Struggling to sleep and considering the medicinal route? While sleeping tablets are effective in the short term if you really can't sleep, they also come with some important side-effects to consider.
Dr Roger Henderson looks at the different types of sleeping tablets that are available in the UK, their side-effects, alternative treatment options, and how to stop taking sleeping tablets if you have been using them for some time:
What are sleeping tablets?
Sleeping tablets are sedatives that are sometimes prescribed if you have difficulty in sleeping and suffer from insomnia. However, all types of sleeping tablets have potential risks, including becoming dependent on them.
The risks and benefits of this type of treatment vary between different medications and most doctors now try to avoid prescribing sleeping tablets whenever possible due to the potential problems linked to them.
Where can you get sleeping tablets?
Sleeping tablets are only available on prescription in the UK. Before prescribing a sleeping tablet your doctor will ask you questions about your sleeping pattern in order to understand more about your insomnia, and may occasionally arrange some simple tests to exclude any underlying conditions that may be causing difficulty sleeping. They should also discuss non-drug options that may help with your sleeping such as cognitive behavioural therapy (CBT) and general sleep hygiene options.
Very short courses of sleeping tablets can be helpful in certain situations, such as following a bereavement or sudden severe shock but doctors advise they should not be used for more than two weeks at a time.
Types of sleeping tablets available
The following types of sleeping tablet are currently available on prescription and over-the-counter in the UK:
• Benzodiazepines and ‘Z-drugs’
Benzodiazepines and ‘Z-drugs’ are the most commonly prescribed types of sleeping tablets and are only available on prescription. Examples of benzodiazepines include:
Drugs that act in a very similar way to benzodiazepines are sometimes called the ‘Z-drugs’ as their names begin with the letter Z and examples of these include zopiclone and zolpidem.
Antihistamines are not technically a sleeping tablet as they are normally used to treat allergies such as hay fever, but these can be prescribed or bought from a pharmacist without a prescription to help with sleep problems, as the sedating forms of antihistamines may help cause drowsiness and sleep.
Antihistamines are not as powerful as benzodiazepines and Z-drugs, and can cause a ‘hangover’ feeling the following day. If taken for a long time they may also cause rebound insomnia when stopped, so current UK guidelines do not recommend these are taken solely as a sleeping tablet.
Melatonin is a naturally occurring hormone made in the body which helps to regulate the daily body cycles and in some countries (but not the UK) is used in the treatment of jet lag. Slow-release melatonin is licensed to be prescribed for people aged 55 and over as a treatment for chronic insomnia. It is normally given for three weeks initially and can be given for a further 10 weeks after this if shown to be helpful. As with benzodiazepines and Z-drugs, problems such as drowsiness, confusion and falls have been reported with melatonin.
• Antidepressant tablets
If depression or anxiety is felt to be causing insomnia then antidepressant tablets may be considered as a possible treatment by your doctor. Previous treatment options included barbiturates, chloral hydrate and chlormethiazole but these are no longer used.
• Herbal remedies
Some over-the-counter herbal remedies may help induce sleepiness including products containing valerian, magnesium and chamomile. However, unlike prescription drugs, supplement manufacturers don’t have to show their products are safe or effective before selling them. If you are considering taking herbal sleep remedies, ask your pharmacist for advice.
Will your doctor prescribe sleeping tablets?
Most GPs now try to avoid prescribing sleeping tablets whenever possible. The main concern doctors have is with the risk of dependence and tolerance occurring. Your body can quickly become used to the effect of sleeping pills, and withdrawal symptoms occur if the tablets are stopped suddenly. Typical symptoms of sleeping pill withdrawal can include:
Being unable to sleep
Being oversensitive to sound or light
It can take as little time as a week - or even less in some cases - for tolerance to develop and increasing doses are required for the sleeping tablets to work. If you have been taking a Z drug or a benzodiazepine for more than two to four weeks you will need to gradually come off these to prevent withdrawal symptoms occurring.
Sleeping tablet addiction
Addiction is different to dependence and tolerance. Some people taking sleeping tablets may become addicted to them, and suffer uncontrollable cravings for these drugs. This can occur even if they have withdrawn from taking them slowly so that dependence no longer occurs, and some people do appear to be more likely to become addicted to sleeping tablets than others.
Although yet to be conclusively proved, there is some evidence now that people who take sleeping tablets for a long time may be at an increased risk of developing dementia, Alzheimer’s disease and premature death.
Some people on these tablets may also become depressed, forgetful or aggressive, and are known to have more accidents such as falls and car accidents. Older people taking sleeping tablets have a higher risk of falling (especially in the night) and breaking bones such as their hips or wrists.
Benzodiazepines and driving
The DVLA is responsible for deciding if a person is medically unfit to drive. Significant number of road traffic accidents can involve drivers under the influence of alcohol, drugs, or illness and sleeping tablets can impair driving skills in the same way. It is the responsibility of anyone holding a driving licence to inform the DVLA of any medical condition that may affect safe driving - failure to do so is a criminal offence that may lead to a fine of up to £1,000.
It is the responsibility of your GP to ensure you are aware of this and will discuss this when you attend an appointment regarding your prescription.
⚠️ Always remember that benzodiazepines and Z drugs make you sleepy - if this happens do not drive, use tools or machinery and do not drink alcohol.
How to come off sleeping tablets
If you are currently taking sleeping tablets and feel you may have become dependent, as a general rule aim to reduce the dose a little at a time, with the help of your doctor, rather than stopping them suddenly.
Your doctor may advise switching to a different benzodiazepine called diazepam as it may be easier to gradually reduce the dose of this drug rather than others. It also may be easier to cut down and stop sleeping tablets while on holiday (away from life pressures) or when any life crisis has passed.
Some people have worse sleep when reducing their sleeping tablets, but when they do stop them completely they usually report feeling much better physically and mentally as a result.
Sleeping tablets advice and warnings
Read the following advice before considering taking sleeping tablets:
✔️ Sleeping tablets should not be prescribed without other possible causes of insomnia – such as itching, breathlessness, indigestion or pain – being assessed and treated, typically without sleeping tablets being needed.
✔️ Check with your doctor or pharmacist that you are not taking any other medicines that may be causing sleep problems.
✔️ Ask your doctor about being given a copy of the ‘good sleep guide’ which gives advice about how to get a good night’s sleep without tablets – advice includes getting more exercise, avoiding caffeine, and suggestions to improve your bedtime routine.
✔️ Never take a sleeping tablet until bedtime. Always wait until you have finished all your evening activities and are ready to go to bed before taking one.
✔️ Always take sleeping tablets strictly as prescribed by your doctor. Never take a higher dose than prescribed and always remember they are for short-term use only. If they do not work, don’t take more pills without first talking to your doctor.
✔️ Never mix alcohol and sleeping tablets. Alcohol increases their sedative effect and so should be avoided completely as even a small amount may cause dizziness and confusion when mixed with sleeping tablets.
✔️ Remember that you may have some nights of poor sleep after stopping taking sleeping tablets.
✔️ If you have any concerns about the effect sleeping tablets may be having on you, discuss these with your doctor.
Last updated: 12-02-2021
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