What is a sleeping pill?

Sleeping pills, also known as hypnotic or sedative medications, are a diverse range of drugs that work on the central nervous system to induce sleep.

Your doctor may prescribe you sleeping pills if you’re having difficulty sleeping – but they will be for short-term use only. All sleeping medications can be habit-forming, and some of them can lead to serious dependence. You can also buy over-the-counter sleep remedies, which have a lower risk of developing a dependency. However, no sleeping pills address the underlying causes of insomnia, and relying on them for long periods risks worsening it. This phenomenon is called rebound insomnia.

Types of sleeping pills

Benzodiazepines

Benzodiazepines are mainly prescribed for anxiety in the UK, but they are sometimes prescribed for sleep. They slow down the central nervous system by increasing the amount of GABA, the body’s main calming neurotransmitter, in the brain.

You will know if you have been prescribed a benzodiazepine by looking at the name on the box – it will end in ‘-pam’ or ‘-lam,’ as seen in the generic names diazepam and alprazolam.

Benzodiazepines are extremely addictive and should only be used in the short term. Doctors are not supposed to prescribe benzodiazepines for more than two weeks, but overprescription has been reported in the UK. This is particularly common in elderly patients, who are at far more risk of side effects from benzodiazepines, like confusion and falls.

Withdrawals from benzodiazepine addiction can be life-threatening, so they should be used very carefully. Some benzodiazepines stay in your system for longer than others – and this means withdrawing from them differs depending on the type. Short-acting benzodiazepine withdrawals can start within a day after stopping them, while withdrawal symptoms may start after a few weeks for long-acting benzodiazepines. To manage withdrawals, you will need to taper off the medication.

Z drugs

The Z drugs – zolpidem and zopiclone – are so-called because they begin with the letter z. They work similarly to benzodiazepines.

Z drugs are now more commonly prescribed for insomnia than benzodiazepines in the UK. Current research on whether they’re less dangerous than benzodiazepines is mixed – they were thought to be less risky, with fewer side effects, at the time of their release, and some studies do claim that adverse effects are less common and less severe. However, you can become addicted to them.

Antihistamines

Antihistamines are usually used to help with the symptoms of allergies. However, some older antihistamines are available over the counter as sleep aids. The two main antihistamines used as sleeping pills in the UK are diphenhydramine (Nytol) and promethazine (Sominex).

Like many sleeping pills, antihistamines should not be taken long-term, as they can cause dependence. Additionally, some studies have linked long-term use of sedative antihistamines to an increased risk of dementia.

Melatonin

Prescription melatonin is a synthetic version of a hormone that naturally occurs in your body. Melatonin levels rise at night and return to normal during the day, helping to control how and when you sleep.

Melatonin is not thought to be addictive, but you can become dependent on it for sleep, which can worsen your insomnia.

Orexin receptor agonists

There’s only one drug in this class – daridorexant – and it’s very new. NICE, The National Institute for Health and Care Excellence, only published their guidelines recommending it in October 2023.Orexin receptors are found in the central nervous system and are involved in the sleep-wake cycle. By blocking these receptors, daridorexant promotes sleepiness.

Daridorexant is currently the only medication recommended for treating long-term insomnia in the UK. This doesn’t mean you will be prescribed it long-term. It means that medication is considered a poor option for people who have been struggling with their sleep for a long time, and other interventions like CBT are preferred. Daridorexant is recommended for people who have been experiencing insomnia for at least 3 months and who have tried CBT and haven’t been successful.

Herbal remedies

Some over-the-counter plant extracts are used as sleep remedies. These include valerian root and CBD (cannabidiol).

Neither of these are thought to be physically addictive, although the sedating effect of these drugs can be addictive. Like all sleep aids, issues can arise from becoming reliant on the remedy to sleep and not addressing the root causes of insomnia.

Potential side effects and risks

A wide range of drugs are used as sleeping pills, and all of them will have side effects. Common side effects of sleeping pills as a class of drugs include:

• Appetite changes
• Gastrointestinal disturbances, like vomiting or diarrhoea
• Balance problems
• Feeling sleepy the next day
• Attention or memory problems
• Shaking
• Strange dreams
• Weakness

Benzodiazepines and Z drugs must be used with extra caution due to their addictive potential and have similar withdrawal symptoms. Benzodiazepine withdrawal can cause psychosis and seizures, and while Z drugs are not thought to cause these symptoms they can still have severe withdrawal effects. Both types of drugs can induce insomnia, anxiety, depression, perceptual disturbances and stomach cramps during withdrawals.

Considerations for safe use

You should never combine sleeping tablets with other sedating medications, or alcohol or illegal drugs. This combination has the potential to be dangerous or even fatal.

All sleeping pills run the risk of creating dependence. If you’ve had insomnia for a while, options such as sleep hygiene, CBT or referral to a sleep clinic should be attempted rather than using sleeping pills. Your doctor should discuss these options with you and prescribe medication.

Getting better sleep means limiting or avoiding the most common sources of insomnia – alcohol, caffeine, nicotine, stimulant drugs – and trying to manage stress, anxiety and depression, which can cause insomnia. This may mean exploring other medications and treatment plans. Sleep hygiene, like going to bed at the same time every night and keeping your room quiet and at a comfortable temperature, can also help.

These long-term solutions must be explored because medication is not a long-term solution to insomnia. If taken for a long time, you can become dependent on sleeping pills, or addicted to them.

UKAT can help with prescription drug addiction

A survey once found that 48% of the UK population had taken a prescription medication in the week prior to the survey. While not all prescription medications are addictive, a subset of them are – and you may need prescription drug addiction treatment to help you discontinue them.

We understand the underlying causes of sleeping pill addiction, and we have years of experience with helping people leave sleeping pills behind forever.

Contact us today to take your first step on your journey to a healthier, happier life.