So sleeping pills help me sleep. Can I take sleeping pills forever?

What you need to know about sleeping pills.

If used right, at the right time, sleeping pills can help curb further health issues, be it physical or psychiatric.  Sleep deprivation can spiral out of control resulting in worsening of depression, pain, and other existing conditions and can even bring about illnesses that may not otherwise have surfaced.  Sedatives are a wonderful class of medications that can be helpful but before starting treatment with sedatives, it is important to gauge whether it is in fact, necessary to treat and for how long if sleeping pills are called for

Why is it important that sleeping pills not be taken for a long period of time?

Benzodiazepam (BDZ)

BDZs like Temazepam, Flurazepam, or Estazolam decrease latency to sleep and increase sleep continuity and total sleep. They help you fall asleep faster and stay asleep longer. However, much like any other medication that we turn to for any given condition, they are not free of issues.

Tolerance is one of the major issues with the use of BDZs. When a sleeping pill that belongs to BDZ class is used for an extended period, pharmacodynamic tolerance or adaptation to some effects of BDZ hypnotics may develop. When the duration of therapy with BDZs continue for longer period than recommended, it is possible that you may not be able to obtain the same sedative effects you observed at the beginning of therapy.

Extended use of BDZ sleeping pills can also result in increased wakefulness during the last third of the night and the appearance of increased signs of daytime anxiety. This is especially pronounced with medications that have a short elimination half-life. Meaning, if a medication is quickly eliminated from your body, there is a lack of such medication at the GABA-BDZ receptor complex site in between doses. Since BDZs have some anxiolytic effects as well, it follows that during the period where there is a lack of such medication in your body, you may experience an apparent increase in anxiety. You may also experience wakefulness at the last leg of your sleep period as the effects of the sleeping pills wear off.

BDZs can also cause physical and psychological dependence. Benzodiazepines are addictive and habit-forming which is part of the reason why they are only recommended for short-term use. Most studies and clinical trials out there were based of 2 weeks in duration. Even at the end of such short duration of therapy for insomnia, some patients already experienced some of the withdrawal symptoms such as irritability, nervousness, and ironically INSOMNIA. This leads back to the fact that the relative absence of the sleeping pills can cause increased wakefulness.

The incidence of these issues appears to be directly proportional to the duration of therapy with the sleeping pills, increasing in frequency with extended use for sleep.

Benzodiazepine-like non-BDZs

BDZ-like non-BDZs, sometimes referred to as Z-hypnotics are also recommended for short-term use which is understandable since they employ the same mechanism of action to help you sleep. They provide decrease in time to sleep onset for the most part.

Unlike BDZs, some of the studies done with this class of sleep medications suggest up to 35 weeks of use may be beneficial with no tolerance noted. However, the relationship here also appears to be directly proportional. The longer you are taking these sleeping pills the more likely you will experience rebound insomnia when you stop taking them.

The occurrence of withdrawal symptoms after you stop taking these sleeping pills is not well established but there is evidence of symptoms such as fatigue, nausea, vomiting, flushing, lightheadedness, panic attacks, nervousness, and abdominal discomfort.

Rozerem

Rozerem works differently from the benzodiazepine sleeping pills and benzodiazepine-like sleeping pills (please read my hub Sleeping pills: How do they help you sleep? for further information on how they help you sleep).  Rozerem works by exerting its effects on the Melatonin receptors unlike the other sleeping pills so it is not expected to produce side effects such as learning and memory impairment, drug dependence, and rebound insomnia.  However, it is relatively new thus less data is available and is still recommended for short duration of treatment.

Cognitive-Behavioral Modification

Long-term use of sleeping pills should be avoided but rather used as an aide while determining the primary cause of insomnia to treat it effectively.  Sedative/hypnotics do not treat the underlying causes of insomnia. In insomnia, non-pharmacological measures such as good sleep habits (please see Trouble Sleeping? Things you can do TODAY to help get rid of your insomnia. for more information) should always be considered prior to the use of use of sleeping pills and reinforced as necessary on an ongoing basis.

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Comments 4 comments

James A Watkins profile image

James A Watkins 5 years ago from Chicago

Thank you for this useful Hub. I do have trouble sometimes sleeping. Over the counter sleeping pills do help. So does Ambien, if you can get it. :)


WannaB Writer profile image

WannaB Writer 5 years ago from Templeton, CA

Thanks for explaining how these work. My problem lies more in falling asleep than in staying asleep. The only good writing time I have is after everyone else has gone to bed and the phone stops ringing. That's when I do web site modifications and writing for the various sites I belong to. It's really hard to turn my brain off because the clock says I ought to be in bed. When I obey the clock, I can't fall asleep anyway and get more stressed because its seems it's a waste to just lie there when I'm not sleeping.

You didn't mention the OTC sleeping aids like DoxylamineSuccinate, which I will sometimes take when I don't want to use a BDZ-like non-BDZ. usually save the big guns for when I have too much pain to find a comfortable sleeping position or if I haven't had good sleep (at least five or six hours) for at least two consecutive nights. I try not to take anything but melatonin most nights, along with Calcium and magnesium and amitriptyline HCL, which the doc has prescribed for every night. Usually these are sufficient. My husband has always been one who can lie down and be out like a light.


terixf profile image

terixf 5 years ago from USA Author

Doxylamine is a great medication that can help you sleep. Much like Diphenhydramine often used for the same purpose, it is an anti-histamine used for sleep because it happens to be very sedating. Anti-histamines are not habit forming and can be of great help. However, they have a tendency to make you feel groggy or tired in the morning. I think it might be a great idea to perhaps discuss non-sedative class of medications used as sleeping pills in the future.

Thanks for the great idea!


Anonymous 4 years ago

I reckon that one can take Melatonin every night, for many years, without any negative long-term side-effects? It's long-term safety isn't established, but it is not expected to have long-term drawbacks, based on the current studies.

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