Dependence on sleeping pills

Mrs. Hasan began taking a sleeping tablet nine years ago, after her husband’s heart surgery, from the pharmacy near her house in Dhanmondi. One became one and a half, then two. If she misses a night, she lies awake trembling. She has never told her doctor, because it is only a sleeping tablet.

An illustration drawn from common experience. The person is invented; the pattern is not.

Understanding sleeping pill dependence

Sedatives and sleeping tablets, especially benzodiazepines, are effective for short periods but can lead to tolerance and dependence when taken for weeks or months. In Bangladesh they are sometimes bought without a prescription. Stopping suddenly after long use can cause rebound insomnia, anxiety, shaking and, in some cases, seizures. In older people they also raise the risk of falls and confusion.

Signs and symptoms of sleeping pill dependence

• Needing a higher dose for the same effect
• Being unable to sleep at all without the tablet
• Anxiety, shaking or sweating when a dose is missed
• Buying tablets without a prescription, or from several pharmacies

Treatment for sleeping pill dependence

Never stop long-term sedatives suddenly. A doctor makes a gradual, personal reduction plan, often over weeks or months, and treats what lies underneath: insomnia, anxiety or depression. Cognitive behavioural therapy for insomnia, which the American College of Physicians recommends before sleeping tablets, can be part of the plan.

What getting better can look like

Mrs. Hasan might come down, over months, from two tablets to one, then to half. Then there might be a night of natural sleep, and a morning when she realises she did not reach for the strip.

Common questions about sleeping pill dependence

Can I stop taking sleeping tablets on my own?

After long use, stopping sedatives suddenly can cause rebound insomnia, anxiety, shaking and, in some cases, seizures. Please talk to a doctor before changing the dose. A gradual, personal reduction plan, often over weeks or months, is far safer.

Is there a treatment for insomnia without tablets?

Yes. The American College of Physicians recommends cognitive behavioural therapy for insomnia as the first treatment for chronic insomnia, before sleeping tablets. A doctor also looks for anxiety, depression or other causes that keep sleep from coming.

When to see a psychiatrist

If you depend on sleeping tablets, please talk to a doctor before changing the dose. A gradual plan is far safer.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

If you or someone else is in immediate danger, call 999 or go to the nearest hospital emergency department.

Sources

• Qaseem et al., Annals of Internal Medicine, 2016 (PMID 27136449)