Sleeping tablets are considered a 'last resort' if you have poor sleep (insomnia). They are sometimes prescribed for a short period to get over a particularly bad spell of insomnia.
Why are doctors reluctant to prescribe sleeping tablets?
There are a number of 'self-help' therapies to try if you have poor sleep (insomina) but sometimes sleeping tablets may need to be prescribed. A perfect sleeping tablet would cause sleep, but have no possible problems. Unfortunately, there is no perfect sleeping tablet. Possible problems when taking sleeping tablets include the following:
- Drowsiness the next day. You may not be safe to drive or to operate machinery.
- Clumsiness, drowsiness, and confusion in the night (if you get up). These can occur, for example, if you have to get up in the night to go to the toilet. You may fall over and injure yourself. Some people have fallen down stairs due to the drowsy effect of sleeping tablets. (Older people who take sleeping tablets have an increased risk of breaking their hip, as the result of a fall.)
- Tolerance. With benzodiazepines and Z drug sleeping tablets (see below), if you take them each night, your body becomes used to them. This means that, in time, the usual dose has no effect. You then need a higher dose for it to work. In time, the higher dose does not work, and you need an even higher dose, and so on. It only takes between 3-14 days of continued use to become 'tolerant' to a benzodiazepine or Z drug sleeping tablet.
- Dependence. Some people become dependent (addicted) to benzodiazepines or Z drugs. This means that withdrawal symptoms occur if the tablets are stopped suddenly. Withdrawal symptoms include anxiety, shaking, or just feeling awful.
Are there different types of sleeping tablet?
Benzodiazepines and Z drugs
Benzodiazepines and Z drugs are sometimes used as sleeping tablets. Benzodiazepines include temazepam, loprazolam, lormetazepam, and nitrazepam. They are only available on prescription. Other related drugs called zaleplon, zolpidem, and zopiclone are also sleeping tablets. Strictly speaking are not benzodiazepines. They are known as the Z drugs. However, they act in a similar way (they have a similar effect to benzodiazepines on the brain cells).
These medicines are commonly used to treat allergies such as hay fever. However, drowsiness is a side-effect of some antihistamines - for example, promethazine. This 'side-effect' is useful in some people who have difficulty sleeping because of their allergy. An antihistamine is the active ingredient of some sleeping tablets that you can buy from pharmacies, without a prescription. Antihistamines are not as powerful as benzodiazepines or Z drugs at causing sleep. Also, they may cause a 'hangover' effect and some drowsiness in the morning. They may also cause rebound insomnia if you take them for a long time. For these reasons, current UK guidelines do not advise the use of antihistamines to be used solely as a sleeping tablet.
Melatonin is, strictly speaking, not a 'sleeping tablet'. Melatonin is a naturally occurring hormone made by the body. The level of melatonin in the body varies throughout the day. It is involved in helping to regulate the 'circadian rhythms' (daily cycles) of various functions in the body. A melatonin supplement is sometimes advised in older people (more than 55 years of age) with persistent insomnia. The recommended duration of treatment is for three weeks only.
Chlormethiazole, chloral, and barbiturates are old fashioned sleeping tablets. They are not commonly used these days, as benzodiazepines and Z drugs are usually preferred.
What is the alternative to sleeping tablets?
Your doctor or nurse may give you advice on how to tackle poor sleep naturally.
If a sleeping tablet is prescribed
If your doctor prescribes a benzodiazepine or Z drug as a sleeping tablet for you, it will usually be only for a short time (a week or so). This is to help you get over a particularly bad patch. Sometimes a doctor will advise sleeping tablets to be taken on only 2 or 3 nights per week, rather than on every night. This prevents either tolerance to or dependence on the tablet from developing.
What if I am already taking a sleeping tablet regularly?
For various reasons, some people have become used to taking a benzodiazepine or Z drug sleeping tablet every night. As a rule, if you are taking one of these sleeping tablets each night, you should consider reducing or stopping them. However, in some people, problems of tolerance or dependence (see above) mean that it can be difficult to stop the tablet suddenly.
If you want to reduce or stop benzodiazepine or Z drug sleeping tablets, it is best to consult a doctor or nurse for advice. The sort of advice may include the following:
- Do it gradually, and cut the dose down a little at a time. A switch to a different benzodiazepine (diazepam) may be advised. This is because it is easier to gradually reduce the dose of diazepam than it is with other benzodiazepines or Z drugs.
- It is best to wait until any life crisis has passed, and your level of stress is as low as can be.
- Consider stopping the tablets whilst on holiday, when you have less pressure from work, family, etc.
- You are likely to have a period of worse sleep when you stop the tablets. Try to anticipate and accept this.
- Advice on coping strategies, and tips on how to improve your sleep pattern naturally.
See separate leaflet called Stopping Benzodiazepines and Z Drugs for more details. However, stopping benzodiazepine or Z drug sleeping tablets is not practical in every case.
Further reading & references
- Insomnia - zaleplon, zolpidem and zopiclone for the management of insomnia; NICE Technology Appraisal (Apr 2004)
- Insomnia; NICE CKS, July 2009
- Benzodiazepine and z-drug withdrawal, NICE CKS, March 2009
- Consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders; British Association for Psychopharmacology (2010)
- Sola CL et al, Sedative, Hypnotic, Anxiolytic Use Disorders, Medscape, Jun 2011
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Tim Kenny
Dr Colin Tidy
Prof Cathy Jackson