Sleeping pills addiction
Sleeping pills addiction refers to the dependence that can develop from the use of both prescription and over-the-counter sleep aids. Medications like zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta), known as Z-drugs, work on GABA-A receptors in the brain and are prescribed primarily for short-term insomnia management. Despite their intended use, these drugs have a risk of abuse, especially when combined with alcohol or other sedatives, which can amplify adverse effects. Over-the-counter options often contain antihistamines like diphenhydramine and may become less effective over time due to quick tolerance.
While these medications can offer temporary relief, they can lead to symptoms of addiction, including withdrawal effects such as insomnia, anxiety, and physical discomfort when not taken. Serious side effects may include cognitive impairment and sleep-related behaviors, such as sleepwalking or sleep-driving. The potential for dependence and serious complications underscores the importance of comprehensive medical evaluation and careful prescribing practices, especially for individuals with a history of mental health issues.
Subject Terms
Sleeping pills addiction
DEFINITION: Nonbenzodiazepine sleeping pills include both prescription and over-the-counter (OTC) medications. Prescription medications, especially those that act on the GABA-A receptor of the central nervous system, are more likely to be abused than are melatonin-like or OTC sleeping pills.
STATUS: Legal in the United States and worldwide
CLASSIFICATION: Various scheduled classifications
SOURCE: Natural and chemically synthesized
TRANSMISSION ROUTE: Oral ingestion of tablets and capsules
History of Use
Zolpidem (Ambien, Edluar), a nonbenzodiazepine sleep aid, was approved as a prescription by the US Food and Drug Administration in 1992. Zaleplon (Sonata) was approved in 1999, and eszopiclone (Lunesta) was approved in 2004. Often called the Z-drugs, these drugs are sedative-hypnotics that work by binding with GABA receptors in the brain. Since the introduction of zolpidem, there have been reports of diversion and abuse because of the addictive nature of these medications. When abused, these medications are often combined with alcohol or other sedating drugs, which heightens adverse reactions.
OTC sleep aids like Tylenol PM, Advil PM, Tylenol Simply Sleep, and ZzzQuil typically contain an antihistamine such as doxylamine or diphenhydramine. These medications are quickly tolerated, making them less effective over the long run.
Effects and Potential Risks
Zolpidem, zaleplon, and eszopiclone all have mechanisms of action involving the GABA-A receptor within the central nervous system, whereas ramelteon (Rozerem) and suvorexant (Belsomra) are selective agonists of melatonin. Chemically, zolpidem and zaleplon bind specifically to a1 subunits on GABA-A receptors.
Generally, these medications are indicated only for short-term management of insomnia and should be ingested only when the patient will get at least seven to eight hours of uninterrupted sleep. However, because of their addictive properties, these medications are often used for limited periods of time and have label restrictions to that effect. Overall, of these medications, eszopiclone has less potential for abuse or dependence in most patients.
Benzodiazepines are often prescribed for anxiety and panic disorders but are in the same family of drugs as the sleeping pills mentioned above. They are not recommended for insomnia because of their high addiction potential, but their sedative effect is practical for some patients. These drugs include alprazolam (Xanax), temazepam (Restoril), and Triazolam (Halcion).
Common adverse effects of this class of medications include daytime sedation, drowsiness, cognitive impairment, problems with motor coordination, and dependence. Although reported less frequently, more serious complications include sleep-related behaviors, such as sleepwalking, sleep-eating, sleep-driving, and temporary amnesia. There also have been reports of worsening depression and suicidal thoughts, so a complete psychological history is an important factor in the decision of what sleeping medication, if any, to prescribe. Depending on the medication, symptoms of overdose may include drowsiness, confusion, lack of coordination, slowed or difficult breathing, slow heartbeat, or even loss of consciousness. Sleed-aid and other benzodiazepine overdoses can be reversed with the drug flumazenil (Romazicon).
Those who misuse sleep medicines can experience withdrawal. This can involve tiredness, insomnia, strange dreams, gastrointestinal discomfort and distress, anxiety or panic, shaking, sweating, light-headedness, and even seizures.
Bibliography
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Plumptre, Elizabeth. "What Is a Sleeping Pill Addiction?" VeryWell Mind, 1 Feb. 2024, www.verywellmind.com/sleeping-pill-addiction-and-abuse-5213740. Accessed 20 Sept. 2024.
"2020 National Survey of Drug Use and Health (NSDUH) Releases." SAMHSA, Substance Abuse and Mental Health Services Administration, US Dept. of Health & Human Services, www.samhsa.gov/data/release/2020-national-survey-drug-use-and-health-nsduh-releases. Accessed 2 Dec. 2022.
"2022 National Survey of Drug Use and Health (NSDUH) Releases." SAMHSA, Substance Abuse and Mental Health Services Administration, US Dept. of Health & Human Services, www.samhsa.gov/data/release/2022-national-survey-drug-use-and-health-nsduh-releases. Accessed 20 Sept. 2024.
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Wagner, Judy, et al. “Beyond Benzodiazepines: Alternative Pharmacologic Agents for the Treatment of Insomnia.” Annals of Pharmacotherapy, vol. 32, no. 6, 1998, pp. 680–91.