15308 Sleeping Pills

Overview

Sleeping pills (also called sleeping tablets or sedatives) are medicines that help you fall asleep, stay asleep, or both. Doctors usually offer them for a short time when insomnia (trouble falling or staying asleep) is severe or is really affecting your daily life. They are a short-term helper, not a cure: they do not fix the reason you are not sleeping, and they tend to work best when used alongside simple changes to your sleep habits and a talking therapy designed for sleep.

Yes. Sleep problems are very common, and sleeping pills are among the most widely prescribed medicines. Having a short course prescribed is a normal part of care for many people. What matters is that the course stays short where possible and that the reasons behind your poor sleep are looked at too.

Anyone can be prescribed sleeping pills, but they are used most often by adults going through stress, anxiety or low mood, people in pain or with a long-term illness, shift workers, new parents, and people coping with a crisis or bereavement. Older adults are more likely to be given them, and are also more likely to feel their side effects.

Symptoms

Common symptoms

• Lying awake for a long time before falling asleep, or waking in the night and struggling to get back to sleep
• Feeling tired, irritable or foggy during the day because of poor sleep
• Feeling sleepy or 'hungover' on the morning after taking a sleeping pill
• Memory problems, poor concentration, or feeling unsteady on your feet while taking them
• Needing a higher dose to get the same effect, or feeling anxious about running out
• Trouble sleeping again when you stop, or withdrawal symptoms such as restlessness, sweating, shakiness or a racing heart

Symptoms in children

• Sleeping pills are rarely prescribed for children and are only used in very specific situations under specialist care
• If a child is not sleeping, doctors usually look for the cause first, such as bedtime routines, worries, nightmares, breathing problems or conditions like ADHD
• Behavioural approaches and support for the family are usually tried well before any medicine is considered

Symptoms in older adults

• The effects of sleeping pills are felt more strongly and last longer, because the body clears them more slowly
• Higher risk of confusion, memory problems, dizziness, falls and broken hips
• More likely to feel drowsy or unsteady the next day, which affects driving and daily tasks
• Doctors usually prefer non-medicine approaches first, and if a tablet is used, keep the course as short and as low as possible

Causes

Main causes

• Short-term insomnia caused by stress, grief, worry, a new baby, travel or shift work
• Long-term sleep problems linked to anxiety, low mood, pain, breathing problems during sleep, or needing the toilet at night
• Habits that keep sleep poor, such as late caffeine, alcohol, screens in bed, an irregular bedtime, or a noisy or bright bedroom
• How the medicines work: sleeping pills calm activity in the brain, and with regular use the brain adapts, so the same dose does less and stopping can bring a few nights of poor sleep

Risk factors

• Being over 65
• Taking sleeping pills for more than a few weeks
• Drinking alcohol, or taking other sedating medicines at the same time, such as some painkillers, antihistamines or antidepressants
• Breathing problems such as sleep apnoea or long-term lung disease
• Liver or kidney problems, which change how medicines are cleared from the body
• A history of substance misuse, or past dependence on sedatives
• Pregnancy or breastfeeding
• Mental health conditions, which both raise the chance of insomnia and can be affected by sedatives

When to see a doctor

See a doctor urgently if:

• You have taken more than the prescribed amount, or mixed sleeping pills with alcohol or other sedating medicines
• You feel confused, very drowsy, or unsteady, or you have had a fall
• Your mood is getting much worse, or you have thoughts of harming yourself
• You have been taking sleeping pills for a while and want to stop: ask for a plan rather than stopping suddenly

Book a routine appointment if:

• Poor sleep is lasting more than a few weeks or affecting your work, mood or relationships
• You need a higher dose, or you feel you cannot sleep without a tablet
• You are still tired during the day despite sleeping
• You snore heavily, wake gasping, or your partner notices you stop breathing in your sleep
• You are pregnant, breastfeeding, or taking other medicines and want to check whether a sleeping pill is safe for you

Diagnosis

There is no single test. Your doctor will usually start by talking with you about your sleep: how long it takes to fall asleep, how often you wake, how you feel during the day, and how long this has been going on. They will ask about your mood, stress, health conditions, caffeine and alcohol, and all the medicines you take, including ones you buy. They may ask you to keep a simple sleep diary for a week or two. This helps show whether the problem is falling asleep, staying asleep, or something else such as a breathing problem during sleep.

Tests that may be done

• A sleep diary kept for one to two weeks
• A review of all your medicines, including over-the-counter ones, to spot anything that affects sleep
• Questionnaires about anxiety, low mood and daytime sleepiness
• Blood tests if a physical cause is suspected, such as thyroid problems or anaemia
• A referral to a sleep clinic for a sleep study if sleep apnoea or restless legs are suspected

What to expect at your appointment

Appointments are usually relaxed and based on conversation rather than tests. Your doctor will want to understand what is keeping you awake and what matters most to you, then agree a plan with you. That plan may include changes to your routine, a referral for talking therapy for sleep, treatment of an underlying problem, or a short course of a sleeping tablet if it is right for you.

Treatment

Treatment for poor sleep works best when it targets the cause and your habits, rather than relying on tablets alone. The first-line approach is a structured talking therapy for sleep, which teaches your body and mind to sleep better and keeps working long after the sessions end. Sleeping tablets can play a short, supportive role, but they are usually a temporary help rather than a long-term solution.

Self-care at home

• Keep regular times for going to bed and getting up, including at weekends
• Get up after about 20 minutes of lying awake and do something quiet in dim light until you feel sleepy
• Keep the bedroom dark, quiet and cool, and use the bed mainly for sleep and rest
• Cut out caffeine after early afternoon, and avoid alcohol as a sleep aid: it makes sleep lighter and more broken
• Put screens away for the hour before bed, and try a calm routine such as reading, stretching or breathing exercises
• Get outside in daylight during the day and stay active
• Write down worries or a to-do list before bed so your mind has somewhere to put them
• If you are taking a sleeping pill, take it exactly as prescribed, never with alcohol, and never drive if you feel drowsy

Medical treatments

Your doctor will usually offer a talking therapy designed for sleep as the main treatment, either one-to-one or in a group, in person or online. If a medicine is used, it will usually be a short course at the lowest dose that helps, reviewed regularly, and stopped with a gradual plan so your sleep has time to settle. Your doctor may also treat conditions that keep you awake, such as pain, low mood, anxiety or a breathing problem during sleep, and may adjust other medicines that affect sleep. If you have been taking sleeping tablets for a while, your doctor can help you reduce them slowly and safely, with support along the way.

When is surgery considered?

Surgery is not used to treat insomnia or dependence on sleeping pills. Very occasionally, an operation may be considered for a physical problem that disturbs sleep, such as some airway or nasal problems, but this is decided with a specialist and is not part of routine sleep treatment.

Living with this condition

Living with poor sleep can be exhausting, and it is easy to fall into a cycle of worrying about sleep and then sleeping worse. Try to keep your days steady: a regular getting-up time, daylight, movement, meals at similar times, and a wind-down hour before bed. If you are taking sleeping pills, keep track of how you feel the next day and tell your doctor honestly, so the plan can be adjusted. Many people find a sleep diary helps them see progress that is easy to miss.

Lifestyle tips

• Protect a regular getting-up time, even after a bad night
• Build activity into your day, but keep vigorous exercise a few hours away from bedtime
• Limit alcohol, and avoid using it to get to sleep
• Keep naps short and early, or skip them if they make nights worse
• Ask your household for quiet time and dim light in the hour before bed
• Keep a wind-down routine that you can repeat every night
• Review all your medicines with your pharmacist or doctor, including ones you buy, to check whether any affect sleep

Diet and exercise

Regular movement most days helps sleep and mood, and being outside in daylight helps set your body clock. You do not need intense exercise: a daily walk counts. Try to finish big meals a few hours before bed, cut back on caffeine in the afternoon and evening, and avoid heavy drinking in the evening. Nothing here is a cure on its own, but together these habits give sleep a much better chance.

Mental health and emotional wellbeing

Poor sleep and low mood or anxiety are closely linked, and each can make the other worse. If you have been feeling down, hopeless, anxious or unable to enjoy things, tell your doctor: treating those feelings often improves sleep too. If at any point you have thoughts of harming yourself or ending your life, treat it as an emergency. Contact your local emergency number or a crisis line in your country straight away, or go to the nearest emergency department, and tell someone you trust.

Prevention

You cannot always prevent poor sleep, but you can reduce the chance of it becoming a long-term problem, and you can lower the chance of becoming dependent on sleeping pills. Acting early on sleep problems, using talking therapy for sleep first, keeping any course of sleeping tablets short, and going back to good bedtime routines as soon as possible all make a real difference.

Vaccines

There is no vaccine for insomnia or for dependence on sleeping pills.

Screening programmes

There is no routine screening test for sleep problems or for sleeping pill dependence. Your doctor may ask about your sleep during check-ups, especially if you have low mood, anxiety, pain, a long-term condition or take regular medicines, and screening for anxiety and depression can help pick up treatable causes.

Complications

If left untreated

• Ongoing poor sleep that affects mood, memory, concentration and energy
• Tolerance, where the same dose stops working and higher doses are tempting
• Dependence, where you feel you cannot sleep without a tablet
• Withdrawal symptoms such as restlessness, sweating, shakiness, a racing heart or disturbed sleep when stopping suddenly
• Daytime drowsiness and unsteadiness, leading to falls, broken bones and road accidents
• Worsened low mood or anxiety, and less energy for the things that help
• An underlying sleep apnoea being missed, because sleeping tablets can make it worse

Long-term outlook

The outlook is good. Sleep problems respond well to the right support, and most people who want to come off sleeping pills can do so safely with a gradual plan and some patience. Expect some unsettled nights along the way: that is normal and it settles. With steady routines, help for the underlying cause, and a doctor working alongside you, better sleep is very achievable.

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