An estimated 4% of US adults (approximately nine million people) have a prescription for sleeping pills. Many of these individuals may be unaware of the potential dangers associated with regular use, even when used as directed. Notably, the Food and Drug Administration (FDA) recently mandated that “black box warnings” be included in prescribing information for three of the most popular sleeping pills – eszopiclone (Lunesta), zaleplon (Sonata) and zolpidem (Ambien), which are collectively referred to as “z-drugs”. Z-drugs are sedative-hypnotics, which reduce brain activity, leading to drowsiness/sedation and reduced levels of anxiety. Sedative-hypnotics are often associated with dependency and withdrawal issues.
Although less commonly prescribed for sleep disorders, benzodiazepines (e.g. Xanax, Valium, Ativan) and barbiturates (e.g. Fiorinal, Fioricet) may also be prescribed for insomnia. Both of these drug classes also pose a high risk for dependency and withdrawal and should be taken with caution.
What Causes Sleeping Pill Withdrawal?
Z-drugs work by enhancing the effects of a neurotransmitter called GABA. Increased GABA signaling causes reduced brain excitability, which causes the sedation associated with z-drugs. Even short-term regular use of z-drugs leads to tolerance, which means that larger and larger doses are required in order to achieve the same effect.
The development of tolerance precipitates dependency and reflects chemical changes that occur in the brain. When drugs are not taken to maintain this change, withdrawal symptoms frequently manifest in the form of insomnia, restlessness, and anxiety. Benzodiazepines are generally associated with similar symptoms that are more intense and last longer.
Some people try to flush sleeping pills out of their systems in an attempt to cure withdrawal effects (or pass a drug test). Because z-drugs have short half-lives (between 1 and 7 hours), they are generally completely metabolized within a day or so. However, the withdrawal symptoms that result from z-drug use are caused by chemical changes in the brain that persist even after the drug is completely eliminated.
Sleeping Pill Withdrawal Side Effects
Z-drug withdrawal symptoms are common among users who try to reduce or eliminate their use, and include both physical and psychological effects. It is important to understand that even after the drugs are completely out of your system, withdrawal symptoms frequently persist for weeks, months, or even years after cessation.
- Physical Withdrawal Symptoms
The most commonly reported physical symptoms of sleeping pill withdrawal are insomnia, tremors, weakness, heart palpitations, nausea, and dizziness. Although rare, some people with severe dependency issues may have seizures if they quit without tapering.
- Psychological Withdrawal Symptoms
Several psychological symptoms are associated with sleeping pill withdrawal, including:
Anhedonia or inability to enjoy activities that were once pleasurable
- Symptoms of Post Acute Withdrawal Syndrome (PAWS)
Many people believe that once the acute withdrawal symptoms are over (generally within a few weeks of cessation), dependency/addiction is over. Unfortunately, this is not true in most cases. Post-acute withdrawal syndrome (PAWS) is a major component of recovery for many people, and it can be incredibly frustrating.
PAWS includes the same symptoms as acute withdrawal, but the degree to which the symptoms affect a person tend to fluctuate over time. These uncomfortable physical and psychological symptoms may persist for months or even years after the last use of the drug, but they will subside over time. PAWS often involves drug cravings and the temptation to relapse, so it is very important for people in recovery to understand that prolonged withdrawal symptoms are a normal part of recovery and do not reflect a failure to recover.
- Protracted Withdrawal Symptoms
Protracted withdrawal is a synonym for PAWS. According to the Substance Abuse and Mental Health Services Administration, protracted withdrawal symptoms are defined as “the presence of substance-specific signs and symptoms common to acute withdrawal but persisting beyond the generally expected acute withdrawal timeframes.”
- Can Sleeping Pill Withdrawal Kill You?
Deaths due to sleeping pill withdrawal (especially benzodiazepines) are possible, generally in people who have taken them daily for extended periods of time and who quit cold turkey. Withdrawal-related deaths are caused by a dramatic chemical imbalance in the brain, due to a sudden and substantial decrease in GABA signaling that can cause potentially lethal seizures.
Regular use of sleeping pills are significantly associated with an increased risk of death, although z-drugs are considered less risky than benzodiazepines. However, most deaths are linked to complex sleep behaviors (e.g. sleepwalking), not withdrawal.
How Long Do Sleeping Pills Stay in Your System?
Sleeping pills tend to have relatively short half-lives (1-7 hours for z-drugs, up to 12 hours for short-acting benzodiazepines), so they are rapidly metabolized and are generally not detectable in urine, blood, or saliva tests for more than a day or two. However, sleeping pill addiction withdrawal can persist for weeks, months, even years after the drugs have been completely eliminated from the system.
Sleeping Pill Detox for Treatment of Withdrawal
It is not uncommon for users to question how to make sleeping pills wear off. Unfortunately, there is no safe way to speed up the metabolism of sleeping pills.
For people who are seeking treatment for a sleeping pill addiction, medically supervised detox is frequently recommended. Medical detox involves an evaluation with a medical professional who can evaluate the degree of dependency and prescribe a taper for the drug. In extreme cases, benzodiazepines with moderate to long half-lives may be prescribed to attenuate withdrawal symptoms.
It is important to undergo an evaluation with a medical professional before detoxing in order to ensure a safe, successful experience. Outpatient detox is only recommended for people who have mild dependency issues. Z-drugs (including commonly prescribed brand names Lunesta, Sonata and Ambien) often respond well to outpatient detox. Chronic users of sleeping pills, especially benzodiazepines, may find that a short residential stay prior to outpatient care can maximize successful outcomes.
Additional benefits of outpatient detox include access to medical healthcare professionals who can address questions/concerns that arise during the detox period. Furthermore, clinicians can prescribe a tapered sleeping pill prescription that will minimize withdrawal symptoms.
Detoxing at Home
For those with mild dependency issues, home detox can be a viable option although consultation with a doctor or rehab facility before attempting to detox is recommended.
- Risks of Abrupt Discontinuation: For people who have used sleeping pills daily for long periods of time, abrupt discontinuation of the drugs can be dangerous. Because these drugs change brain chemistry, getting off sleeping pills cold turkey could potentially cause seizure-inducing chemical imbalances. Benzodiazepines have a higher risk associated with quitting cold turkey than z-drugs.
- Controlled Taper: The most effective way to recover from dependency is to wean off of sleeping pills. Gradually reducing the amount of the drug taken is the best way to prevent potentially debilitating withdrawal side effects, and is safer than abruptly quitting. Talk to your doctor or a rehab facility to create a personalized tapering schedule.
Finding a Detox Center
There are several factors to consider when choosing a detox center:
For people who suffer from serious sleeping pill addictions, a short stay in a residential facility may be the best way to get on the path to recovery. Even outpatient clients may have the best results using a clinic that is not the one where they’ve gone to get prescriptions; avoiding triggers is particularly important in early days of recovery.
Many insurance programs (including Medicaid) may cover some of the cost of rehab. In addition, many facilities offer sliding fee scales or scholarships for people seeking rehab.
Some rehab facilities provide endorsements from satisfied clients. Facilities that report 100% success rates should be looked at with suspicion; it is unlikely that any treatment modality results in 100% success for any addiction disorder.
An underappreciated component of many substance use disorders is an underlying mental health issue or past emotional trauma. It is often beneficial to find a rehab facility that can evaluate whether a dual diagnosis is appropriate.
Key Points: Understanding Sleeping Pill Withdrawal and Detox
Some key points to remember about sleeping pill withdrawal and detox are:
- The most commonly prescribed sleeping pills are “z-drugs” like Lunesta, Sonata and Ambien, although some people are prescribed short- or medium-acting benzodiazepines like Halcion, Versed or Xanax.
- Although both z-drugs and benzodiazepines have a relatively high risk for development of dependency, benzodiazepines are associated with more significant dependency/addiction issues and withdrawal symptoms
- Sleeping pills cause chemical changes in the brain that persist even after all of the drug has left the system.
- In some cases, the chemical changes can cause long-lasting (months or years) withdrawal symptoms, referred to as post-acute withdrawal syndrome (PAWS)
- Common physical symptoms associated with sleeping pill withdrawal include insomnia, tremors, weakness, heart palpitations, nausea, and dizziness. In extreme cases, seizures may occur with abrupt cessation
- Common psychological symptoms associated with sleeping pill withdrawal include anxiety, panic attacks, anhedonia, depression, paranoia, and loss of memory
- Sleeping pill detox is generally most successful when done after consultation with a medical professional
- Quitting sleeping pills cold turkey is generally not recommended; tapering (weaning off) is the safest way to successfully overcome sleeping pill dependency.
If you or a loved one is struggling to overcome sleeping pill dependency, please call The Recovery Village Palm Beach at Baptist Health. Our experts can work with you to develop a treatment plan, provide information about what to expect from detox and withdrawal, and offer long term support and education in order to maximize your success in recovery.
Chong, Yinong; Fryar, Cheryl D. and Gu, Qiuping. “Prescription Sleep Aid Use Among Adults: United States, 2005–2010” Centers for Disease Control and Prevention, August 2013. Accessed August 19, 2019.
Food and Drug Administration. “FDA adds Boxed Warning for risk of serious injuries caused by sleepwalking with certain prescription insomnia medicines.” Updated May 14, 2019. Accessed July 30, 2019.
Weaver, Michael F. “Prescription Sedative Misuse and Abuse.” The Yale Journal of Biology and Medicine, September 2015. Accessed July 30, 2019.
Gunja, Naren. “The Clinical and Forensic Toxicology of Z-drugs.” The Journal of Medical Toxicology, June 2013. Accessed July 30, 2019.
Parsons, Graham. “Dependence on benzodiazepines or Z-drugs: having that conversation.” The Pharmaceutical Journal, October 2012. Accessed July 30, 2019.
Mager, Dan. “Detoxing After Detox: The Perils of Post-Acute Withdrawal.” Psychology Today, May 2015. Accessed July 29, 2019.
Substance Abuse and Mental Health Services Administration. “Protracted Withdrawal: Substance Abuse Treatment Advisory.” July 2010. Accessed July 27, 2019.
Kripke, Daniel F; Langer, Robert D; Kline, Lawrence E. “Hypnotics’ association with mortality or cancer: a matched cohort study.” BMJ Open, February 2012. Accessed July 27, 2019.
Lann, Meredith; Molina, DK. “A Fatal Case of Benzodiazepine Withdrawal.” The American Journal of Forensic Medicine and Pathology, June 2009. Accessed July 27, 2019.
Javadi, Seyed Alireza Haji Seyed; Hajiali, Farid; Nassiri-Asl, Marjan. “Zolpidem Dependency and Withdrawal Seizure: A Case Report Study.” Iranian Red Crescent Medical Journal, November 2014. Accessed July 27, 2019.
Griffin, Charles E; Kaye, Adam M; Bueno, Franklin Rivera; Kaye, Alan D. “Benzodiazepine Pharmacology and Central Nervous System–Mediated Effects.” The Ochsner Journal, 2013. Accessed July 27, 2019.