undergoing withdrawal symptoms.
• Craving sleeping pills.
• No longer participating in previously enjoyed activities.
• Having mood swings.
• Needing larger doses to fall asleep.

The purpose of an intervention is to get an addict into rehabilitation immediately. Many families employ an intervention consultant to help handle such situations. Intervention specialists can provide insight, support, and helpful guidance to an addict and his family. Their knowledge and expertise can positively help families as they navigate through this complicated step in their lives.

Prolonged use of sleeping pills can cause physical and psychological dependence on the drug. During the formation of dependence, the body starts to rely on the drug as it can no longer naturally fall asleep. As a result, when a patient abruptly ceases the consumption of sleeping pills, they may experience uncomfortable and intense symptoms known as withdrawal.

Withdrawal from sleeping pills can be intense, although it largely varies from person to person based on factors, such as the intensity, method of consumption, and length of addiction. Some of these symptoms can also be life-threatening if immediate medical attention is not provided. During a typical detox process, doctors will monitor their patient’s vital signs and address any life-threatening health concerns that may arise.

Withdrawal from sleeping pills may include physical and psychological symptoms. Patients with severe addiction, polydrug abuse, and co-occurring mental health disorders may experience the most intense and complicated withdrawal symptoms that would require medical attention.

Some of the common sleeping pill withdrawal symptoms are:

• Body spasms
• Seizures
• Anxiety
• Insomnia
• Delirium
• Drug cravings
• Irritability
• Depression
• Confusion
• Hallucinations
• Profuse sweating
• Rapid heart rate
• Hand tremors
• Nausea
• Vomiting

The formation of dependence can cause the return of insomnia when the patient ceases their consumption of sleeping pills. The return of such insomnia is often much intense that initially experienced before being prescribed these medications. Rebound insomnia can last for a few days or a few weeks, depending upon the severity of one’s addiction.

“Rebound insomnia is like having a double dose of insomnia. The body — which couldn’t sleep in the first place — adapts to needing a sleeping pill to sleep, and when it is then taken away, the insomnia is compounded.”

-Dr. Cosmo Hallström, Royal College of Psychiatrists, Daily Mail, 2010

Rebound insomnia can cause an almost complete loss of sleep for several days. The duration of rebound insomnia may depend on factors, such as the half-lives of the medication, the frequency of drug use, and the dosages taken by the individual at a given time.

The half-lives of most commonly used sleeping pills are:

• Lunesta – six hours
• Sonata – one hour
• Ambien or Ambien CR – 2.5 to 3.1 hours
• Rozerem – 1 to 2.6 hours

The drugs with shorter half-lives tend to display faster and more intense rebound effects that often resolve faster. These effects may diminish within a few days to a week after quitting the drug use. On the contrary, drugs with longer half-lives tend to display less intense rebound effects. However, they may take longer to diminish.

The withdrawal process and the duration vary drastically from one sleeping pill user to another. But for most, withdrawal symptoms start to appear within several hours to a few days after quitting the drug use. Most of these symptoms disappear after a week or two, but the psychological symptoms may last for several more weeks. These persistent symptoms are called as post-acute withdrawal symptoms or PAWS and can include insomnia, anxiety, irritability, agitation, mood swings, and poor concentration, amongst many others.

Since sleeping pill withdrawal symptoms can be quite dangerous, users are strongly advised to seek treatment at a medically supervised treatment facility. Patient’s with sleeping pill addiction is generally advised to taper off their medications rather than quitting cold turkey. Abruptly quitting the drug can cause intense withdrawal symptoms that can be difficult to handle. Although tapering drug use takes time, it reduces the intensity of withdrawal symptoms’ and decreases the chance of a relapse.

During detox, patients are constantly monitored to ensure the process is carried out safely. Medications are also administered as needed based on each patient’s condition. If the symptoms worsen or certain health issues arise, the doctor will modify the treatment accordingly. After the completion of detoxification, patients will receive further treatment at an inpatient or outpatient treatment center.

Treating a sleeping pill addiction requires counseling and a gradual reduction in dosage during detox. Therapies such as cognitive-behavioral therapy can effectively manage sleeping pill addiction, as it helps develop healthier sleeping patterns without medication.

Prolonged use of sleeping pills can cause adverse changes to brain function that would require gradual and long-term treatment to reverse. Depending on the severity of one’s addiction, some patients may require months to reverse the damages caused. Those who are diagnosed with a severe addiction must continue with treatment at an inpatient rehabilitation. With reports of high-profile deaths caused by sleeping pill misuse over the years, inpatient rehab facility benefits are more evident than ever before.

Those who have been consuming sleeping pills for a longer time and at high doses benefit significantly from inpatient recovery. Inpatient rehab functions by removing patients from their unhealthy environment so they could develop healthier sleeping habits, relaxation, and self-care strategies to relieve stress and anxiety.

Inpatient rehabilitation is also more beneficial for those struggling with polydrug addiction and co-occurring disorders. Many patients with underlying psychiatric problems, such as depression, are more likely to relapse if such issues are not properly addressed. Psychiatric illnesses are usually the general cause of a patient’s insomnia, and treating it is a vital part of rehabilitation.

“most addicted individuals need at least three months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment.”

–National Institute on Substance Abuse (NIDA).

Inpatient rehabilitations provide patients with a structured schedule void of all distractions and temptations. This greatly helps patients focus solely on their recovery. A day to day inpatient rehab program may include community meetings, recreational therapy, one-on-one counseling, support group meetings/treatment, and occasional family visits or family therapy.

Outpatient rehabilitation is an ideal choice for patients diagnosed with a mild form of addiction. Although this rehab does not provide any residential or medical components of inpatient treatment, it does, however, provide patients with the flexibility to receive the treatment they require and return back to their lives. This is an ideal situation for those who have unavoidable obligations and responsibilities at home and at work. This program is also best suited for patients who complete inpatient rehabilitation as it provides them with the additional treatment they require as they gradually integrate into their day to day life.

Addiction is recognized as a chronic illness that requires lifelong treatment. Continued therapy after recovery is, therefore, an essential part of a patient’s journey. Stress, anxiety, and sleep problems are all typical during recovery that must be promptly addressed to avoid relapses. Ongoing recovery may consist of therapy, counseling, and support groups.

Individuals with long-term insomnia are better treated with cognitive-behavioral therapy as they are more effective over time than using drugs. Such treatments help patients learn positive and healthy sleeping habits, relaxation skills, meditation, and improve cognitive processes. These programs can highly benefit patients by improving their health and wellbeing.

Here are a few relapse prevention techniques:

• Avoiding caffeine
• Establishing a structured sleep schedule
• Exercising regularly
• Taking short 15-20-minute naps when needed
• Using stress-reduction strategies
• Maintaining good sleep habits

Some tips for regular and comfortable sleep include:

• Regular exercise: Daily exercise can decrease tension, anxiety, and stress significantly. Exercises or physical activities such as walking, hiking, and swimming can greatly improve the quality of sleep.
• Sticking to bedtime: The body’s internal clock tends to unbalance when bedtimes are inconsistent and unplanned. Those who follow a scheduled bedtime consistently will eventually feel tired when bedtime arrives.
• Address the underlying cause: Insomnia is a common symptom of depression and anxiety. Those who neglect these issues find it difficult to sleep, leading to a vicious cycle of sleepless nights. Addressing these issues through counseling and therapy can treat insomnia without the need for medication.