ARTICLE OVERVIEW: Sedatives prescribed for anxiety or insomnia such as benzodiazepines, selective benzodiazepine receptor subtype agonists (z-drugs), and barbiturates….can be addictive! These sedatives are controlled substances due to their potential for misuse and abuse. This article looks deeper into the characteristics of these meds. Then, we’ll look at signs of addiction, basic addiction treatments, and alternative treatments for insomnia.
TABLE OF CONTENTS
- Why Sleeping Is Important
- Main Sleep Problems
- How Sleeping Pills Work
- The Top 10
- Addictive Potential
- Signs Of A Problem
- Withdrawal Treatment
- Medications for Withdrawal
- Alternative Treatments For Insomnia
- How to Get Help
Why Sleeping Is Important
Sleep is an important part of your daily routine. In fact, each of us spend about one-third of our lifetime asleep. Quality sleep and getting enough of it at the right times is as essential to survival as food and water. Why?
Without sleep you can’t form or maintain the pathways in your brain that let you learn and create new memories, and it’s harder to concentrate and respond quickly.
In fact, according to this NINDS, National Institute of Neurological Disorders and Stroke article, sleep is important to a number of brain functions, including nerve cell communication. While sleeping occurs, toxins are removed from the brain that build up while you are awake. Everyone needs to sleep; its loss could affect almost every tissue and system of the body from brain, heart and lungs to metabolism, immune function and mood.
Main Sleep Problems
Sleep is a complex and pervasive cognitive state that can be affected in many different ways. While there are around 90 diagnosed sleeping problems, sleep disorders can be divided into these main categories:
- Those producing insomnia (complaints of difficulty falling asleep, staying asleep, or nonrestorative sleep).
- Those causing daytime sleepiness.
- Those disrupting sleep.
Furthermore, occasional insomnia is extremely common, affecting up to 80% of the population. This Institute of Medicine 2006 book on sleep issues in the U.S. reports that an estimated 50 to 70 million Americans chronically suffer from a disorder of sleep and wakefulness, hindering daily functioning and adversely affecting health and longevity. Furthermore, chronic insomnia affects 15% of the population.
How Do Sleeping Pills Work?
Sleep is divided into stages. This is important to know because it is the fundamental base of how medications are prescribed to treat sleep disorders. In fact, you will need a full assessment of your sleeping patterns before a doctor can prescribed you a medication at all.
Basically, sleeping pills are used to get you to sleep, or to keep you asleep. The drugs are psychoactive, which means that they cross the blood, brain barrier and act on the central nervous system, including the brain. Each works differently. You can view a diagram of main brain transmitters affected in this 2014 article from the medical journal, Current Opinion in Neurobiology.
Sleeping pills are classed as hypnotic, or soporific, drugs and can be extremely habit forming. Historically, sedative/hypnotics have been some of the most commonly prescribed drugs. However, some people come to rely on sleeping pills to get to sleep and cannot sleep without them.
The Top 10
- Ambien, Ambien CR (zolpidem): Z-drug, induces sleep and improves sleep maintenance.
- Ativan (lorazepam): Benzodiazepine, induces sleep and improves sleep maintenance.
- Edluar (zolpidem): Z-drug, induces sleep.
- Estazolam: Benzodiazepine, induces sleep and improves sleep maintenance.
- Halcion (triazolam): Benzodiazepine, induces sleep and improves sleep maintenance.
- Klonopin (clonazepam): Benzodiazepine, induces sleep and improves sleep maintenance.
- Lunesta (eszopiclone): Z-drug, induces sleep and improves sleep maintenance.
- Restoril (temazepam): Benzodiazepine, induces sleep and improves sleep maintenance.
- Rozeram (ramelteon): Melatonin agonist, induces sleep.
- Sonata (zaleplon): Z-drug, induces sleep.
Are They Addictive?
Yes, sleeping pills can be addictive.
Although sleeping pills can be addictive, this does not mean that everyone who takes them will become a pill addict. In fact, people generally develop a physical dependence on and/or tolerance to the most well-known and used types of sleeping pills (benzodiazepines) after a short 1 – 2 weeks of taking them.
Regardless of the buildup of physical dependence or tolerance (needing more drug to achieve the same original effects), addiction is further characterized by these requirements:
- Continued use of sleeping pills despite negative consequences related to their use.
- Obsessive thoughts about sleeping pills.
- Experiencing cravings for taking or using sleeping pills.
- Withdrawal symptoms when you stop taking sleeping pills.
Signs of a Problem
If you think that you have a sleeping pill problem, follow your instinct.
Take into account the following. Ask yourself these 8 questions, as outlined in the World Health Organization ASSIST Tool:
- Which psychoactive substances have you ever used in your lifetime?
- At what the frequency have you used sleeping pills in the past three months?
- At what frequency do you experience a strong desire or urge to use each substance in the last three months?
- How often have you experiences health, social, legal or financial problems related to substance use in the last three months?
- How often does use of each substance has interfere with your personal or work responsibilities in the past three months?
- Has anyone else has ever expressed concern your use of sleeping pills? How recently did that occur?
- Have you ever tried to cut down or stop use and failed in that attempt? How recently was that?
- Have you ever injected any substance? How recently?
Then, seek a diagnosis with a professional. People who can help include:
- Psychologists or psychiatrists.
- Medical doctors, especially those trained in addiction medicine.
- Licensed clinical social workers.
- An addiction treatment clinic or certified center.
Withdrawal Treatment: Basics
The first thing you need to consider if you’re addicted to a sleeping medicine is how to quit safely. Prescription sleeping meds are super-strong! Getting off them safely is of number one importance.
This 2015 article published in the Yale Journal of Biology and Medicine warns that persons who chronically take sedative medications and become addicted, whether prescribed by a physician or bought on the black market, are at risk for an acute withdrawal syndrome. The severity of withdrawal is affected by concurrent medical illness. Risk factors for severe withdrawal (delirium tremens) include larger amounts of sedatives taken chronically, longer time of use, older age, and comorbid medical or psychiatric problems.
The main symptoms related to sleeping pill withdrawal include:
… and sometimes seizures and psychosis . Withdrawal symptoms usually peak at around 5 days. Some people do not progress to severe withdrawal and the symptoms simply subside after a few days with or without treatment, but it is impossible to predict who will progress or not.
NOTE HERE: Not much information is available about long-term physiological and psychological consequences of intermittent, high-dose use of sedatives, especially if you’re using other drugs.
Medications for Withdrawal
Withdrawal syndrome often requires detoxification with medication, preferably and in most cases under medical surveillance. Pharmacotherapy is indicated for management of moderate to severe withdrawal. However, there is little consistency in treatment of withdrawal, and there are no standard protocols for withdrawal management in widespread use. Main medicines used to begin treatment include:
Benzodiazepines and barbiturates are effectively used to treat withdrawal and have been studied in clinical trials. Benzodiazepines have largely replaced barbiturates for pharmacologic prevention and management of sedative withdrawal syndrome, and the choice of benzodiazepine depends on characteristics such as duration of action, need for metabolism, and speed of onset of effects. However, for persons who have been abusing benzodiazepines, a different type of sedative may be appropriate to use for treatment of withdrawal symptoms, such as phenobarbital.
Non-benzodiazepine anticonvulsants such as carbamazepine and gabapentin have been used for treatment of mild to moderate alcohol withdrawal and may be useful for treatment of withdrawal from other sedatives.
Alternative Treatments For Insomnia
- Valerian Root is typically consumed as a tea, but more and more companies are adding it to their ingredient profiles. It has had reported impacts on sleep which have encouraged companies to keep using it. This is likely because of its anti-anxiety effects. Therefore, it is possible that people who notice its effects were also plagued by chronic stress or anxiety.
- Passionflower is another great ingredient that works well in many products as well as by itself in tea. It is especially known for its anti-anxiety effects, but also for muscle relaxation properties. These are both great for calming down before going to sleep and helping relax anxious thoughts before bed.
- Melatonin seems to react similarly to the crowd-favorite Nyquil. It will make you doze off quickly, but the sleep you have might be disrupted or funny. People report vivid dreams through the night which suggests it can extend your REM time to take up more than the quiet hours. You do not need a ton of it to make it work effectively, and it is definitely recommended that you do not drive after taking it.
Additional lifestyle recommendations from this 2015 article published in the medical journal, Primary Care, include:
- Do not try to force sleep.
- Set a routine in bedtime and waking hours.
- Avoid taking naps during the day.
- Limit time in bed to just sleeping. If you wake up during the night and cannot go back to sleep, get out of bed and go back to bed when you’re ready to sleep again.
- Avoid physical activity before bed. Exercise should be done at least 2 hours before going to bed.
- Avoid eating a heavy meal, drinking coffee and alcohol or excessive amounts of beverages before going to bed.
- Make the sleep environment as comfortable as possible with respect to lighting, temperature, noise, etc.
How to Get Help?
If you’re having problems with sleeping medications…or have been taking them for longer than a couple of weeks at a time…SEEK MEDICAL HELP! You may have developed dependence on the medication and require professional guidance for withdrawal.
If you think the issue is even deeper than that, speak first with someone that you trust. Addiction is no longer stigmatized as a moral deficiency, but as a medical and mental health condition. Then, check with your prescribing doctor and report symptoms and behaviors so that you can work together to identify next steps.
If the fear of not knowing what happens during an addiction treatment program, do not lose hope! Quitting any addictive drug is made easier and safe in the hands of trained professionals.
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