Most people will experience sleeping problems at some point in their lives. According to the NHS, it’s thought that around a third of people in the UK live through an episode of insomnia – the medical term for regular sleeping difficulties.
Sleeping problems can significantly impact a person’s life – affecting their mood, energy, relationships, and motivation. Experiencing insomnia can be frustrating and demoralising, and you may be desperate to find a solution.
In modern practice, NHS doctors rarely prescribe sleeping pills for insomnia. Long-term use of sleeping pills is ineffective and risks physical dependence and addiction to the prescribed medication. Instead, treatment involves lifestyle changes and behavioural therapy that address the causes of insomnia and support healthy sleeping habits.
What Causes Sleeping Problems?
There are many possible causes of sleeping problems and insomnia. Some of these include:
- light and noise
- experiencing stressful events
- underlying mental health conditions like anxiety and depression
- alcohol, caffeine, and nicotine
- stress
- shift work
- jet lag
While some of these causes are only temporary (like jet lag), others may lead to longer-term problems that can last for months or years. When insomnia lasts for more than three months, it’s known as long-term insomnia.
How Do Sleeping Pills Work?
There are many different types of sleeping pills, affecting the brain and body in distinct though often similar ways.
Over-the-counter sleeping pills like Nytol often contain antihistamines – a group of medications that people use to reduce allergic reactions. Antihistamines block the action of histamine in your brain, making you feel drowsy. However, there is limited clinical evidence supporting their efficiency.
The most common prescription sleep aids are selective gamma-aminobutyric acid (GABA) medications like zolpidem (Ambien) and eszopiclone (Lunesta). GABA is a neurotransmitter that reduces central nervous system activity and slows down the brain. These medications work by binding to certain receptors in the brain, enhancing the effects of GABA, decreasing anxiety and helping you to sleep.
In the past, doctors used to prescribe benzodiazepines like diazepam for sleep disorders. This practice has now stopped because of the high risk of dependence, even after short periods.
Sleeping Pills and Dependence
While sleeping pills may be effective in the short term, they cannot cure long-term sleep problems. Usually, medications like zolpidem are only prescribed for short periods of up to 4 weeks. However, many people take sleeping pills for longer than they are prescribed or at higher doses.
If you take sleeping pills for longer than they are prescribed, you are likely to develop a tolerance to the substance. You develop a tolerance when your body adjusts to the presence of the medication and begins to adjust its natural functions in response. You begin to need to take higher doses of the medication to experience the same effects. Over time, you become dependent on the substance to feel normal.
This means that if you take sleeping medication long-term, it will become less and less beneficial to your sleep. You may find that you end with no improvement at all. If you then try to stop taking the medication, you may experience withdrawal symptoms as your body readjusts.
What Is Withdrawal From Sleeping Pills Like?
If you’ve been taking sleeping pills for longer than a few weeks, you should talk to your doctor before you stop taking them. Withdrawal symptoms can involve anxiety, restlessness, and mood changes. You may also become sensitive to light, touch, and noise. Your insomnia may return, possibly worse than before.
Withdrawal from sleeping pills can be tough and should be avoided by safe prescription practices. However, if you have developed a dependence on medications, professional medical support can guide you through the withdrawal process safely. You can speak to your GP or contact a treatment provider to explore detox programs.
What Are the Possible Side-Effects of Sleeping Medications?
Some people experience serious side effects from sleeping medications, even with short-term use.
Possible side-effects of selective GABA medications include:
- memory loss
- hallucinations
- falling over
- delusions
- feeling low or sad
Anyone experiencing these side effects should stop taking the medication immediately and speak to their doctor.
Mixing Sleeping Pills with Other Medications
Mixing sleeping pills with other medications (or herbal remedies) can be dangerous. Sleeping pills may interact with other drugs, making you more drowsy and sometimes depressing the central nervous system to potentially fatal levels.
In particular, you shouldn’t take sleeping pills with:
- medications for schizophrenia or bipolar disorder
- medications for depression
- medications for epilepsy
- other sleeping pills
- anti-anxiety medications
- medications for fungal infections
- strong painkillers (particularly opioids)
- ritonavir
What Are the Alternatives to Sleeping Pills?
While sleeping pills are not a safe or effective solution to long-term sleeping problems, there are other things you can do. Lifestyle changes and talk therapy can effectively improve insomnia and help you get more quality sleep.
Insomnia usually improves by changing your sleeping habits. You could try:
- going to bed and waking up at the same time each day
- winding down for at least an hour before bedtime, such as by reading or having a bath
- making sure that your bedroom is dark and quiet
- exercising regularly
- making sure that your bed is comfortable
According to the NHS, you should try to avoid:
- smoking, or drinking alcohol, tea, or coffee within 6 hours of bedtime
- eating a big meal late at night
- exercising within four hours of bedtime
- using electronic devices with bright lights before bed
- sleeping in after a bad night’s sleep
If you have persistent sleeping difficulties, you may also benefit from cognitive-behavioural therapy to identify and change the thought and behavioural patterns that are preventing you from sleeping. You can talk to your GP or a treatment provider about the options available.
Sometimes, insomnia is a consequence of other underlying mental health conditions like anxiety and depression. It may also exacerbate symptoms of these disorders, reinforcing a vicious cycle of poor sleep and mental health.
In these cases, it is important to treat the underlying condition alongside insomnia. Talk therapies like cognitive-behavioural therapy, medications, and holistic treatments can all help improve symptoms of anxiety and depression and improve overall well-being.
Together, these alternatives to sleeping pills provide safe and effective treatment options for insomnia that can support mental wellness while avoiding the risks of dependence and withdrawal.
