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Sleeping Pills

Potential effects, signs of misuse, and how to start on a path to recovery

Prescription anti-insomnia medications can help people who are having trouble sleeping. One of the most commonly prescribed sleep medicines is zolpidem, marketed in tablet form as Ambien, Ambien CR, and Edluar and in mist form as Zolpimist. Other often prescribed sleep aids include eszopiclone, known by the brand name Lunesta, and zaleplon, marketed as Sonata.

Although these so-called “Z-drugs” or “Z-hypnotics” may help with sleeping problems, they can be misused; lead to dependency and withdrawal symptoms; and, in rare cases, cause death from an accident, overdose, or suicide.

However, recovery from sleeping pill misuse is possible.

Signs and effects of sleeping pill misuse

If you have trouble sleeping, zolpidem or other Z-drugs can help you sleep peacefully and wake up feeling refreshed.

However, Z-drugs can have lingering effects. People may experience drowsiness the morning after taking a Z-drug — even if they took only the prescribed dose. Even if they feel alert, their motor skills may not be as sharp. This effect, known as “next-morning impairment,” could make it difficult to operate a car or heavy machinery. It could also throw off their balance, potentially causing them to fall. These effects worsen if they take more than the recommended dose or stay on these drugs for too long. (A sleep treatment should last no more than four weeks.)

For people who are age 65 or older or have mobility issues, using a Z-drug can increase the risk of a tumble and bone fracture. And at any age, consumption of a Z-drug makes a trip to the emergency room more likely, particularly if the drug is taken with another sedative like a benzodiazepine or alcohol.

The FDA has warned that eszopiclone, zaleplon, and zolpidem can cause complex sleep disorders such as sleepwalking or sleep driving, in which people can be seriously injured or die.

Z-drugs have caused other adverse health effects, including hallucinations, amnesia, and parasomnia (when someone acts or talks as if they are awake when they are actually asleep).

Z-drugs can lead to dependency, withdrawal, sedation, coma, and, in some cases, overdosing and death, mainly when taken in combination with other drugs and alcohol. The use of certain prescription Z-drugs could also increase the risk of suicide. If you or a loved one has had a mental health diagnosis, misused other drugs, or had alcohol dependence, it may be safer to seek nonmedicinal sleep aids than to use Z-drugs.

Signs that you or a loved one may be at risk of misusing or becoming dependent on a Z-drug include taking a higher dose than prescribed, taking the medication for longer than is recommended, going to different doctors to get new prescriptions, experiencing cravings when you try to stop using the medication, or injecting the drug.

If you think you or a loved one is in danger from misusing sleeping pills, call 911.

Prescription sleeping pill withdrawal symptoms

Use of prescription sleeping pills in the Z-drug category should be stopped gradually. Withdrawal symptoms are most common among people who suddenly quit a high dose of a Z-drug after using it over a long period. These symptoms may include anxiety, confusion, cravings, heart palpitations, high blood pressure, difficulty speaking, inner restlessness, stomach pain, tremor, and, infrequently, psychosis and seizures.

Negative effect of prescription sleeping pills on the brain: Z-drugs slow activity in the brain and, when used as intended, can assist in sleep. These sedatives act on the brain’s GABA receptors, which control sleep and motor function, among other things. The precise ways in which Z-drugs affect the brain are still being studied.

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Treatment for prescription sleeping pill misuse

Recovery from prescription sleeping pill misuse is possible. To safely stop misuse of a sleep medication, contact a licensed medical professional who can help you taper use of the drug and who can counsel you in other ways to get a good night’s sleep.

Therapy: Your provider may also refer you to a therapist for counseling and to learn nonpharmaceutical methods for alleviating symptoms or causes of insomnia. These methods include behavioral therapies; meditation and mindfulness; and physical exercises such as walking, yoga, and tai chi, which lower blood pressure, relieve stress, and improve sleep.

Medication: Even as your doctor works with you to promote sleep in nonpharmaceutical ways, they may recommend that you slowly stop using the sleep medication until you no longer have it in your system.

Recovery: Promote your recovery by naturally improving your sleep patterns. Ways to do this include going to bed and waking up at the same time every day, sleeping in dark and quiet areas, and avoiding meals and caffeine before bed.

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Sources

An Insight into Z-Drug Abuse and Dependence: An Examination of Reports to the European Medicines Agency Database of Suspected Adverse Drug Reactions, International Journal of Neuropsychopharmacology, April 2019

Association between anxiolytic/hypnotic drugs and suicidal thoughts or behaviors in a population-based cohort of students, Psychiatry Research, September 2020

Benzodiazepines and Z-Drugs: An Updated Review of Major Adverse Outcomes Reported on in Epidemiologic Research, Drugs in R & D, Sept. 1, 2017

Emergency department visits involving benzodiazepines and non-benzodiazepine receptor agonists, American Journal of Emergency Medicine, April 14, 2017

FDA adds Boxed Warning for risk of serious injuries caused by sleepwalking with certain prescription insomnia medicines, FDA Drug Safety Communication, Feb. 18, 2022

Hypnotic hazards: adverse effects of zolpidem and other z-drugs, Australian Prescriber, Dec. 1, 2008

Questions and Answers: Risk of next-morning impairment after use of insomnia drugs; FDA requires lower recommended doses for certain drugs containing zolpidem (Ambien, Ambien CR, Edluar, and Zolpimist), FDA, Feb. 13, 2018

Taking Z-drugs for Insomnia? Know the Risks, Food and Drug Administration, April 30, 2019

The Clinical and Forensic Toxicology of Z-drugs, Journal of Medical Toxicology, Feb. 13, 2013

The Z-Drugs Zolpidem, Zaleplon, and Eszopiclone Have Varying Actions on Human GABAA Receptors Containing γ1, γ2, and γ3 Subunits, Frontiers, Nov. 19, 2020

Tips for Better Sleep, Centers for Disease Control and Prevention, Sept. 13, 2022

Trends in the Use of Benzodiazepines, Z-Hypnotics, and Serotonergic Drugs Among US Women and Men Before and During the COVID-19 Pandemic, JAMA Network Open, Oct. 25, 2021