Information on Sleeping Pills, Detox and Rehabilitation

Last updated: Friday, 12, November 2021

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"Sleeping pills" is a term used to describe medications used to help individuals who have difficulty falling asleep or staying asleep on their own. Sleeping pills are hypnotics, meaning that they promote or extend sleep. They are also sometimes called sedatives, or tranquilizers, which means "calming," and can refer to the ability to cause drowsiness. The most common prescription sleeping pills, or hypnotics, are drugs called benzodiazepines, or benzos, for short. Examples of benzos include medications like Valium and Xanax. There are also more specialized and newer drugs designed explicitly for sleep called Z-drugs, collectively, because most of their names begin with the letter Z. Sleeping pills can have serious side effects if overused or abused, including addiction, long-term health consequences, and death. Most people begin taking sleeping pills due to insomnia, which can arise for a variety of reasons. But rather than solving the root cause of the lack of sleep, sleeping pills simply mask the issue for a period, causing the user to feel that the problem is resolved.

Sometimes sleeping pills are abused as a replacement for other drugs or medications which a person could be addicted to, particularly other sedatives or alcohol. Because these drugs are chemically similar and work on the same parts of the brain, one can often "swap" addictions between certain drugs without triggering withdrawal symptoms. This can happen when a person is trying to quit a particular substance and may mistakenly believe that another is safer. Sleeping pills are frequently taken in conjunction with other substances, both illicit and legal. This can be extremely dangerous and quickly lead to overdose. These drugs are not limited to prescription-only forms. There are many over-the-counter sleeping pills which are also abused. These mostly fall within the antihistamine drug class and include medicines like Unisom and Benadryl. And some people use medications that aren't made for sleep but will cause drowsiness as a side effect, such as cold or allergy medications. Advil PM, Nytol, Sominex, ZzzQuil, Tylenol PM all contain diphenhydramine, the active ingredient in Benadryl. Their packaging claims it to be non-habit forming, yet there's research that concludes that it enhances the release of dopamine in the brain that produces an effect similar to cocaine. And there's a risk of psychological addiction.

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Commonly used sleeping pills include:

  • Ambien (zolpidem tartrate)
  • Dalmane (flurazepam hydrochloride)
  • Halcion (triazolam)
  • Lunesta (eszopiclone)
  • Prosom (estazolam)
  • Restoril (temazepam)
  • Rozerem (ramelteon)
  • Silenor (doxepin)
  • Sonata (zaleplon)
  • Desyrel (trazodone)
  • Belsomra (suvorexant)
  • Over-the-counter sleeping pills (including antihistamines, melatonin, herbal formulations, and others)

Street names for sleeping pills include barbs, phennies, reds, red birds, tooies, yellows, yellow jackets, bars, benzos, blues, candy, chill pills, french fries, downers, planks, sleeping pills, totem poles, tranks, zanies, and z-bar, A-, zombie pills.

The History of Sleeping Pills

The history of sleeping pills began with man's search for a solution to insomnia. Some of the first drugs used for this purpose were alcohol and opioids, both of which have the same liability. They are only effective at inducing sleep and are destructive in maintaining it. This creates the illusion of helping because they fall asleep quickly, but they then awaken more frequently and sleep less soundly.

The discovery of chloral hydrate in the mid-nineteenth century and the clinical development of barbiturates as sedatives at the beginning of the twentieth was the modern inception of the sleeping pill. Others, later including methaqualone (Quaaludes), became popular as sleeping pills. Each was touted as a potential solution to insomnia. But as time went on, their many drawbacks also became evident. Tolerance, dependence, and medically severe withdrawal syndromes have been the primary issues with virtually all of these medications.

The first sleeping pills were very toxic. Taking as few as ten doses could prove fatal. They suppressed respiration, and the barbiturates also had the property of stimulating enzymes in the liver to break down other drugs more quickly. Because of these many drawbacks, they have been used less and less, and hardly ever for sleep anymore. They did spur the search for safer drugs, though, and it is worth knowing about them to understand the context from which currently used drugs came. As we look at the many dangers and concerns about benzodiazepines, it is important to remember that they initially became popular because they were perceived as an improvement over barbiturates.

As we will see, each new generation of sleeping pills, including Z-drugs, has brought improvements, though after the initial enthusiasm has died down, there is usually recognition of limitations. Although benzodiazepines had first become available in the 1960s, by the late 1980s, there was growing concern about daytime sedation as well as dependence-producing potential. Just as benzodiazepines were initially hailed as a great improvement over barbiturates, Z-drugs were thought to have significant advantages over benzodiazepines. But these have been a very similar story, as stories of addiction and abuse began to emerge shortly after the drug's release. These include startling accounts of people performing complicated tasks like driving while apparently awake, yet they have no recollection of doing such. They have also been attributed to more significant instances of psychosis and other severe mental health conditions.

According to the first government survey of its kind, nearly 9 million U.S. adults take prescription sleep aids, with use more common among those who are older, female, white, and more educated.

What do sleeping pills look like?

There are many different sleeping pills that each look different. Here are some examples:

This is a picture of Ambien 5mg pills.
AMBIEN
This is a picture of Dalmane 15mg pills.
DALMANE
This is a picture of Halcion 25 mg pills.
HALCION

Effects of Sleeping Pills

Generally, all sleeping pills will cause some degree of drowsiness and sedation. Because of this, it is never safe to drive or perform other complex or dangerous tasks while under the influence of them. This also makes them dangerous to mix with other drugs or medications, particularly those that cause sedation also. Because there are so many different kinds of sleeping pills with different action mechanisms, it is always best to err on the side of caution and refrain from consuming other substances without checking with a doctor first.

Sleeping pills can have severe side effects. These side effects can happen with both prescription and over-the-counter sleeping pills. Possible side effects include:

  • Oversleeping
  • Being too tired to drive the next morning safely
  • Being too drowsy to work or perform other necessary functions the following day
  • With some prescription sleeping pills, doing potentially dangerous activities such as eating, walking, leaving your house, having sex, making phone calls, carrying on conversations, or driving while you are not fully awake. You may not even be aware of these activities as you are doing them in your sleep
  • Allergic reaction (anaphylaxis)
  • Facial swelling (angioedema)

Side effects may worsen in those who drink alcohol, the elderly, and individuals with sleep apnea, as their breathing may be further impaired when using particular sleeping pills. If used over a long period, an individual may become addicted to or dependent upon sleeping pills. This overuse can have serious long-term health consequences, including:

  • Memory problems
  • Mental and behavioral disorders
  • Learning problems
  • Worsening of insomnia symptoms beyond their baseline when the pills are discontinued
  • Tolerance.  Over time it takes more of the drug to get the same effect
  • Withdrawal symptoms-often include sweating, shaking, and nausea

Side effects specific to benzodiazepines include serious illnesses and premature deaths from cancer, serious infections, mood disorders, accidental injuries, suicides, and homicides.

Nonbenzodiazepine drugs are known to cause parasomnia, which are unwanted behaviors people engage in while "asleep." Part of the sleeper's brain is awake, and the other asleep, and people engage in all kinds of behaviors such as eating, texting, driving, walking, and even sex, all with no memory of doing those things.

OTC drugs such as Nytol, Sominex, and Unisom are known to cause grogginess the next day, forgetfulness, clumsiness, urinary retention, constipation, dry mouth and throat, nausea, and headaches.

Sleeping Pill Overdose

Drug overdose deaths have consistently increased year on year since 1999, with more than 64,000 deaths reported in 2016.

Sedative drugs, including barbiturates and benzodiazepines, are among the chief causes. Benzodiazepines have alone accounted for nearly one in seven of these deaths.

As sedatives work by depressing the central nervous system, the overuse of the drugs can slow body functions to such a degree as to cause unconsciousness, respiratory failure, and death. Accidental overdose can occur if the user takes too much of a sedative or combines it with other drugs the enhance the depressive effects.

Signs of an overdose of sedatives are similar to those of alcohol, which is also a depressant. Slowing the brain function initially affects the parts of the body which control voluntary functions. When a person overdoses, the drug can begin to affect the person's involuntary functions, such as breathing and heart rate.

Symptoms of a sedative overdose include:

  • Slurred speech
  • Unsteadiness
  • Difficulty breathing
  • Dizziness or fainting spells
  • Vomiting
  • Inability to think or respond normally
  • Slowed respiration
  • Slowed heartbeat
  • Increasing coldness of the skin
  • A bluish tinge to the lips, fingers, and skin (cyanosis)
  • Unconsciousness
  • Shock
  • Coma

People who have overdosed on sedatives will be admitted to the hospital and monitored closely, usually in intensive care. Approximately one in four overdose deaths occur after a person has been admitted.

Treatment may involve some or all of the following:

  • A stomach pump
  • Administration of activated charcoal to absorb the excess drug
  • Medications to flush the drug through the bowels or urinary tract
  • Administration of intravenous fluids to prevent dehydration and stabilize body functions
  • A respirator if breathing has been impaired
  • Dialysis to better clean the blood
  • Medications to stabilize heart function
  • Psychiatric care, including a short-term suicide watch

From 2002 to 2015, the rate of overdose deaths involving the combined use of sedatives and opioids has doubled. Today, the majority of sedative-related overdose deaths occur for this reason.

Sleeping Pill Addiction

The cycle of addiction always begins with a problem, and at first, it is not the drugs. The drugs begin as a solution to the problem. And when it comes to sleeping pills, insomnia is usually the problem.

Insomnia is one of the most common reasons for doctor visits in the United States. A healthy adult needs an average of 6 to 8 hours of sleep per night. Sometimes, an individual might have a problem getting this amount of sleep. Forty-eight percent of Americans report occasional insomnia, and 22% say they suffer insomnia every night or nearly every night. Approximately 10% of people have chronic insomnia, which occurs at least three times per week for at least three months.

But if there's a cause of insomnia that hasn't been addressed, patients may still have trouble sleeping and can quickly become physically or psychologically addicted. More than 500,000 people in the U.S. are currently abusing Ambien and other sedatives. Doctors often recommend sleep medications during periods of stress, such as divorce or moving. Many people that have developed a sleeping pill addiction don't realize that they're addicted until they try to stop taking the medication. They may have assumed that because their doctor prescribed the pills, they couldn't become addicted or that sleeping pills are safe.

But what occurs is that their body and neurochemistry quickly adjust to the drug's presence, and physical dependence begins. This can soon lead to cravings and factors which accelerate substance abuse disorder.

Signs of a sleeping pill addiction include:

  • inability to sleep without a sleeping pill
  • cravings for sleep medication
  • several failed attempts to quit
  • visiting more than one doctor for prescription refills
  • frequent memory loss
  • increasing dosage without consulting a doctor

How to help a loved one addicted to sleeping pills

Sleeping pill addiction is not something to be taken lightly. If someone you know is showing signs of abusing sleeping pills, you must do something before it's too late. These drugs are incredibly dangerous and have claimed many lives, some of whom were quite famous.

The trouble with sleeping pill addiction is it usually begins from a serious problem like insomnia. You must keep this in mind if you'll be confronting the person about getting help. Never trivialize the importance of their issue. Not being able to sleep will drive a person to insanity and certainly solutions like taking chemical substances each night. But being addicted to sleeping pills is no way to live, as most don't live long anyhow.

Because they may be very defensive about their trouble with sleep and need for the pills, never suggest getting off the sleeping pills without having some solution in place for how they might get sleep. Do your research on the front end. You can always call us at the number on this page and discuss treatment options for sleeping pill addiction. This way, you'll be armed with information and can tell them about how they'll be helped.

If they don't want help, then you have a different problem on your hands. This is where most people give and decide that there's nothing they can do. But this is not true, because there's always something you can do to help someone.

Where most people err is in accusing the person of using drugs or demanding that they go to treatment or else. If they are hiding their drug use, they can simply lie if you confront them about it. Ignoring it is the worst possible option, so you must find a way to confront them without triggering defensive responses. Instead of getting angry or even asking them if they use drugs, simply tell them your concerns. Stay calm and listen to what they have to say.

They will likely become uspet or blame you for their life circumstances. Ignore this, as it has nothing to do with the issue at hand. If you stay focused on helping them and stay calm, they may just tell you the truth. If not, move on to intervention.

Intervention works best when professionals are used. These people are trained to get someone who doesn't want help to be willing to accept it. This is vital. It's not just about forcing their hand. Intervention is about getting the person to give it a shot, even if only for a while. They may discover that as they become sober that they can think clearly and decide they want a better life.

Sleeping pill addiction can take someone's life quietly and quickly while they appear to be asleep. Don't let them slip away. Act before it's too late.

Sleeping Pill Treatment

When a person decides it's time to get help for addiction to sleeping pills, this is often the beginning of the challenge. In the case of severe or long-term addiction, merely discontinuing the drug is not an option. This is because of the phenomenon of physical dependence, which occurs with most sedative drugs. Withdrawal can be life-threatening.

This is why most people who enter treatment for sleeping pill addiction first go through medical detoxification as a first step. Medical detoxification, or med detox for short, is exactly what it sounds like. It is the process of medically assisting and supervising drug withdrawal and detoxification in patients that are physically dependent on chemical substances. In this way, a person's withdrawal symptoms can be managed, and they can be made safer and more comfortable. This allows for proper tapering of medication, too, since cold-turkey cessation may be counterproductive by incurring unnecessary suffering, even if it can be made safe through the use of other medicines.

After medical detox is complete, the person should enter treatment immediately. Med detox is not rehabilitation and only serves to get the person into a drug-free condition to be treated without the effects of the drugs getting in the way.

When it comes to treatment, there are two primary forms. The most common and most effective is inpatient treatment. Inpatient drug treatment is considered the gold standard of drug rehabilitation. It is where the person lives and stays at the facility for the entirety of their treatment. This provides many benefits, including around-the-clock support and restrictions, which make relapse much more difficult. Most inpatient programs are around one month in length, but some may last as long as 90 days or even more.

The other primary form of rehabilitation for sleeping pill addiction is outpatient treatment. It is most commonly used to supplement inpatient care and acts as an intermediary step before complete independence. Outpatient treatment is different because the patient lives at home and travels to the facility for treatment sessions periodically. This may be as frequent as daily at first or as infrequently as weekly once the patient has become more stable and nearing completion. Within the above two formats, there are many different methods of rehabilitation. These often are a matter of personal preference but warrant additional research from anyone pursuing treatment. Some programs may have religion as a core element, which could conflict with a patient's core beliefs ad result in a less than optimum outcome. Other programs may lack spiritual or other components which similarly discourage participation or affect outcomes.

This is why one should never enter treatment blindly if they can help it, and spend some time speaking with the staff of even touring the facility if possible.

In searching for a treatment program that is right for you, take time to answer all of their questions honestly. They are screening you to see if their program is the appropriate level of care for your needs, medically. They must have an accurate idea of your drug use to ensure that you'll be safe.

 

4%

of U.S. adults aged 20 and over used prescription sleep aids in the past monty between 2005-2010

5%

of adult women used prescription sleep aids

3.1%

of adult men used prescription sleep aids

Sleeping Pill Statistics

  • The total estimated number of zolpidem-related emergency department visits involving overmedication increased among males and females between 2005-2006 and 2009-2010.
  • In 2010, females accounted for two thirds – or 68 percent – of zolpidem-related E.D. visits involving overmedication.
  • Patients ages 45 to 54 represent the largest proportion of zolpidem-related E.D. visits involving overmedication.
  • More than 57 percent of zolpidem-related E.D. visits involving overmedication in 2010 included other pharmaceuticals that were combined with zolpidem.
  • Nearly half (47 percent) of zolpidem-related E.D. visits involving overmedication resulted in either a hospital admission or transfer in 2010, 26 percent of which were admissions to intensive care.
  • Among individuals with sleep disorders, 13.7% are taking or prescribed nonbenzodiazepines, while 10.8% are taking benzodiazepines, as of 2010 in the USA.

Hypnotic sleeping pills dramatically increase one's risk of dying, even at relatively low rates of use. A study of electronic medical records suggests that sleeping pill use may be associated with up to 500,000 additional deaths per year. The results also found that medium-to-high rates of sleeping pill use were associated with a substantial increase in cancer risk.

Subjects in the study, who had an average age of 54, were followed for 2.5 years between 2002 and 2007. The raw death rate for all users of sleeping pills was 4.86 times higher than that of nonusers. After adjusting for demographic and lifestyle factors, users' death rate was still 4.56 times that of nonusers. Most surprisingly, even those in the lowest third of sleeping pill consumption (0.4 to 18 doses per year) were 3.6 times more likely to die. Those in the middle third of consumption (18 to 132 doses per year) were 4.43 times more likely to die, and those in the top third (more than 132 doses per year) were 5.32 times more likely to die, suggesting a dose-response relationship.

Sleeping pill users in the middle third had a 20% increased risk of developing new major cancer, whereas those in the top third had a 35% increased risk. Zolpidem users in the top third had a 28% increased risk of major cancer. Temazepam users in the middle third had a 44% increased risk of major cancer, and users in the top third had a 99% increased risk.

In a July 2018 Consumer Reports survey of 1,767 U.S. adults, nearly one-third of people who complained of sleep problems at least once per week said they had used an over-the-counter or prescription sleep drug the previous year. Only about a third of people who took sleep medications—either OTC or prescription—reported very good or excellent sleep on those nights.

About 4% of U.S. adults aged 20 and over used prescription sleep aids in the past month. The percentage of adults using prescription sleep aids increased with age and education. More adult women (5.0%) used prescription sleep aids than adult men (3.1%). Non-Hispanic white adults were more likely to use sleep aids (4.7%) than non-Hispanic blacks (2.5%) and Mexican American (2.0%) adults. Prescription sleep aid use varied by sleep duration and was highest among adults who sleep less than 5 hours (6.0%) or sleep nine or more hours (5.3%). One in six adults with a diagnosed sleep disorder and one in eight adults with trouble sleeping reported using sleep aids.

Hypnotic drugs used to prompt or maintain sleep have been connected to 20 reported deaths and 46 severe but nonfatal injuries. Injuries included accidental overdoses, falls, and near-drownings, while deaths were caused by carbon monoxide poisoning, hypothermia, car accidents, apparent suicide, and more.

Only 35 percent of Americans get enough sleep each night.

Sleep is blamed for more than 100,000 crashes and 1,500 deaths each year.

More than 30 percent of Americans use stimulants to make up for poor sleep.

Taking a sleeping pill will, on average, get someone to sleep 12 minutes faster, 11 minutes longer, and doesn't increase the quality of sleep.

Common Terminology Surrounding Sleeping Pills

Term Definition
Sedatives substances that cause sedation, or a lessening of physiological activity. Sedatives cause drowsiness and induce a calm state.
Hypnotics are a class of psychoactive drugs whose primary function is to induce sleep and treat insomnia. Whereas the term sedative describes drugs that serve to calm or relieve anxiety, the term hypnotic generally describes drugs whose primary purpose is to initiate, sustain, or lengthen sleep. Because these two functions frequently overlap, they are often referred to collectively as sedative-hypnotic drugs.
Insomnia A condition where the person has chronic difficulty falling or staying asleep.
Tranquilizer A tranquilizer refers to a drug designed to treat anxiety, fear, tension, agitation, and disturbances of the mind, specifically to reduce states of anxiety and tension.
Tolerance Reduced response to a drug with repeated use.
Physical Dependence Adaptation to a drug that produces symptoms of withdrawal when the drug is stopped.
Psychological Dependence A mental state of fixation and reliance upon a substance to cope with life.
Overdose Injury to the body (poisoning) that happens when a drug is taken in excessive amounts. An overdose can be fatal or nonfatal.
Drug Misuse The use of illegal drugs or prescription drugs in a manner other than as directed by a doctor, such as use in greater amounts, more often, or longer than told to take a drug or using someone else's prescription.
Illicit Drugs The nonmedical use of a variety of drugs that are prohibited by law. These drugs can include amphetamine-type stimulants, marijuana/cannabis, cocaine, heroin, other opioids, and synthetic drugs, such as illicitly manufactured fentanyl and ecstasy (MDMA).

CONTRIBUTORS TO THIS ARTICLE

Joseph Kertis

Author

on November 12, 2021

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Michael Leach, CCMA

Medically Reviewed

on November 12, 2021

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Michael Leach is a Certified Clinical Medical Assistant, who has over 5 years of experience working in the field of addiction. He spent his career working under the board-certified Addictionologist Dr. Rohit Adi. His experience includes working with families during their loved one’s stay in treatment, helping those with substance abuse issues find treatment, and teaching life skills to patients in a recovery atmosphere. Though he has worked in many different areas of rehabilitation, the majority of his time was spent working one on one with patients who were actively withdrawing from drugs. Withdrawal and the fear of going through it is one biggest reason why an addict continues to use and can be the most difficult part of the rehabilitation process. His experience in the withdrawal atmosphere has taught him that regardless of what approach a person takes to get off drugs, there are always mental and emotional obstacles that need to be overcome. He believes having someone there to help a person through these obstacles can make all the difference during the withdrawal process.