In the world of hypnotics, better known as sleeping tablets, there are several classes of medications. Benzodiazepines, regularly named ‘benzos’, and z-drugs are the two classes used most by patients. Although these drugs are primarily used to treat sleeping disorders and anxiety, they can also be prescribed as additional therapy to treat depression and manage chronic pain. There are additional pills in the market, but not as commonly used as the former two – see a comparison of sleeping pills.
Insomnia treatment with the above classes is indicated for short term use (up to 2 weeks), but many patients keep using them for much longer. Here lies the bigger problem.
Long term use of benzodiazepines and z-drugs
Although one can notice improvements in some measurements of sleep, such as shortening the time to fall asleep, the risk of encountering adverse events increases mostly for the elderly. Long term use of benzos may lead to developing issues of tolerance, dependency and withdrawal symptoms. For elderly people, there is an increased risk of car collisions, falls, indoor accidents and more.
Physicians were advised by the American Geriatrics Society to avoid prescribing benzodiazepines to older patients, for insomnia treatment. Nevertheless, many physicians aware of the mentioned risks still renew prescriptions because of the dependency their patients have developed. This leaves a massive population in need of treatment with a worsened condition than before – addiction.
Sleeping pills withdrawal
Withdrawing from benzodiazepines’ short term consumption is easy – just stop taking it. However, things get a little trickier when it comes to longer periods.
Long term use may lead to addiction, and as such an immediate stop of consumption has a high potential of experiencing rebound insomnia and withdrawal effects such as seizures, muscle cramps and tremors. Therefore, long term users should not stop taking these pills at once.
According to multiple studies, tapering off benzodiazepines slowly is the right way to go, preferably with guidance from professionals. A mixture of non-pharmacological treatments (such as cognitive behavioral therapy) while lowering the pill’s dosage has shown better results compared to a stand-alone approach.
Recent studies have shown a different withdrawal approach involving the use of prolonged-release melatonin called Circadin. Used to treat insomnia itself, this melatonin formulation was consumed while gradually lowering benzodiazepine dosage. Patients enjoyed a significantly better sleep and most of them did not return to using benzos or z-drugs.
As a stand-alone sleeping pill, Circadin has shown to improve many sleep measurements while still keeping a good safety profile, hence no dependency or withdrawal issues.
Not all sleeping pills were created equal.