Sleeping Pills: Risks, Dependence and Safer Ways to Sleep

7 min read · Medicines · By the Asthra Health Care team

Why people turn to sleeping pills

Poor sleep is very common. Stress, worry, shift work, late-night screen use, pain, frequent urination, snoring and depression can all disturb sleep. After a few bad nights, it is tempting to ask a chemist or relative for a sleeping tablet. But sleeping pills treat the symptom, not the cause, and many of them are habit-forming. In India, several of these medicines are controlled and should be sold only on a doctor's prescription.

Types of sleeping pills

The most common group is benzodiazepines, such as alprazolam, clonazepam, lorazepam and nitrazepam. Related 'Z-drugs' like zolpidem and zopiclone act on the same brain system. Some antihistamines that cause drowsiness, certain antidepressants and melatonin-type medicines are also used. Each has a different profile of benefits and risks, and a doctor chooses according to your age, health and the reason for your sleep problem.

Dependence and tolerance

With regular use, the body gets used to benzodiazepines and Z-drugs. The same amount starts working less well, which is called tolerance, and people feel they need more. Stopping suddenly can then cause rebound insomnia, anxiety, shaking, sweating and, in severe cases, seizures. This is dependence, and it can develop within weeks.

For this reason, doctors usually prescribe these medicines only for short periods, sometimes only on some nights, and plan a gradual reduction. Never increase, stop or restart sleeping pills on your own. If you notice you are thinking about the pill every evening or cannot sleep without it, tell your doctor.

Other risks to know

Sleeping pills can leave you drowsy the next morning, slowing reactions and making driving or operating machinery dangerous. They can affect memory and concentration. Some people have done things like walking, eating or even driving while not fully awake, with no memory of it later.

• Falls and hip fractures, especially in elderly people
• Confusion and memory problems in older adults
• Dangerous breathing slowdown when mixed with alcohol or opioid painkillers
• Worsening of sleep apnoea, a condition that causes loud snoring and breathing pauses
• Risk of overdose, particularly in people with depression

Who needs extra caution

Elderly people are most at risk of falls and confusion and should avoid these medicines unless a doctor feels they are truly necessary. Pregnant and breastfeeding women should not take sleeping pills without medical advice, as some can affect the baby. People with liver disease, lung disease, sleep apnoea, depression or a history of alcohol or drug misuse need careful assessment. Children should never be given adult sleeping medicines.

Finding the cause of poor sleep

A doctor will ask about your routine, stress, mood, snoring, pain and other medicines. Treating the underlying problem often improves sleep more than any pill. Depression, anxiety, thyroid problems, heartburn, prostate enlargement, restless legs and sleep apnoea are all common hidden causes. Blood tests such as thyroid function, blood sugar, iron studies and vitamin B12 may be ordered, and a sleep study may be advised if sleep apnoea is suspected.

Safer habits that help sleep

Cognitive behavioural therapy for insomnia is a structured talking treatment recommended by major guidelines as the first choice for long-term insomnia. It helps change the worries and habits that keep poor sleep going, and its benefits tend to last. Simple sleep habits also help many people.

• Keep the same wake-up time every day, including weekends
• Avoid tea, coffee and colas in the late afternoon and evening
• Put away phones and screens well before bedtime
• Keep the bedroom dark, quiet and cool
• Get daylight and exercise during the day, but not heavy exercise late at night
• If you cannot sleep, get up, do something calm, and return when sleepy

If you already take sleeping pills

If you have been taking sleeping pills for a long time, do not stop suddenly. Talk to your doctor, who can help you reduce slowly and safely, often while working on better sleep habits. Keep these medicines locked away from children and anyone at risk of self-harm. Consult a doctor or pharmacist before combining them with any other medicine, including cough syrups and painkillers.

This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.