Sleeping Pills: How To Taper Off Of Them
Sleeping Pills: How to Taper Off of Them
Millions of Americans rely on sleeping pills to help them fall asleep and stay asleep. You may be taking sleep medicines to help with your insomnia. At some point, you may decide that you’d like to take less or stop taking them. What follows is information about how to do it safely. Your physician must always be informed and supervise any changes you make to your sleep medicine. But first a brief overview of the different types of sleep medicines.
Types of Sleeping Pills
There are 5 types of medicines that help with sleep: antihistamines, melatonin-receptor agonists, benzodiazepines, non-benzodiazepines, and antidepressants. Their names and availability vary from country to country.
Antihistamine medicines are most often used to treat allergies. Some antihistamines cause drowsiness (sedative effect). That is the reason that they can help with sleep. Two common antihistamines are diphenhydramine (Benadryl) and doxylamine (Unisom).
After continuous use, the sedative effect of antihistamines can fade. As a result, the longer you take them, the less likely they are to make you sleepy.
Side effects might include daytime drowsiness, dry mouth, and dizziness. Older people may experience confusion, hallucinations, blurred vision, constipation, nausea, problems with urination, and rapid heart rate when taking antihistamines.
Those with glaucoma, asthma, chronic obstructive pulmonary disease (COPD), or severe liver disease should not take antihistamine medicines.
Melatonin, a hormone produced in the brain, plays a role in the sleep-wake cycle. Two melatonin-receptor agonists are ramelteon (Rozerem) and agomelatine (Valdoxan). They mimic the effect of melatonin by activating the melatonin receptors, which bind melatonin in the brain. Their effect is stronger and lasts longer than melatonin itself.
Side effects of melatonin-receptor agonists include nausea, headache, and liver dysfunction.
When discontinued suddenly after 6 to 12 months of use, worsening insomnia (rebound insomnia) and withdrawal symptoms may occur.
Two benzodiazepine medicines are lorazepam (Ativan) and temazepam (Restoril). These medicines target a brain chemical called gamma-aminobutyric acid (GABA) that reduces nervous system activity and promotes sleep.
Benzodiazepines may be addictive. They can cause daytime sleepiness, drowsiness, and dizziness (hangover effect) - which increase the risk of accidents. They should not be taken with pain prescriptions as it may result in serious interactions.
Additionally, there are studies that associate benzodiazepines with the development of dementia.
Nonbenzodiazepines or Z-drugs
These medicines are commonly prescribed for sleep. Zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata) are three of them.
Z-drugs target GABA receptors just like benzodiazepines. However, they don’t stay in the body as long as benzodiazepines, thus they are less likely to cause a hangover effect.
Side effects include headache, gastrointestinal (GI) problems, and dizziness. Z-drugs are considered less addictive than benzodiazepines.
Certain antidepressant medicines may be prescribed to help with sleep - those that act on the brain receptors, histamine and serotonin, and cause sedation. Three of the antidepressants are doxepin (Silenor), trazodone (Desyrel) and mirtazapine (Remeron). They work best when a very low dose is taken before bedtime.
When taken long-term, they can lead to oversedation. This increases the risk of accidents, especially in older adults. Other side effects include headache, dry mouth, and weight gain.
Tapering Sleeping Pills
Have you considered reducing or stopping your sleeping pills? If so, you may have thought about a number of different reasons for doing so. You may have uncomfortable side effects. You may not want to rely on medicine to sleep. Maybe you don’t like the way the pills make you feel. Or they may be costly. Regardless of the reason, Goodpath can help.
Our sleep program can support your efforts to taper off of sleeping pills. We provide cognitive behavioral therapy for insomnia (CBT-I), sleep supplements, mindbody techniques, and nutritional support.
All of the therapies can help with trouble sleeping. With CBT-I in particular, 90% of people who take sleeping pills can reduce or eliminate them according to studies.
Important! Your doctor should supervise any changes you make to your sleep medicine.
The reduction techniques have two important elements:
A gradual, progressive reduction works best. Stopping abruptly or cold turkey often causes problems like physical symptoms, increased anxiety (withdrawal response), and more severe insomnia (rebound insomnia).
Planning and patience is needed. The longer you’ve taken the medicine, the slower the taper. It’s a process that can last weeks to months.
You should pair the reduction techniques with measures to help you sleep - CBT-I, sleep supplements, relaxation techniques, and sleep hygiene.
Sleep hygiene includes many components. For example, you should:
Go to bed and wake at the same times each day
Block as much noise and light as possible
Use your bed for sleep and sex only
Get out of bed if you haven’t fallen asleep within 20 minutes
Make dietary changes - avoid alcohol, caffeine, and foods that promote indigestion
Steps to Reduce Sleep Medicines
Here is a step-by-step sleep medicine reduction technique. Examples follow to help you better understand the tapering process.
Think about the number of nights per week you generally use sleeping pills and on the nights you use sleeping pills, the number of pills per night.
Remember: Be patient, it takes time.
On two nights during the first week of tapering, reduce the number of pills you are taking by ½. Space the two nights apart. If you are only taking 1 pill, cut the pill in ½ (a pill cutter may help).
Try to choose nights when you expect the next day to be low-stress, e.g. few work, school, family obligations.
Use positive sleep thoughts provided in our CBT-I program, e.g. The worst thing that can happen if I do not sleep well is that I may not be in the best mood the next day.
Once you are sleeping reasonably well on the two nights with less medicine, you are likely to feel more confident about reducing your sleep medicine.
Then reduce the number of pills by ½ on two more nights per week. Space out the four nights you’re taking less medicine, e.g. every other night. Continue halving the number of pills/night until it’s every night.
Try to stick to the plan without going back to the full dose.
Remember: Feeling OK about taking less medicine may happen immediately, or may take a week or two.
Begin to go medicine-free in the same way you decreased the medicine by ½.
On two nights/week, don’t take any sleep medicine.
Once you are sleeping reasonably well on the two nights with no medicine, add two more nights/week with no medicine. Space out the four nights you’re not taking any medicine, e.g. every other night.
Continue with no pills/night until it’s every night
Don’t forget, this is a process and may take weeks or even months.
Examples of Sleep Medicine Reduction Techniques
The following examples will help you with your steps for reducing sleep medicines. Some of the details described above aren’t included here, since the examples focus on numbers of pills/day and number of days/week.
Example 1 - I take a sleeping pill every night
Step 1: I will think about the number of nights/week and the number of pills/ night I use sleeping pills - I take 1 pill every night. Step 2: I will pick two nights this week and take ½ a pill. Step 3: I will reduce the number of pills by half on two more nights/week, then I will half the number of pills/night until it’s every night. Step 4: I won’t take any medicine on two nights/week. Then, I won’t take any medicine on two more nights/week. I will continue with no pills/night until it’s every night.
Example 2 - I take a sleeping pill four night a week
Step 1: I will think about the number of nights/week and the number of pills/night I use sleeping pills - I take 1 pill four nights a week. Step 2: I will pick two of the four nights I take pills this week and take ½ a pill. Step 3: l will take ½ a pill on all four nights per week. Step 4: Once I am down to ½ a pill on the four nights I usually took sleeping pills, I won’t take any pills on two nights a week, and then I will stop altogether.
Example 3 - I take 2 sleeping pills every night
Step 1: I will think about the number of nights/week and the number of pills/night I use sleeping pills - I take 2 pills every night. Step 2: I will pick two nights this week and take only 1 pill. Step 3: I will take 1 pill every other night and then only 1 pill every night. Step 4: I will take ½ a pill on two nights a week, then ½ a pill every other night, then ½ pill every night. Then I won’t take any pills on two nights a week, then I won’t take any pills every other night, then I won’t take any pills at all.
You may find that you need help with the steps. Our CBT-I program can give you the tools you need to deal with your trouble sleeping. Goodpath coaches can also provide support. Remember, your doctor should supervise any changes you make to your sleep medicine.