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Can Sleeping Pills Be Addictive? (Understanding the Science)


The U.S. Centers for Disease Control and Prevention (CDC) reported a disturbing fact about sleep deprivation in this country. According to a study conducted by the CDC, more than a third of U.S. adults were not getting enough sleep regularly.

Because of sleeplessness, countless people are turning to sleep aids, including prescription and non-prescription pills. When Consumer Reports surveyed more than 4,000 American adults, the publication discovered that about one-third of them tried a prescription or non-prescription sleep medication or a dietary supplement.

However, certain sleeping pills can be addictive because of how they affect the brain. Learn more about the science behind these medications and how they work. 

What Are Sleeping Pills?

Sleeping pills are a catchall term for prescription and over-the-counter (OTC) medications that people use to treat insomnia, which is having difficulty falling and staying asleep. In general, sleep medications act on the brain and body to reduce excitability, which, in turn, generates drowsiness and calm.

But each kind of sleeping pill achieves this end in its own way. Under these categories, there are four types of drugs people use for sleep: barbiturates, benzodiazepines, Z-drugs (all prescription) and OTC medications (non-prescription).

The Problem with Sleeping Pills 

There is no substantial evidence that these medications actually work.

Dr. Daniel Buysse, a sleep medicine expert and University of Pittsburgh School of Medicine professor, said these medications have limited effectiveness. Sleep medicines can certainly help you fall asleep faster or return to sleep if you wake up in the middle of the night, but the benefits are typically modest, Buysse said to Consumer Reports.

“Most only increase total sleep time by about 20 to 30 minutes,” Buysse said.

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The Dangers of Sleeping Pills

The side effects of sleep medications are grogginess and drowsiness, symptoms that often linger into the next day. Those lingering effects can lead to car accidents and injuries from falls.

Another effect of sleeping pills is parasomnias. Parasomnias are your behaviors, movements, and actions you take where you have no control, states WebMD.

Such events are rare, but people on these medications have reported parasomnia-related behaviors like sleepwalking, sleep eating, having sex in a sleep state, and sleep driving.

What’s more, according to a 2017 study published by the University of Manitoba, there have been reports that increasingly link benzo and Z-drug use to conditions such as cancer, pancreatitis, dementia, respiratory disease exacerbation, and infections. But the study concluded that there was not enough evidence to support those claims.

WebMD states that there are specific side effects associated with these medications, including:

  • Nausea
  • Vomiting
  • Itching
  • Rash
  • Hives
  • Blurry vision
  • Pounding heartbeat
  • Chest pain
  • Shortness of breath
  • Swelling of the eyes, face, lips, tongue, or throat
  • Difficulty breathing or swallowing
  • Feeling like the throat is closing
  • Hoarseness

The Addictiveness of Sleeping Pills

Psychological addiction to sleeping pills is possible when you see these drugs as the only way to get good sleep.

“If the sleeping pill effectively promotes sleep but is stopped suddenly, for instance, some people may show signs of psychological dependence, with the desire to want to keep taking them. However, this is not an actual chemical addiction,” states a report from The New York Times.

Also, the more potent drugs of this class, barbiturates, and benzodiazepines, are capable of producing euphoric sensations at large enough doses. Users can get trapped into a pattern of abuse when recreationally taking these drugs (more on this later).

Types of Sleeping Pills

Benzodiazepines

Benzodiazepines or benzos are the most commonly prescribed sleep medications. They are central nervous system (CNS) depressants that are also used to treat anxiety and seizures as well. Some benzos are prescribed to aid people who are going through alcohol withdrawal. They are intended for short-term use only.

How They Work

Benzodiazepines (or benzos) stimulate gamma-Aminobutyric acid or GABA, a neurotransmitter in the brain responsible for reducing excitability in the nervous system. So, when a person takes a benzo, it depresses the nervous system, leading to drowsiness and sedation.

This action can also produce euphoria, which is also why benzodiazepine medications are abused.

Popular benzodiazepine sleep medications include:

  • Triazolam (Halcion)
  • Estazolam (ProSom)
  • Temazepam (Restoril)
  • Quazepam (Doral)
  • Flurazepam (Dalmane)
  • Lorazepam (Ativan)

Benzodiazepine Dangers

When people use benzos for longer than their prescription allows or exceed the recommended dosage, that’s when the dangers of this medication present itself. Benzos are no joke.

When someone misuses them, they can find themselves hurtling toward addiction. Benzos are capable of producing a mellow, calming effect. Depending on the degree of abuse, these drugs are capable of imparting significant euphoria. 

When someone uses benzos but abruptly stops, it could lead to unpleasant symptoms of withdrawal, which include:

  • Seizures
  • Heavy sweating
  • Depression
  • Fast heart rate
  • Hallucinations
  • Paranoia
  • Altered sense of reality
  • Abdominal cramping
  • Nausea and vomiting
  • Nervousness
  • Muscle cramps
  • Burning, tingling in the body, or “skin-crawling” feeling
  • Sensitivity to light, pain, or sound
  • Tremors
  • Difficulty falling or staying asleep
  • Irritability
  • Confusion and disorientation

Barbiturates

Barbiturate medications have mainly been replaced by benzodiazepines and Z-drugs and are not widely prescribed for sleep. These medications are highly addictive and have acute withdrawal symptoms.

How They Work 

As a central nervous system (CNS) depressant, barbiturates also bind to GABA receptors to dampen excitability. These old guard medications relieve symptoms of anxiety, lessen muscle spasms, and prevent seizures, in addition to inducing sleep.

Different kinds of barbiturates vary in how long they stay in your body. As Medical News Today explains, barbiturate medications, depending on what they are, can act in a very short, intermediate, or long fashion in the body. The time they take to go into effect can start at 30 minutes after the drug is taken and last between four to 16 hours.

The feeling they give is similar to alcohol intoxication.

Popular barbiturate medications include:

  • Phenobarbital (Nembutal)
  • Mephobarbital (Mebaral)
  • Amytal sodium (amobarbital sodium)
  • Butisol (butabarbital sodium)
  • Seconal sodium pulvules (secobarbital sodium)

Barbiturate Dangers

What makes barbiturates so dangerous is that only a small amount of it can be the difference between a therapeutic amount and a lethal dose. Use of barbiturates can produce effects that are similar to alcohol intoxication. Typically, barbs can make people experience a relaxed euphoria, have slurred speech and a loss of coordination, along with confusion and impaired judgment. These physically and psychologically addictive medications were widely abused in the 1960s and 1970s, leading many to experience a lethal overdose.

Though not as widely used today, they remain substances of abuse.

Medical News Today states that side effects from barbiturates include: 

  • Respiratory arrest and death
  • Forgetfulness
  • Confusion
  • Headache
  • Lack of coordination
  • Vomiting

Z-Drugs

Z-drugs are non-benzodiazepine medications that mimic benzos. As their name suggests, these drugs begin with the letter z or phonetically sound like they do. At any rate, these medications are regarded as hypnotics.

How They Work

These class of drugs came after barbiturates and benzos. Thus, they are seen as an improvement, in that they do not produce the severe side effects of those other drugs.

They were also developed to be less habit-forming than their predecessors as well.

Z-drugs work like benzodiazepines in that they enhance GABA in the body, which produces sleepiness. However, they go about it differently. They are more selective. They only target specific types of GABA receptors and only certain areas of the brain, according to the Inner Compass Initiative. Still not much else is known about these medications.

Popular Z-drug medications include:

  • Eszopiclone (Lunesta)
  • Zolpidem (Ambien)
  • Zaleplon (Sonata)

Z-Drug Dangers

Despite their perception as being safer than benzos and barbiturates, Z-drugs are also addictive and habit-forming. Frequent and severe side effects are associated with these drugs.

According to Inner Compass Initiative, those common and serious side effects include:

  • Heart attack
  • Mania
  • Rectal hemorrhage
  • Weakness
  • Loss of muscle coordination
  • Headache
  • Agitation
  • Excessive thirst
  • Nausea
  • Gastrointestinal issues
  • Joint pain
  • Respiratory infection
  • Impotence

OTC Medications

Over-the-counter sleep medicines are popular sleep remedies because they do not require a prescription, and they tend to be affordable. Medications in this category contain antihistamines, which work to block histamines. The antihistamines these medicines contain are diphenhydramine and doxylamine.

How They Work 

Histamines are natural chemicals in humans that are triggered when the body comes into contact with an allergy trigger, whether that is pollen, dust mites or ragweed, according to WebMD.

In addition to blocking histamines and allergy symptoms, these medications induce drowsiness.  

Dietary supplements like melatonin and valerian also fall under the OTC category. Melatonin is a hormone that controls and maintains sleep-wake cycles.

Valerian supplements are derived from the plant by the same name. These products are marketed as sleep aids, but not much is known about their effect on the body. 

woman covering her face

Popular OTC sleep medications include:

  • Benadryl (diphenhydramine)
  • Aleve PM (diphenhydramine)
  • Unisom (doxylamine succinate)
  • Alavert (loratadine)
  • Claritin (loratadine)
  • Zyrtec (cetirizine)
  • Allegra (fexofenadine)
  • Melatonin
  • Valerian

OTC Medication Dangers

Just because they do not require a prescription, does not mean antihistamine-based sleep aids do not pose dangers. Typically, healthy adults do not experience side effects from these drugs, but older people with pre-existing health conditions are prone to specific symptoms.

According to Consumer Reports, the side effects of antihistamine OTC medications include:

  • Next-day drowsiness
  • Constipation
  • Dizziness
  • Confusion

Next-day drowsiness can cause poor driving performance, which can lead to accidents. These medicines can also cause impaired coordination and balance.

While there are no known side effects associated with valerian, melatonin use can come with these symptoms, states Mayo Clinic:

  • Nausea
  • Drowsiness
  • Headache
  • Dizziness

Other less-common effects from melatonin are:

  • Irritability
  • Confusion
  • Hypotension
  • Mild anxiety
  • Mild tremor
  • Diminished alertness

Mixing Sleeping Pills with Alcohol

Sleep medications, whether they are of the prescription or OTC variety, should never be abused with alcohol. For barbiturates, benzodiazepines, and Z-drugs, such use can lead to respiratory arrest and coma. They can also cause significant sedation, which could lead to vehicular accidents and falls. 
According to this Psychology Todayarticle, mixing alcohol with sleeping pills is like playing a game of roulette.

Sources

Brandt, J., & Leong, C. (2017, September 01). Benzodiazepines and Z-Drugs: An Updated Review of Major Adverse Outcomes Reported on in Epidemiologic Research. Retrieved from https://link.springer.com/article/10.1007/s40268-017-0207-7

Brent A. Bauer, M. (2017, October 10). Pros and cons of melatonin. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/melatonin-side-effects/faq-20057874

Carr, T. (n.d.). The Problem With Sleeping Pills. Retrieved from https://www.consumerreports.org/drugs/the-problem-with-sleeping-pills/

The Centers for Disease Control and Prevention. (n.d.). CDC Newsroom. Retrieved from https://www.consumerreports.org/drugs/the-problem-with-sleeping-pills/

The Centers for Disease Control and Prevention. (n.d.). CDC Newsroom. Retrieved from https://www.cdc.gov/media/releases/2016/p0215-enough-sleep.html

Consumer Reports. (n.d.). Why Americans Can't Sleep. Retrieved from https://www.consumerreports.org/sleep/why-americans-cant-sleep/

FNP, K. D. (2018, June 25). Barbiturates: Uses, side effects, and risks. Retrieved from https://www.medicalnewstoday.com/articles/310066.php

Psychology Today. (n.d.). Alcohol and Sleeping Pills-A Strange Combination. Retrieved from https://www.psychologytoday.com/us/blog/the-power-rest/201111/alcohol-and-sleeping-pills-strange-combination

Skinner, G. (n.d.). Can You Get Hooked on Over-the-Sleep Aids? Retrieved from https://www.consumerreports.org/drugs/over-the-counter-sleep-aids-can-you-get-hooked/

The Inner Compass Initiative. (n.d.). "Sleep Aids" or Z-drugs. Retrieved from https://www.theinnercompass.org/learn-unlearn/intervention/sleep-aids-or-z-drugs

The New York Times. (2010, July 16). Are Sleeping Pills Addictive? Retrieved from https://consults.blogs.nytimes.com/2010/07/16/are-sleeping-pills-addictive/

WebMD. (n.d.). Antihistamine Medications: What's Available and Side Effects. Retrieved from https://www.webmd.com/allergies/antihistamines-for-allergies

WebMD. (n.d.). Side Effects of Sleeping Pills: Common and Potentially Harmful Side Effects. Retrieved from https://www.webmd.com/sleep-disorders/guide/understanding-the-side-effects-of-sleeping-pills#2

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