Sleeping tablets: are they safe, and how do you stop them?

What are sleeping tablets?

Sleeping tablets, which many people also call sleeping pills, are medicines that help you fall asleep or stay asleep. There are several groups, which work in different ways.

• Benzodiazepines: sedative medicines used for sleep and also for anxiety.
• Z-drugs: a related group, also called benzodiazepine receptor agonists.
• Sedating antihistamines: some are sold over the counter. Evidence that they help insomnia is limited, and the European insomnia guideline does not recommend them.
• Medicines acting on melatonin receptors, and orexin receptor antagonists: these work differently. Melatonin itself has its own guide.
• Some antidepressants and antipsychotics: these can cause drowsiness. If you take one, it may be treating something other than sleep.

This guide does not list tablet names, because a name alone cannot tell you whether a medicine is right for you. To find out which group yours belongs to, look for the generic name on the strip and ask your doctor or pharmacist.

Dependence and withdrawal, covered below, mainly concern benzodiazepines and Z-drugs, so ask your doctor what applies to your tablet.

Why are sleeping tablets only meant for short-term use?

Sleeping tablets are meant for short-term use because their benefit can fade within weeks, while their risks carry on.

The Indian Psychiatric Society’s guideline limits medicines to short-term insomnia. It does not routinely recommend them for chronic insomnia, where a therapy called CBT-I is preferred. The European Insomnia Guideline says medicines should generally be limited to no more than four weeks, and used with care even then, because the body can get used to them within days to weeks.

This is guidance for doctors, not a deadline for you. Both guidelines accept that longer treatment may suit some people, and the Indian guideline notes this where CBT-I is not possible. What matters is regular review, so it is reasonable to ask your doctor whether your tablet is still needed.

Can you become dependent on sleeping tablets?

Yes, some sleeping tablets can cause dependence, particularly benzodiazepines and Z-drugs, even when you take them exactly as prescribed.

Dependence here means your body has adapted to the medicine, so you may feel unwell when it is reduced. It can develop within weeks, and it varies from person to person. It is not the same as addiction, and it does not mean you are weak or have done anything wrong.

• Tolerance: the same tablet does less over time. It can be tempting to take more on a bad night, but raising the dose is not advised, as it may speed up dependence. Please speak to your doctor instead.
• Rebound insomnia: sleep gets worse after a tablet is reduced or stopped. It can feel like proof that you cannot sleep without the tablet, but withdrawal symptoms are often hard to tell apart from the original problem, even for doctors. Knowing this in advance can help.

What are the main risks of sleeping tablets?

The main risks of sleeping tablets are falls, next-day drowsiness, memory problems and stronger effects when mixed with alcohol.

• Falls: these tablets can cause night-time confusion and falls, and older adults are at higher risk, including of hip fractures. If an older parent takes one, tell their doctor about any fall or new confusion.
• Driving: drowsiness can carry over into the next day and affect your driving. Please do not drive or use machinery if you feel drowsy or slow.
• Memory and thinking: some people notice poorer memory or concentration. Mention this to your doctor rather than putting it down to age.
• Alcohol: alcohol adds to the sedating effect, and the combination carries more risk than either alone. The same applies to other sedating medicines, including opioid painkillers. Tell your doctor honestly how much you drink. If you drink heavily every day, please also read about why stopping alcohol suddenly can be risky.
• Actions you do not remember: rarely, people walk, drive or do other things while not fully awake, particularly with Z-drugs. If it happens, speak to your doctor right away, before your next dose.
• Pregnancy: if you are pregnant or planning to be, tell your doctor early, so that the risks for you and your baby can be weighed together.

A tablet is prescribed for one person, so please do not share them, however kindly meant. If you have been using someone else’s tablets, or buying them without a prescription, tell a doctor rather than stopping suddenly.

Why can stopping sleeping tablets suddenly be unsafe?

Stopping sleeping tablets suddenly can be unsafe because your body has adapted to them, and an abrupt stop can bring on withdrawal.

Withdrawal can range from anxiety and poor sleep to, more seriously, seizures and delirium, a state of severe confusion. These serious problems are typically linked with suddenly stopping high doses. Even so, the risk depends on the medicine, the dose, how long you have taken it, your age and your other health conditions, so it needs a doctor’s judgement.

Someone who took a tablet only briefly may not need a slow reduction, but that is also your doctor’s decision. Please do not stop or cut down by yourself, even if you feel ready.

If you have already stopped, or have run out, and you feel unwell, contact your doctor the same day.

How do I stop taking sleeping tablets safely?

The usual way to stop sleeping tablets is a gradual reduction planned with your doctor, at a pace adjusted to how you respond. No single schedule suits everyone, so this guide does not give one. If the doctor who first prescribed your tablet is no longer available, your family doctor or a psychiatrist can review it.

A psychiatrist will usually start by asking which tablet you take, for how long, why it was started, what else you take, how much you drink, and what happened if you missed a dose or tried to stop before. The answers help show how slowly to go, and whether anxiety, depression or another problem needs treatment too.

A supervised reduction usually involves:

• bringing the dose down in steps, at a pace set for you
• checking how you are after each reduction
• slowing down or pausing if symptoms become hard to manage
• treating the reason the tablet was started
• agreeing a realistic goal, which may be stopping altogether or reaching a lower dose where the risks no longer outweigh the benefits

Many people can do this without a hospital stay, though some difficult nights are common. Admission may be considered if withdrawal is likely to be severe.

Guidelines also support offering CBT-I during a reduction, because it works on the habits and worries that keep insomnia going.

A relative can help by coming to appointments, noticing changes you might miss, keeping tablets stored safely and being patient through harder nights. If your mood drops during a reduction, tell your doctor straight away.