By: Harvard Health Letters
Do you take a drug to help you sleep every night? You’re not alone. Millions of Americans rely on prescription sleep medications, called sedative hypnotics.
“People believe they can’t sleep without them, and they stay on them for years,” says sleep expert Dr. Lawrence Epstein, an instructor in medicine at Harvard Medical School. But you can wean yourself off the drugs using a combination of dose reduction and behavior changes.
Understand What You’re Up Against
Epstein points to two challenges when it comes to fighting sleep aid dependence. One is that when you stop taking the drugs, you get a withdrawal response that keeps you from sleeping well.
“If you stop too quickly you can get rebound insomnia, which makes symptoms worse,” says Epstein.
The other challenge is that the rebound insomnia then convinces users they need the drugs to sleep. In reality, the medication is just preventing withdrawal symptoms. That cycle creates dependence, which is different from an addiction that’s characterized by compulsive use and preoccupation with a drug that interferes with normal life.
Starting the process
The encouraging news is that Epstein helps people end the use of sleep medications every day. It starts with a gradual, progressive reduction in the amount of sleep medication you take. Make sure this is done under the direction of a physician. Abrupt stopping can trigger seizures in some people.
Reducing the medication requires planning.
“Each time you lower the dose your sleep will be disrupted because you’ll have the withdrawal effect. So be prepared, and know your sleep won’t be as good for a few days,” says Epstein.
The longer you’ve been on the medications, the slower your doctor will make the taper. It’s a process that can last weeks to months.
The Key to Sleep Success
Reducing medications may not be enough to help you rest each night. So your doctor will likely pair the process with tools to counter behaviors that do not promote sleep. This includes:
- Cognitive behavior therapy, which helps you redirect your thoughts to reduce anxiety about sleeping
- Relaxation techniques such as guided visualization
- Recognizing the stimuli that prevent sleep, such as television, computer, or smartphone screens
- Improving sleep hygiene, by using the bed for sleep and sex only; blocking as much noise and light as possible; going to bed and waking at the same times each day; and getting out of bed if you haven’t fallen asleep within 20 minutes
- Dietary changes, such as avoiding alcohol, caffeine, and foods that promote acid indigestion.
Don’t Drive with Sleep Aids in Your System
Know your reaction to a medication before you get behind the wheel in the morning.
Sleep drugs may help you get a decent night’s rest, but they come with the risk of impairment – even amnesia – the next morning.
“It’s not an unusual side effect. It has to do with how long the drug lasts in your system,” says Epstein.
You’ll know you’re affected if you have a hard time getting started in the morning, or if you’re groggy when you wake up. That may put you at risk for impaired driving, or an amnestic effect on your behavior.
“Sometimes people tell me they’ve done things and they do not remember them, including driving,” says Epstein.
It’s vital to know how long these drugs last in your body. There are short-, medium-, or long-acting drugs within the various classes of sleep medications. Some, like zolpidem (Ambien), are short-acting. Others, such as eszopiclone (Lunesta) and temazepam (Restoril), are medium-acting. Long-acting drugs include flurazepam (Dalmane) and clonazepam (Klonopin). Make sure you ask your doctor or pharmacist how long your medication lasts.
What to do About It?
“If the problem is falling asleep, pick a drug that doesn’t last long. If the problem is awakening during the night, pick one that lasts longer, but learn how long it takes you to get rid of the medication, and put aside enough time for sleep to let the drug clear from your body,” advises Epstein.
In general, long-acting drugs are most likely to cause trouble. If you’re still groggy in the morning, talk to your doctor about a different medication or dose, and don’t get behind the wheel of a car.