Sleeping Pills – Do the Benefits Outweigh The Risks?

image of sleeping pills next to a clockHow often have you stared into the darkness between you and the bedroom ceiling, frustrated that once again you can’t fall sleep?

Do you find yourself reaching for another sleeping pill or promising yourself that you’ll get some the next day?

I know from experience that this is a natural reaction to the stress of not sleeping. When insomnia starts making life difficult, it’s natural to want to fix it as quickly and effectively as possible.

But are sleeping pills the best option? And do the benefits of taking them outweigh the risks?

If you search the internet you’ll find lots of advice about the risks of taking sleeping pills, especially over a long period of time. And recent medical research into the potential side-effects suggests it might not always be such a good idea.

It’s of course very easy to take the moral high ground and say sleeping pills are bad for you and you shouldn’t take them. But if they’re the only way you’ve found to ensure you can get some sleep, then I can see why you might decide to accept the risks.

In this article I’ll cover some of the main advantages and risks of taking sleeping pills. I’ll also look at some important statistics regarding sleeping pill use among adults, and alternative approaches you can try.

Do remember though that if you’re currently taking prescription drugs, it’s important to consult your doctor before stopping or changing your dosage.

How many people take sleeping pills?

In 2013 the U.S. Department of Health and Human Services sponsored a large US study into prescription sleep aid use among adults. The drugs included sedatives to reduce anxiety and specific sleeping pills.

They found that 5% of women in the USA and 3% of men reported taking prescription drugs over the last month to help them sleep. That equates to about 9 Million adults a year taking pills in the US alone.

As shown in the chart below, on average more older people took sleeping pills than younger people.

graph showing how many people take sleeping pills by age categoryNon-Prescription drugs

In 2012 the Royal Pharmaceutical Society in England reported on a survey of over 2000 people about their sleep problems.

Their research suggested that 51% of people with insomnia had self-diagnosed and then bought over the counter sleeping pills without consulting their doctor first.

The survey also found some worrying trends with people taking sleeping pills for long periods of time:

  • 30% of the people who said they have insomnia had been taking sleeping pills for more than a month without advice from a professional.
  • 14% of insomniacs had been taking sleeping pills for over six months.
  • 18% of the people couldn’t even remember how long they’d been taking them for.

They also identified that 70% of people didn’t know, or were wrong about, how many health conditions can lead to insomnia. In fact, for chronic insomnia, which lasts longer than a month, only 1 in 5 cases are not related to another health condition.

For the other 4 out of 5 people, it’s an underlying health condition which is either creating the insomnia or existing alongside it, making it harder to treat.

In the United States, 1 in 10 people will suffer from chronic insomnia (lasting longer than a month) at some point in their lives.

In a country where access to healthcare is much more difficult than the United Kingdom, you might expect an even higher ratio of people to be self-diagnosing and buying sleeping pills than in the UK survey.

That might explain why in 2010, sleeping pills and related medicines accounted for 30 billion dollars in the United States.

Arguments against taking sleeping pills

The arguments most often quoted against using sleeping pills include:

  • They may mask an underlying medical condition which is interfering with your sleep. Experts say that the priority should be to identify the root cause of your sleep problems.
  • They can have worrying effects on your health and even increase your risk of death or cancer (see below for more about this).
  • Your body can rapidly build a tolerance to the drugs, meaning you have to keep increasing the dosage for them to work effectively.
  • Some of the drugs can be addictive and therefore difficult to eventually stop taking them.
  • Your insomnia or poor sleep quality can be even worse when you stop taking sleeping pills.
  • They can affect your mental state the next day, leading to lower levels of concentration and higher risks of having an accident.
  • Sleep experts say that sleeping pills might make you fall asleep and stay asleep. However, they don’t guarantee you’ll get the right type of sleep. For example, they may reduce your quantity of deep restorative sleep (for more on this, read the article about why we sleep).
  • They can interact with other drugs, so you need to be careful if you’re on other medication.

There are also reports which suggest that drinking alcohol at the same time as taking sleeping aids is very often a bad idea. I’ll cover some of these points in more detail later in the article.

Reasons why people take sleeping pills

Despite knowing the risks and side effects of these drugs, tens of millions of people around the world still take them. Let’s have a look at some of the main reasons people take them:

  • Anyone who’s suffered from prolonged sleep problems knows that it can have a negative impact on your physical and mental health. So when feeling exhausted, desperate or stressed by a lack of sleep, it’s very tempting to try anything which might help.
  • They can be very effective in sending you to sleep quickly and keeping you asleep, even if the sleep quality isn’t perfect.
  • If used for a limited period they can be effective in resetting your body clock to sleep at the right time.
  • They are easy to use and don’t require lengthy routines such as relaxation techniques.
  • They are convenient and many of the sleeping pills can be bought over the counter or on the internet.
  • If you have other health problems which keep you awake, then a sleeping pill may be an attractive way to help you sleep.
  • Most of the side effects are well known, so if you’re prescribed them your doctor should warn you about the risks.
  • Many people do trust their doctor’s advice. So if prescribed a sleeping pill, they will take it believing it’s the best solution.

image of a person sleeping in bed with their feet hanging outCan you believe everything you read?

Before I cover some of the results about the possible health risks associated with taking sleeping pills, there are 2 important points to mention:

  • Firstly, I’m not a medical practitioner and I would therefore urge you to consult your doctor before taking any action, such as stopping taking any current prescription sleeping pills.
  • Most of the research studies do mention the difficulty in being absolutely sure about the cause and effect and the consequent risk of bias in the studies. For example, can ill-health result in a need to take sleeping aids rather than sleep aids actually causing health problems?

Possible issues with taking sleeping pills

Are they addictive?

The modern and most commonly prescribed sleeping tablets are not chemically addictive in the same sense as many recreational drugs or even nicotine.

However, you can develop what’s called a psychological dependence or habit forming condition. In this case, when you stop taking the pills you might find you revert back to your sleeplessness.

This can then lead to you experiencing a strong and sometimes overwhelming urge to start relying on the pills again.

For this reason, in most cases sleep experts recommend that you only take them for a short period of time. They also suggest that people should slowly reduce the frequency and/or dosage level rather than stop abruptly.

Increased risk of death

There have been a number of studies over the last few years indicating that there’s a significant increased risk of death for people taking certain sleeping pills regularly.

One of the largest cohort studies was reported in the British Medical Journal in 2014.

The team compared the medical records of 34,727 patients prescribed anxiolytic (used to treat anxity) or hypnotic drugs (sleeping pills), or both, with 69,418 similar patients not prescribed with any of these drugs.

The study looked at the patient’s records for, on average, 7.6 years. Interestingly, they also found that people are often prescribed both of these pills, namely a sedative and sleeping pill (76% of people in the study).

They also attempted to adjust their findings to allow for other health conditions which might impact on the results. This included physical and psychiatric problems, sleep disorders and use of other drugs.

Their overall findings are that people taking these types of drugs are more than twice as likely to die compared to the comparison group.

After excluding deaths in the first year, there were approximately four excess deaths linked to drug use per 100 people followed for an average of 7.6 years after their first prescription.

Of course, the overall risk of death is still relatively small.

Cancer risk

There have been a number of studies which linked use of sedatives and sleep aids to an increased incidence of cancer.

In 2015 a group of researchers from Norway, Finland and the United Kingdom reported the results of a very large study of the use of sleep aids and risk of cancer.

They based their work on data from the Finnish Public Sector Study, which they linked to registers of cancer and drug prescription. It covered nearly 30,000 people over a seven year period, of whom 5000 developed cancer.

Their overall conclusion was that:

Sleep medication use was associated with an increased cancer incidence of the respiratory system

They also found that the risk of developing cancer increased the longer people used these sleep aids and the greater number taken. The report suggests that:

  • People who took sleeping pills at least twice a week were more than twice as likely to develop cancer of the respiratory system (mouth, throat etc) than non-users.
  • Long-term use, such as for over three years increased the risk even further.
  • The risk was greater for older people than the occasional use by a younger person.

Sleeping pills might be masking another health problem

a woman with a coughIf you have an underlying health condition which is causing the insomnia, then sleeping pills might not be the best answer.

For example, if an illness is making someone cough all night, then a sleeping pill would not cure the cough.

And it also might not knock the person out so strongly that the cough didn’t keep them awake.

But going to a doctor, diagnosing the reason for the cough and treating it might just mean the illness, the cough and the insomnia are all be tackled at once.

Higher risk of having a car accident

In 2013 Dr Ryan Hansen of the University of Washington’s school of pharmacy reported on the outcome of a study into the links between some sleeping pills and the increased risk of having a car accident.

The team compared the medical and driving records between 2003 and 2008 of 409,171 people aged over 21 with a driving license.

Just under 6% of these people included in the study had a sleeping pill prescription for either zolpidem (brand name Ambien); trazodone (brand names include Oleptro); or temazepam (brand name Restoril).

Their findings were a little worrying:

  • Those who took Restoril were 27% more likely to have a car crash over the 5 year period in the study, compared to people who didn’t take sleeping aids.
  • Those who took Trazodone or Desyrel were nearly twice as likely to have an accident.
  • Ambian users appeared to have the greatest risk, at more than twice the rate seen for people who didn’t take sleeping pills.

This and other studies resulted in the USA Food and Drug Administration issuing guidance to reduce the amount of active ingredients in sleeping pills, especially those prescribed for women:

Doses should be reduced from 10 milligrams to 5 milligrams for regular products, and 12.5 milligrams to 6.25 milligrams for extended-release pills.

Dr. Ellis Unger, from the FDA’s Office of Drug Evaluation said:

Patients who must drive in the morning or perform some other activity requiring full alertness should talk to their health care professional about whether their sleep medicine is appropriate.

image of a man driving a car the day after taking sleeping pills

Research into dosage levels

Despite some of the alarming research, I suspect many readers will still be willing to take sleeping pills because the benefits will be seen to outweigh the risks.

In that case you might also be interested in some more recent research which might make you think about at least reducing the dosage levels.

In 2015, researchers from the Perelman School of Medicine at the University of Pennsylvania undertook a study to compare the effects of intermittent usage of sleeping pills zolpidem (Ambien) against those who used them every day.

The study split 74 adults with severe insomnia into 3 groups and monitored them over 12 weeks:

  • Group A took a sleeping pill every night.
  • Group B took a sleeping tablet 3-5 times a week.
  • Group C took nightly pills, but half the pills were placebos.

The results were very interesting. All three strategies were effective in helping people to sleep. However the intermittent Group B subjects reported more problems in sleeping and medical issues than the other two groups.

Group C, who took a pill every night, but only half of them were actual sleeping pills, appeared to sleep just as well as Group A, who took a sleeping pill every night.

One of their conclusions was:

When it comes to day-to-day quality of therapeutic outcomes, the strategy we use most frequently, the intermittent doing strategy performed worst…Our findings also go against the standard practice of ‘start low and go slow,’ in favor of a ‘start high and go low’ dosing strategy in which a patient starts with 10 mg nightly and then when the desired result is reached, switch to either a lower nightly dose or intermittent dosing with placebos on non-medication nights.

I think we may well hear more about new dosage and frequency approaches to taking sleeping aids over the next few years.

What’s worse – no sleep or taking sleeping pills?

If given the choice, most people would probably prefer not to rely on sleeping pills if something else worked. And as you can see, there can be serious consequences to the regular usage of sleep aids.

But equally if you read our article about the benefits of sleep, you’ll see that there are also significant health and other safety issues with not getting enough sleep.

So you may find yourself stuck between a rock and a hard place trying to decide between sleeplessness or sleeping pills.

So what can we learn from this?

I suspect you’ll have tried several different techniques to sleep better, either before trying sleeping pills or returning to them once again.

Personally, I’ve managed to more or less get my insomnia under control using alternative strategies, even though it hasn’t been easy. And I have at times resorted to some over the counter sleep aids to help me through difficult patches.

I think it’s a personal choice at the end of the day. If you have the time and patience to try out alternative methods to tackle insomnia, it can only be a good thing.

If you do decide to go down the sleeping pill route, then I would recommend remembering the advice in this article to keep it to as short a period of time as possible. And during that time perhaps prepare yourself to sleep without them, using natural techniques.

What would I suggest?

If you haven’t already, then you might want to talk to a doctor or medical professional about your sleep problems.

Understandably, in some countries like the United States this may not be an option you want to follow due to the cost. But you have to weigh up the risk of leaving a potentially serious underlying health condition untreated.

Because of the risks, I would be cautious about using over the counter sleeping drugs or drugs bought on the internet without first seeking advice from a medical practitioner or pharmacist.

Self-help options

Many doctors will also encourage patients to go down the self-help route, by adhering to what’s called good sleep hygiene.

This is all about making lifestyle choices and developing routines which will promote healthy sleep. It can be extremely effective if you stick to it properly over time.

You might also be interested in reading the article about mindfulness. It includes a section on Cognitive Behavioral Therapy, and some researchers are now saying that CBT can be as, if not more, effective than prescription drugs.

And you could even try some herbal or natural remedies first. Whilst the evidence is still conflicting about how useful they can actually be, many people still swear by them.

If you do take sleeping pills, then you’d probably want to ensure you understand the health risks and be careful not to become dependent on them.

Use them sparingly when you have a really bad episode of insomnia, and stop taking them as soon as possible.

Sometimes just taking one pill for one night can be enough to reset a better sleep pattern.

Comments

The question of whether to take sleeping pills or not can be very emotive. Some people do think researchers over-emphasize the negatives and that the expert advice doesn’t balance the risk with the massive impact that insomnia can have.

I’d be very interested to hear about your experience. For example, have you managed to reduce your reliance on sleeping pills and if so, how?

Or perhaps you’ve tried everything and sleeping pills are the only thing which work for you.

Please feel free to leave a comment below with your views about the pros and cons of taking sleeping pills.

19 CommentsLeave a comment

  • Hi Ethan,
    My name is Toni and unfortunately I am one who ended up in a psychiatric hospital after going thru a 6 month stent of only sleeping 1-3 hours per night. I kept telling my Dr. I am not sleeping, but he would just reply “just turn off your mind Toni,” which was extremely frustrating to me. I got so tired eventually I froze up at work and could not finish my responsibilities! That evening I found myself at the ER having suicidal thoughts of willing to do anything to sleep and would not care if I never woke up again. This led to seeing a psychiatrist on a regular basis for medication
    (Clonopin and Tamazopan) of which now have been linked to early onset of dementia. Looking back I honestly think my sleeplessness was more related to having ADD and not being able to shut my brain off and to a hormone imbalance after a hysterectomy. After taking the above medication for 3 years they have switched me to Clonine and I feel terrible! I am not sleeping and if I do it is interrupted sleep all night long. Of course I am so fearful of not sleeping, after what I went through. I spent last night on the internet looking at relaxation techniques and found your article on mindfulness. Being in the moment. I am hopeful of being able to work on becoming mindful and letting go of the anxious thoughts and not worrying about will I be able to go to sleep!
    Thank you for being transparent concerning your own struggles of insomnia. I wish I had found your site earlier before the Clonopine and Tamazopan.
    Toni

    • Hi Toni
      Thanks for your comment and for sharing your story. It sounds like you’ve really been through a lot. It’s great that you found the article about mindfulness, and that it seems like something you’d like to do. I’m a big advocate of mindfulness as I had such positive results from practicing it myself. I do recommend getting a book on it, ideally one with a CD with exercises to practice. It’s a nice way to learn about it and work through the different exercises.
      Regards
      Ethan

  • Hi Ethan…Mine is a long tale of depression, insomnia and drug dependency. I’m 64. At 20, I’d developed depression and I was prescribed Valium with other medicines. Years rolled on, and on this date I’m taking Clozapine 50 and Etizolam 0.5 every night for sleep and help for depression. I’m very much given to meditation and spirituality. Please help me getting out of this maze, rather hell. I’ll feel obliged to you. Thnx…NM

    • Hi Naresh
      Thanks for your comment. I’m afraid there’s not much I can do to help you personally! But I’d say if you have a history of drug dependency, it’s important to work with your doctor to find the best medicines possible, and preferably ones that aren’t so addictive. If you are into meditation and spirituality, then there are lots of natural techniques you can practice to help you with both depression and insomnia. Perhaps a good place to start would be my article about mindfulness. You might find that a useful read, with practical ideas for tackling your sleep and mental health difficulties in a natural way.
      Regards
      Ethan

  • I don’t beleive that Restoril is bad for you i take 30 mg every night for 30 years and i sleep wonderful one night i did not take one and i could not sleep well so i a hooked on them who cares i drive just fine normal all day and i am now 80 will take them till i die i have RSD in my left leg since 2001 it help me a lot I have no other problem at all also don’t take any other pills also keep myself in shape Regards Elna

    • Hi Elna
      Thanks for your comment. I can understand your point of view, and at the end of the day it’s a personal choice whether to take sleeping pills or not, though better done with the support and advice of a medical professional I think. But if you feel it makes an important difference to your quality of life, I can see why you could accept that.
      Regards
      Ethan

  • I have always had a problem with falling asleep at night, and I am finally ready to do something about it. My doctor recommended that I consider taking sleeping pills, but before I agree I want to know the benefits of using them. It’s good to know that if I were to use them, that they are convenient and get be bought over the counter. Which would be great that to be able to find the one that works right for me.

  • I would just like to see some data on the effects of insomnia. Sleeping pills can cause death and cancer but what does years of not sleeping do to your body. I have had this argument with my dr. I am
    Pretty sure my insomnia has taken years off my life and made me very ineffective many days.

    • Hi Scott
      Thanks for your comment. You’re right in that insomnia can cause all manner of problems in the long term. You can find out more about this by researching the effects of sleep deprivation.
      I know it’s a classic conundrum – whether the effects of not sleeping are worse than the effects of long-term sleeping pill use. And one that for many people doesn’t have an obvious answer when they feel like nothing else helps them sleep.
      Regards
      Ethan

  • I have one of the worse cases of Restless leg syndrome. The only medication that calms my legs also keeps me awake all night. I have gone days and weeks without hardly any sleep. So unfortunately yes I have to take sleeping tablets. I take them about twice a week to guarantee some sleep. I can’t win on this one.

  • Hello,
    This article resonates with me as last week I resorted to prescription sleeping pills (Zopiclone) for the first time. For the last few years I’ve been experiencing chronic insomnia during the winter that recedes more or less when the clocks change in March.
    In summer I get the odd bad night’s sleep that I make up for the following day but in winter I would sleep only 4-6 hours and never recuperate at the weekend. Last winter I was idealistic trying to solve it with exercise (but not late in the evening), cutting out alcohol and caffeine in the evening, vitamin and mineral supplements and herbal teas. These didn’t work particularly well and after a third sleepless night in a row followed by another sick day, I decided enough was enough.
    I’ve decided to take them only when really necessary and keep the dose as low as possible, while maintaining the same strategies with alcohol, caffeine exercise and vitamins and minerals.

    • Hi Robert
      Thanks for your comment. I can understand why you’d want to try a sleeping pill after struggling to sleep. It’s also good that you’ve decided to use them only when necessary and keep working away at the natural techniques. It can take a little time to get into a good rhythm with the natural techniques, but it’s well worth persevering.
      Regards
      Ethan

    • Hi Paul
      Thanks for your comment. Some will be, but many are fine. If you buy them from reputable websites, it’s a safer way to be sure. Personally, unless I know the business, I’d never buy from a website like “buysleepingpillsonlinecheap.com” or something like that.
      Regards
      Ethan

  • Trazodone gave me the worst hangovers I ever had.Ambien works well for me at the 5 mg.dose with no hangovers.Something that works almost as well as ambien is 200-400 mg.of magnesium citrate and 20 mg. of b6.

    • Hi Larry
      Thanks for your comment. It’s very interesting to hear you found that simple magnesium and b6 supplements helped you nearly as much as ambien! It would be great if everyone had good results from supplements which don’t carry the same risk and potency as prescription sleep aids.
      Regards
      Ethan

  • I have been a Mental Health and Addictions Rights Advocate for more than a dozen years, and have taken more medications than I can remember in the last almost 30 years as a patient, and trazodone or desyrel is a really old tricyclic anti-depressant that had the side effect that it was very sedating so is now used as a sleeping pill but in a dose much lower than as an anti-depressant. Temazepam is a benzodiazepine which is long acting and may cause drowsiness the following day, I currently have a prescription for Dalmane or flurazepam, the first marketed for sleep I believe and definitely the longest acting. Ambien is chemically different than the benzodiazepines but binds to the same receptors in the brain, but is shorter acting typically avoiding day time drowsiness. But if taken during the day and you don’t sleep it can cause amnesia, so can Temazepam and Dalmane, you forget things after taking the drug which is usually right before sleep and not a problem. I have been on Mogadon or nitrazepam and Rohypnol is flunitrazepam. The benzodiazepines however disrupt stage 4 deep sleep. I question some of the statistics like the ones for cancer, and have a B.Sc. in Statistics but overall a lot of good info.

    • Hi Paul

      Thanks for your comment and for all the useful points you make. I imagine you have seen a wide range of misuse of sleeping pills in your time, and it sounds like you have a lot of awareness based on your own experience. I’d be interested to know what your overall thoughts are on the use of sleeping pills generally.
      Regards
      Ethan

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