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The best way to stop taking sleeping pills or sedatives is to gradually reduce the dose with the guidance of a doctor. Psychological or therapeutic support can help you do this.
There are situations in life where you feel like you can no longer cope: A serious illness or the breakup of a relationship, for example, can lead to a crisis and be extremely distressing. People may then feel very unsettled, anxious, exhausted or have problems sleeping.
Many people find ways to cope with this stress. But others find that problems like insomnia just don't go away. Some take benzodiazepines or medications containing zolpidem or zopiclone (known as “Z drugs”) during phases like this. They are among the most commonly prescribed sleeping pills and sedatives.
Benzodiazepines can relieve cramps, relax the muscles and make people feel calmer and less anxious. They are also used to help people fall asleep and sleep through the night better. Z drugs are said to particularly help people fall asleep.
Many sleeping pills and sedatives can lead to dependence, though, and they may have strong side effects, including problems with memory or concentration, drowsiness, muscle weakness, abnormal behavior and sleep. They also affect your ability to drive and, particularly in older and unwell people, increase the risk of falling.
Dependence on sleeping pills
Dependency can develop quickly if benzodiazepines or Z drugs are used for too long or at too high a dose. Because of this risk, it's important to keep the dose as low as possible and to only take the medication for as short a time as possible. People can even become dependent after just a few weeks. But it's quite common for these drugs to be taken for several months, or even years.
The German Centre for Addiction Issues (DHS) estimates that 1.5 to 1.9 million people in Germany are dependent on benzodiazepines. Women, and particularly older women, appear to be especially likely to use these medications.
Stopping taking sleeping pills and sedatives
Not everyone notices the symptoms of dependence while taking these medications. So an important first step is to realize that you have got used to the medication or may even already have a dependence. It can be physically and mentally very hard to stop taking medication that you are dependent on. A lot of patience and strength is needed to get through difficult phases without using the medication.
Researchers from the Universities of Queensland and Bond in Australia wanted to find out which approaches can help people to stop taking benzodiazepines. They analyzed 35 studies involving over 16,000 participants that tested the benefits of the following interventions:
- Gradual dose reduction ("tapering") – with and without substitute medication
- Brief motivating contacts with doctors – such as a talk or a letter
- Therapeutic support, for example behavioral therapy
When the studies started, all of the participants had been taking benzodiazepines regularly for longer than three months and were monitored in an outpatient setting.
Tapering avoids withdrawal symptoms and relapses
Withdrawal symptoms can occur when people suddenly stop using sleeping pills or sedatives. Depending on the specific drug, symptoms can start within a few hours, but they may also start later – sometimes even weeks after you stop taking the drug.
Typical withdrawal symptoms include trouble sleeping, restlessness, anxiety, shivering, and feeling dizzy and faint. So they're similar to the symptoms that the sedative was originally meant to get rid of. This may set off a vicious circle: Many people start using the sleeping pills or sedatives again to relieve these symptoms. To avoid such relapses, it's important to try to keep withdrawal symptoms to a minimum when you stop taking the medication. That is why it's common to gradually reduce the dose over several weeks, before you can stop taking the medication completely. There is no good-quality research on the best length of time for outpatient withdrawal. Experts recommend a time frame of two to four months.
Research hasn't shown that it's easier for people to stop taking benzodiazepines if they take a substitute medication while reducing the benzodiazepine dose. Further research is needed to determine whether certain substitute medications – such as antidepressants or antihistamines – might help.
What else can help you to stop taking sleeping pills?
Three studies found that even simple approaches can have a positive effect: More people stopped taking benzodiazepines if their doctor gave them written information advising them to stop. In some of the studies, people received booklets with information about self-help strategies as well. More recent studies also suggest that the letters are especially helpful if the recipients are addressed by name.
The studies also suggest that more people can stop taking sedatives if they are well-informed about the issue of medication dependence and the steps they need to take. Professional psychological support is also useful. Cognitive behavioral therapy (CBT) is apparently the most successful form of psychological support here.
In general, it's important to talk to a doctor or contact an addiction counseling center if you feel like you have lost control over your medication use. Medical, psychological or psychotherapeutic support can help you find ways to successfully stop taking benzodiazepines.
Sources
- Atzendorf J, Rauschert C, Seitz NN et al. The Use of Alcohol, Tobacco, Illegal Drugs and Medicines: An Estimate of Consumption and Substance-Related Disorders in Germany. Dtsch Arztebl Int 2019; 116(35-36): 577-584. [PMC free article: PMC6804269] [PubMed: 31587705]
- Baandrup L, Ebdrup BH, Rasmussen JO et al. Pharmacological interventions for benzodiazepine discontinuation in chronic benzodiazepine users. Cochrane Database Syst Rev 2018; (3): CD011481. [PMC free article: PMC6513394] [PubMed: 29543325]
- Darker CD, Sweeney BP, Barry JM et al. Psychosocial interventions for benzodiazepine harmful use, abuse or dependence. Cochrane Database Syst Rev 2015; (5): CD009652. [PMC free article: PMC11023022] [PubMed: 26106751]
- Deutsche Hauptstelle für Suchtfragen (DHS). DHS Jahrbuch Sucht 2020. Lengerich: Pabst Science Publishers; 2020.
- Deutsche Hauptstelle für Suchtfragen (DHS). Medikamentenabhängigkeit (Suchtmedizinische Reihe Band 5). Köln: BZgA; 2013.
- Dou C, Rebane J, Bardal S. Interventions to improve benzodiazepine tapering success in the elderly: a systematic review. Aging Ment Health 2019; 23(4): 411-416. [PubMed: 29336611]
- Gould RL, Coulson MC, Patel N et al. Interventions for reducing benzodiazepine use in older people: meta-analysis of randomised controlled trials. Br J Psychiatry 2014; 204(2): 98-107. [PubMed: 24493654]
- Mugunthan K, McGuire T, Glasziou P. Minimal interventions to decrease long-term use of benzodiazepines in primary care: a systematic review and meta-analysis. Br J Gen Pract 2011; 61(590): e573-578. [PMC free article: PMC3162180] [PubMed: 22152740]
- Parr JM, Kavanagh DJ, Cahill L et al. Effectiveness of current treatment approaches for benzodiazepine discontinuation: a meta-analysis. Addiction 2009; 104(1): 13-24. [PubMed: 18983627]
- Takaesu Y, Utsumi T, Okajima I et al. Psychosocial intervention for discontinuing benzodiazepine hypnotics in patients with chronic insomnia: A systematic review and meta-analysis. Sleep Med Rev 2019; 48: 101214. [PubMed: 31648145]
- Wright A, Diebold J, Otal J et al. The Effect of Melatonin on Benzodiazepine Discontinuation and Sleep Quality in Adults Attempting to Discontinue Benzodiazepines: A Systematic Review and Meta-Analysis. Drugs Aging 2015; 32(12): 1009-1018. [PubMed: 26547856]
IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.
Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.
Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.
- Using medication: Learn More – What can help when trying to stop taking sleeping...Using medication: Learn More – What can help when trying to stop taking sleeping pills and sedatives? - InformedHealth.org
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