Key Points:

  • “Sleeping pills” is an umbrella term that includes a number of prescription and over-the-counter drugs.
  • Although each drug may exhibit drug-specific side effects, most sleeping pills are associated with similar side effects, including daytime sleepiness, dry mouth, dizziness, headache, unusual dreams, attention deficits, and memory loss.
  • Complex sleep behaviors include sleepwalking and sleep-eating and are frequently reported with prescription sleeping aids. Ambien infamously causes complex sleep behaviors.
  • Sleeping pills are addictive, although the degree of addiction risk is different for each drug. OTC drugs may be the least likely to lead to physical dependence, but psychological addiction is common.
  • To decrease the likelihood of sleeping pill addiction, people should take their medications exactly as prescribed.

Side Effects, Risks or Complications

All sleeping aids have been reported to cause at least some level of psychological dependency (including OTC drugs), and most prescription drugs (particularly BZDs and barbiturates) are linked to physical dependence/addiction. Different classes of sleeping pills may have different side effects, but all have been associated with symptoms like:

  • Complex Sleep Behaviors

    One of the most dangerous side effects of sleeping pills are complex sleep behaviors like sleepwalking. Even people with no history of sleepwalking may sleepwalk after taking sleeping pills. Reports of people dying while performing complex behaviors while they are asleep led the FDA to require several prescription sleeping medications to carry “black box warnings”, which alert users to potentially lethal risks associated with the drug. Examples of lethal complex sleep behaviors include automobile accidents (with the patient driving), drowning, apparent suicide and poisoning.

    Nonfatal injuries associated with complex sleep behaviors include burns, gunshot wounds and attempted suicide. Even first-time and low-dose users can exhibit these behaviors, underscoring the importance of using caution when taking prescription sleeping pills.

  • Physical Effects

    Sleeping pills may affect the body in several ways. People who take these drugs may notice dry mouth, fatigue, headaches, heartburn, digestive problems like gas, constipation or diarrhea, appetite changes, tingling sensations in the hands or feet, balance problems and dizziness, muscle weakness, and shaking or tremors.

    People should stop taking this medication and talk to their doctor if they are experiencing side effects from sleep aids. Sometimes, these symptoms can be a sign of a bigger issue, or they can lead to more serious complications.

    One way to lower the risk of sleeping pill side effects is to make sure to take the medication exactly as prescribed. Taking higher doses can lead to more harmful effects. Additionally, people having trouble with side effects from one drug may have better luck if they switch to another. Different categories of sleeping pills affect different processes in the brain and trying a different medication may produce milder or more severe side effects. People don’t know which sleeping pills are more likely to be effective or less likely to cause side effects until they try them, and some people may have to try a few different types before they find one that suits them.

  • Mental Effects

    How do sleeping pills affect the brain? Those who take sleeping pills regularly may find that they experience memory problems, difficulty concentrating, and vivid dreams.

    Sleeping pills can also cause parasomnias. These sleep disorders consisting of unusual behaviors, emotions and perceptions that occur while someone is falling asleep, sleeping or waking up. Examples include sleepwalking, nightmares, night terrors, teeth grinding and talking in one’s sleep. People often don’t know when they are experiencing parasomnias. However, if there is any indication that someone is experiencing this side effect, they should talk to their doctor. Parasomnias can sometimes take the form of more extreme and potentially dangerous behavior like eating, driving or having sex while asleep.

  • Sleeping Pill Withdrawal Side Effects

    Someone who has become physically dependent on sleeping pills may feel withdrawal symptoms if they try to stop using them. Additionally, a person may find that the drugs become less effective over time as their body adapts to the presence of the medication. If a person becomes physically dependent on sleeping pills, they will probably experience some withdrawal symptoms once they stop using them.

    The most common side effects of sleeping pill withdrawal are insomnia and anxiety. If a person has trouble sleeping once they stop using a sleep aid, they may think that it’s impossible for them to sleep without the medication. However, this is usually a temporary withdrawal symptom that will eventually go away once sleeping pill use is halted. Other sleeping pill withdrawal side effects include bizarre dreams, restlessness and shivering.

  • Side Effects of a Sleeping Pill Overdose

    Sleeping pills overdose symptoms are extreme tiredness, difficulty breathing, stomach pain, and clumsiness or loss of coordination.

    Anyone who suspects a sleeping pill overdose should seek emergency medical care right away. Overdosing on sleeping pills can be fatal. Side effects of a sleeping pill overdose may worsen and result in brain damage if left untreated.

Signs of Misuse

Sleeping pill misuse happens when someone takes their sleeping pill medication outside of its prescribed use:

  • Taking sleeping pills without a prescription
  • Taking them longer than recommended by a doctor
  • Taking them at higher doses than what was prescribed.

However, using sleeping pills over long periods usually makes a person sleep worse. People should only use these medications for a short time.

Can You Get Addicted to Sleeping Pills?

Yes, although different drugs have different levels of risk associated with them. The most dangerous sleeping pills are barbiturates, which are not only addictive but can have severe consequences when mixed with other drugs or alcohol. Benzodiazepines are also associated with a high risk of dependency and addiction. Z-drugs (Ambien, Sonata, Lunesta) have lower risks for dependency. OTC drugs are generally not thought to cause physical addiction, but psychological addiction is commonly reported and can be challenging to overcome.

A person’s risk of addiction is lowered if they take sleeping pills exactly as prescribed. Anyone who has a personal or family history of substance misuse may want to avoid sleeping pills altogether. Adopting other healthy habits, including exercising, limiting caffeine consumption, avoiding electronic screens before bedtime and getting in the habit of waking and going to bed at the same time every day can improve a person’s sleep quality without the use of potentially addictive drugs.

If you suffer from insomnia, the safest long-term way to deal with it is behavioral modifications like establishing a strict bedtime, refraining from looking at a screen in bed or making sure your bedroom is dark and quiet. Cognitive-behavioral therapy has shown success in treating sleep disorders. It usually works as well as sleeping pills but without the risks.

Sleeping Pill Abuse Facts and Statistics

Nearly a third of adults and three-quarters of high school students report not getting enough sleep, so it’s easy to see why people want to turn to medications to help deal with insomnia or other sleep issues. A 2010 study reported that about one in eight people who said they had trouble sleeping used sleep aids. Additional statistics include:

  • Overall: About 4% of adults in the United States used sleeping pills within a month prior to the study.
  • Prevalence in Men: 3.1% of men surveyed said that they use sleeping pills.
  • Prevalence in Women: About 5% of women surveyed reported using prescription sleep aids.
  • Teen Abuse: 5% of teens surveyed used a prescription sleeping pill. In one poll, 28% of parents reported that their teen had tried some type of medication for sleeping difficulties.
  • Senior Abuse: Generally, the older someone is, the more likely they are to use sleep aids. People ages 80 and older reported the highest use of sleeping pills, with 7% of people in this age range saying they used prescription sleep aids in the last month.

No sleeping pills are approved for use in children. However, some kids who have trouble sleeping might be given anti-allergy medication, which might make them drowsy. Some healthcare providers recommend that children use melatonin, but this supplement hasn’t been well-studied in children. Additionally, teens who are prescribed anti-anxiety or sleeping pills are up to 12 times more likely to abuse them later on.

How to Stop Using Sleeping Pills

When people go through withdrawal, they are at a high risk of relapsing because they experience intense cravings and because they may have a desire to use again to help other symptoms disappear. One thing that can help is tapering sleeping pills by gradually taking smaller and smaller doses over time. For some medications, including benzodiazepines like Xanax, tapering is difficult to manage on one’s own and withdrawal symptoms may be more severe. People who have been using more addictive sleeping pills or who have a more severe dependence on sleeping pills may not be able to safely or successfully stop using them on their own. If someone is not sure how to stop using sleeping pills, they can talk to a healthcare professional to learn about:

  • Detox: Sleeping pill detox may last for a couple of weeks. During this time, doctors may slowly wean a person off of the medication until there is no drug left in their body. Going through detox at a medical facility gives people access to medical care in case something goes wrong and they experience severe withdrawal symptoms. This approach also makes people more likely to avoid setbacks.
  • Rehab: Inpatient and outpatient rehab programs provide participants with many opportunities to learn more about addiction, develop healthier behaviors and come up with strategies to help prevent a setback. These programs may involve individual therapy and group counseling as well as educational classes and treatment for other co-occurring mental health disorders.

FAQs About Sleeping Pills

  • What are sleeping pills?

    Sleeping pills are sedatives that can help people who are suffering from insomnia. Many people rely on them to get a good night’s sleep, but sleeping pill side effects and addiction may be a concern. For the most part, these medications are meant to be used for short periods to limit the chances that they will be habit-forming or have harmful effects.

    There are multiple types of sleeping pills that each work in different ways. Some sleeping pills, including anti-anxiety benzodiazepines like Xanax and Valium, are fairly likely to cause physical dependence and addiction. Others, like Lunesta and Ambien, are less likely to cause dependence. Some new types of sleeping pills, such as Rozerem and Silenor, are non-addictive. People who are worried about sleeping pill addiction should talk to their doctor to learn more about options that won’t cause physical dependence.

  • What do sleeping pills do?

    Sleeping pills either help someone fall asleep more quickly or by help them stay asleep throughout the night. This is why they are used to treat insomnia. Sleeping pills are commonly used in other situations as well.

    Approximately 4% of American adults take prescription sleeping pills, and somewhere between 3-11% report using over-the-counter (OTC) sleep aid pills. Sleeping pills, including OTC and  “natural” alternatives, are associated with risk of dependency, addiction and other health consequences.

    Flying – It is generally not recommended to take sleeping pills for short flights or daytime flights. Taking sleeping aids before long, overnight flights also poses risks. Ambien, in particular, has become infamous for causing embarrassing sleepwalking episodes (as was documented by “Betty” in “Confessions of a Fed-Up Flight Attendant: Attack of the Ambien Zombies”). However, if you want to take a sleeping aid for an overnight flight, it is highly recommended that you test the drug ahead of time so you understand how it will affect you. Also, if you take sleeping aids before a flight it is strongly recommended that you avoid alcohol on the flight. Melatonin, another popular sleep supplement, is used by travelers to help ease jet lag. Melatonin regulates the sleep-wake cycle, so supplementing melatonin can help you modify the cycle.

    Anxiety – Benzodiazepines are the most common prescription anti-anxiety drug. Both benzodiazepines and z-drugs (the most common prescription sleeping pill) enhance the efficacy of a neurotransmitter called GABA, resulting in sedation. Benzodiazepines and, to a lesser extent, z-drugs pose a risk for developing dependency and addiction issues and they should be taken with caution.

    Depression – Anxiety and depression often coexist, and z-drugs and benzodiazepines can help with anxious depression. However, prescription sleeping pills should not be taken by people who suffer from major depressive disorders. Z-drugs and benzodiazepines can both make depression worse, and they are associated with increased incidence of suicidal ideation and completion even among people who have not been diagnosed with depressive disorders.

    Diabetes – Many people with diabetes suffer from sleep disturbances due to sleep apnea, diabetic neuropathy, hormonal dysregulation, or other causes. Sleeping pills can have dangerous consequences for diabetes patients. For example, high doses of benzodiazepines can cause respiratory depression. In a patient with sleep apnea, this could be lethal. If you are diabetic, speak with your doctor before using any OTC or prescription sleep aids.

  • How do sleeping pills work?

    Most prescription sleeping pills (including z-drugs and benzodiazepines) work by enhancing the effects of a brain chemical called GABA. GABA is a neurotransmitter that quiets brain excitability. This is why some prescription sleeping pills (notably benzodiazepines) are often prescribed as anti-anxiety drugs.

    The most common sleeping pills purchased without a prescription are melatonin, antihistamines and valerian root. The ways that OTC sleeping pills work vary, and in some cases, the mechanism of action is unclear.

  • What are some common types of sleeping pills?

    Over the Counter Sleeping Pills

    OTC sleeping pills are available without a prescription, and anecdotal reports suggest that many of them are quite useful. However, most of them are relatively untested in controlled research trials.

    Melatonin – Melatonin is a natural hormone that is secreted by the pineal gland and regulates circadian rhythm (the sleep-wake cycle). OTC melatonin supplements can help reduce insomnia. Although melatonin is not associated with tolerance, some people report that they become psychologically dependent on melatonin for sleep.

    Sedating antihistamines – Diphenhydramine (brand names include Zzzquil, Benadryl, Sominex, Unisom SleepGels) and doxylamine (brand names include Unisom SleepTabs and Sleep Aid) are antihistamines that are generally used to treat allergies, but they also induce drowsiness. However, tolerance can develop quickly with regular use and they are associated with side effects like dry mouth and dizziness. In general, sedating antihistamines should not be used regularly as sleep aids.

    Valerian – Valerian root (specifically Valeriana officinalis) is often considered to be a natural sleeping pill, but data supporting its efficacy is inconclusive. In addition, valerian’s mechanism of action remains unclear.

    Before taking any OTC sleeping pills, it is highly recommended that you talk to your doctor. All OTC drugs have the potential to interact with other drugs you take or make existing health concerns worse. In addition, some data exists suggesting that regular use of OTC sleep aids may increase the risk of stroke in middle-aged and older individuals with no prior history of stroke.

    Prescription Sleeping Pills

    In general, FDA-approved prescription sleeping medications are either z-drugs or benzodiazepines. Here is a list of the most common prescription sleeping pills including the most common brand name and the generic medication name.

    Zolpidem (brand name Ambien) – Zolpidem is a z-drug. These drugs work by increasing the effectiveness of the neurotransmitter GABA, which makes the brain less excitable. Although somewhat less risky than benzodiazepines, z-drugs are associated with a risk for dependency/addiction and should not be used daily or long term.

    Zaleplon (brand name Sonata) – Zaleplon is another z-drug used to treat insomnia.

    Lunesta – Lunesta is the brand name for eszopiclone. It’s also a z-drug approved for sleep disorder treatment.

    Temazepam (brand name Restoril) – Temazepam is one of five FDA-approved benzodiazepines for insomnia. Extreme caution should be used when taking benzodiazepines due to the high level of risk of developing dependency/addiction.

    Trazodone (brand name Desyrel) – Trazodone is an off-label drug that is prescribed for sleep disorders. This means that although they are not FDA-approved as sleeping aids, they can still be prescribed for insomnia. Trazodone is an antidepressant and is currently one of the most common sedative-hypnotic type drugs prescribed for insomnia.

  • How long do sleeping pills stay in your system?

    Most sleeping pills will be metabolized relatively rapidly. Z-drugs have the shortest half-life (1-7 hours), and BZDs have intermediate half-lives (up to 24 hours for FDA-approved sleeping pills, up to 80 hours for off-label BZDs).

    How long sleeping pills stay in your system and show up in a drug test depends on the test. Sleeping pills may be detected in:

    Blood: Approximately 2-5 days

    Urine: Approximately 2-5 days

    Hair: Up to months

    Breastmilk: Approximately 2-5 days. If you are breastfeeding, it is imperative that you discuss plans to use OTC or prescription sleeping pills with your pediatrician before you take the first dose. Some drugs are safe to use while breastfeeding, while others can have profoundly negative impacts on your baby.

If you or a loved one is struggling with sleeping pill dependency, The Recovery Village Palm Beach at Baptist Health can help. Call us today to learn how we can help you get your days and nights back in order.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.