Sleeping Pill Addiction
For people who suffer from insomnia or other sleep disorders, sleeping pills can be extremely beneficial – even life-changing. However, these powerful drugs are not without their downsides, and thousands of people around the UK now struggle under the burden of sleeping pill addiction.
What Are Sleeping Pills?
Sleeping pills – more properly known as hypnotic or soporific drugs – are, as the name implies, a type of medication used to induce sleep, commonly used to treat sleep disorders and also in surgical anaesthesia. The term “sleeping pills” is used because many of these medicines are available in tablet form, and this is the most common means of administration; however, most of the drugs available as sleeping pills might also be found in other forms, especially in a hospital or surgical environment.
Numerous different types of sleeping pill are available worldwide and in the UK specifically, and each has advantages and disadvantages. Not all substances used to induce sleep are habit-forming, but unfortunately many of the most popular and most commonly available sleeping pills can be addictive, with potentially serious consequences for the user’s physical and mental health and life circumstances.
Many substances have been used through the ages as a means of bringing on sleep, including both alcohol and opium (the primary active ingredient in which, morphine, is named after the Greek god Morpheus, the “son of Sleep”). As medical science grew more advanced and sophisticated in the 19th century, various other new medications were discovered or invented for the treatment of sleep disorders; from 1869, chloral hydrate was used in the psychiatric treatment of insomnia, while barbiturates became widespread from the early 1900s onwards.
During the second half of the 20th century, alternatives to barbiturates – discovered to be dangerous in overdose and to have a significant dependence liability – were developed including quinazolinones and benzodiazepines. Research into the pharmaceutical induction of sleepis ongoing, driven by the vast profits which can be gleaned from this huge market, and various other medications have since come to market, alongside countless traditional and alternative remedies.
Hypnotic drugs are closely related to sedatives, and both classes of drugs are often described collectively as sedative-hypnotics; while sedatives are usually used to calm patients and/or to relieve anxiety, and hypnotics are primarily used to initiate or sustain sleep, there is a significant crossover in both mechanism and effect (especially considering that most drugs of this type cause dose-dependent effects: the higher the dosage, the stronger the effect, and a substance which is calming at a low dose may cause unconsciousness at a higher one).
Because of the habit-forming properties of many hypnotics, some doctors are somewhat reluctant to prescribe them except in serious cases, and/or before other nonpharmacological remedies have been explored. However, insomnia is a significant problem in the Western world – affecting between 10% and 30% of adults at any given time – and a 2012 study for the Economic and Social Research Council showed that one in 10 British adults regularly takes some kind of sleeping tablet, laying the foundations for a significant addiction challenge in the UK.
As well as being used for their intended purpose, sleeping pills are frequently used and abused recreationally for their intoxicating properties (which can vary from one specific type of hypnotic to another), which is also a significant driver of addiction. Meanwhile, sleeping pills are also occasionally used in the commission of crime, including rape and sexual assault, and robbery.
Other Names for Sleeping Pills
Sleeping pills are commonly referred to by their brand names, of which there are a huge number worldwide (and some of which are discussed below). Medically, they are known as hypnotics (or sedative-hypnotics) – though some people do consume other substances for the purposes of inducing sleep which would not usually be considered to belong to the hypnotics class – and are sometimes described as “somniferous” (“producing sleep”)drugs.
On the street, sleeping pills go by numerous different names, ranging significantly from one substance to another (with street names typically relating to or derived from brand names). Common generic street names for sleeping pills include tranks, sleepies, dopies and forget-mes.
The Different Types of Sleeping Pills
A great number of different medicines are used throughout the world to induce sleep, with various different effects and challenges associated with them.
Barbiturates were the first major class of drugs to be used in the treatment of sleep disorders in the 20th century; they are central nervous system (CNS) depressants, with effects ranging from mild sedation to complete anaesthesia. Barbiturates have fallen out of favour in many countries, including the UK, as they are both habit-forming and dangerous in overdose; nevertheless, as well as being used medically barbiturates are abused for their euphoric and sedative “high”.
Benzodiazepines are typically provided in cases of severe, disabling and/or distressing insomnia, or insomnia occurring alongside or as a consequence of other mental health disorders, especially including anxiety; they are more commonly prescribed as a treatment for those disorders directly. Although introduced as a safer alternative to barbiturates, benzodiazepines are also habit-forming (and withdrawal from benzodiazepine dependence can be fatal) and are frequently abused for their pleasurable intoxicating, euphoric properties.
Nonbenzodiazepines (sometimes known as “Z-drugs”) are a class of drugs which have very similar properties, benefits and risks to benzodiazepines proper, but which are not related to benzodiazepines chemically. Because of their similarities, they are often grouped with benzodiazepines and many doctors may refer to them interchangeably (though technically incorrectly). Although many popular sleeping pills belong to the nonbenzodiazepine class, their relatively recent (from the end of the 1980s) arrival onto the market means that less data regarding their long-term effects is available than for many other medicines; nevertheless, it is known that, like their benzodiazepine cousins, many non-benzodiazepines are addictive, and pose various dangers to physical and mental health (which do not, however, prevent them from being abused).
Numerous substances are used to treat insomnia. Melatonin – a hormone produced in the brain which promotes sleep – is commonly prescribed in the UK and has few adverse effects; it is not known to be addictive. Some users take quinazolinones, though their use is relatively uncommon in Britain. Various antihistamines also have sedative effects and are present in many over-the-counter medications. Some antidepressants and antipsychotics are also used in the treatment of insomnia, with various benefits and disadvantages. Although the effects and dangers of any particular type of sleeping pill will depend upon the nature of the specific medicine in question, many if not most users of sleeping pills will not necessarily associate their pills of choice with the chemical class to which they belong, and will know them better by their brand names.
Ambien – one of various brand names for the drug zolpidem – is used primarily in the short-term treatment of sleeping problems. Ambien is a nonbenzodiazepine hypnotic with a known addiction liability, which is comparatively commonly abused; it has received a degree of public attention thanks to its involvement in various scandals in which problematic and/or illegal behaviour has been blamed on Ambien consumption.
Restoril is a brand name for the benzodiazepine temazepam. Although commonly prescribed in the UK, temazepam (like other benzodiazepines) is addictive, and its abuse poses various other health risks. However, its intoxicating high makes temazepam one of the most commonly recreationally used prescription medications.
Amytal is one brand name for the barbiturate amobarbital (also known as amylobarbitone or sodium amytal), which is not licensed for use in the UK but which can be brought into the country by a licensed pharmaceutical importer for use on a named-patient basis. Because of this apparent loophole, and the ease with which drugs like Amytal can be procured over the dark web, despite its unlicensed status Amytal is used and abused recreationally in Britain despite its dangerous, habit-forming properties.
Zopiclone (sold under brand names including Imovane, Zimovae and Dopareel) is a nonbenzodiazepine hypnotic used to treat insomnia. An active stereoisomer of zopiclone, eszopiclone, is sold in various countries under the name of Lunesta, and both substances are sometimes collectively known as Lunesta Zopiclone. Both zopiclone and eszopiclone are known to be habit-forming, and their use can lead to overdose which can be fatal; nevertheless, they are commonly used and abused recreationally for the sedative high they can produce.
Rozerem – a brand name for the chemical ramelteon – is an agonist of melatonin receptors in the brain, which is used in the treatment of insomnia but does not typically increase the speed with which sleep occurs. Rozerem is not known to be habit-forming, and does not typically cause any of the effects which would see it adopted as a recreational drug of choice.
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Sonata is a brand name for the nonbenzodiazepine zaleplon, used to treat cases of insomnia. Sonata has very short-lived effects (lasting up to about an hour) and so although typically aiding the rapid induction of sleep it does not usually assist in the maintenance of sleep over the duration of a typical night. Zaleplon is known to have habit-forming properties, but nevertheless is comparatively commonly used and abused recreationally for its euphoric high which can also feature brief visual and/or auditory hallucinations.
Indications and Contraindications
The indications and contraindications (when a drug should, and should not, be taken) of sleeping pills vary according to a number of factors, primarily how exactly the substance in question affects the body. Generally speaking, with regards to indications, sleeping pills should only be prescribed over a comparatively short period in cases where sleeping problems are having significant negative, distressing and disabling consequences for the affected individual, and where other nonpharmaceutical treatment methods have been shown to be ineffective; in such cases, however, it is important to note that sleeping pills can have extremely beneficial effects, and with correct supervision (and when taken strictly in accordance with the instructions of the prescribing doctor) can be non-problematic.
Barbiturates, benzodiazepines and nonbenzodiazepines all act by enhancing the effects of the neurotransmitter gamma-aminobutyric acid (GABA) upon the brain and CNS, and while specific contraindications may vary from one drug to another, generally speaking they can be discussed in similar ways.
The muscle relaxant action of sleeping pills can have the effect of causing respiratory depression in certain people, and they are typically contraindicated in individuals suffering from conditions including COPD, bronchitis, myasthenia gravis and sleep apnoea. Many sleep medications are also contraindicated for individuals suffering from mental health issues, in particular depressive disorders as suicidal ideation may result (and, indeed, sleeping pills are an extremely common factor in cases of intentional overdose). People suffering from substance abuse disorders – especially alcohol, opioid, barbiturate or benzodiazepine addiction – generally should not be prescribed sleeping pills as they can interact extremely dangerously with those drugs (however, it should be noted that some sedative-hypnotics are nevertheless used in the treatment of addiction, especially withdrawal, under strict medical supervision).
Pregnant women and those who are breastfeeding are commonly advised not to take benzodiazepines, nonbenzodiazepines or barbiturates as there is a risk of harm to the unborn child and to infants, which can include an increased likelihood of birth defects and sudden infant death syndrome (SIDS) as well as the possibility of dependence (and neonatal withdrawal syndrome) developing in utero or during nursing.
Although elderly people are amongst the most common uses of sleeping pills, the prescription of such medication to the elderly is often considered problematic as they are significantly more susceptible to adverse effects including loss of motor control increasing the risk of accident, and are more likely to suffer serious health consequences in cases of dependence.
Legal Status (UK)
The legal status of sleeping pills in the UK varies from one medicine to another, and if you are concerned about the status of any specific medication you or someone close to you may be taking, check with your doctor rather than making any assumptions. Generally speaking, most sleep medication found in the UK is legal to possess with a valid prescription; however, the comparative ease with which many medicines can be brought into the country via the dark web means that certain medications which are not licensed for use in this country may still be available on the street, and there is no guarantee that simply because some medicine comes in official-looking packaging and is found in a typical medicine cabinet, that means it is legal to possess and has been obtained through legal channels.
Of the substances most commonly used in the UK to treat sleep disorders, barbiturates are the most strictly controlled legally: barbiturates are class-B controlled substances under the Misuse of Drugs Act 1971, and the unauthorised possession of barbiturates could result in up to five years’ imprisonment and an unlimited fine, whilst unauthorised supply has potential penalties of up to 14 years’ imprisonment and an unlimited fine.
Benzodiazepines and nonbenzodiazepines are less strictly controlled, but are still illegal under the Misuse of Drugs Act: they are class-C controlled substances, with penalties for unauthorised possession and supply potentially reaching two years in prison and an unlimited fine, and 14 years in prison and an unlimited fine respectively.
It is important to note that “unauthorised supply” includes giving even very small numbers of sleeping tablets to friends or family members who have not been given a valid prescription for those drugs. If you have been prescribed sleeping tablets, never give them to anyone else: you are exposing yourself to the risk of serious criminal consequences.
Routes of Administration
Sleeping pills, as the name suggests, are usually found in tablet form for oral consumption. However, some substances found in sleeping tablets may also be found in liquids and tinctures; may be administered in medical environments via intravenous or intramuscular injection; and may be found in other forms for use including sublingual, rectal or vaginal administration. Some recreational users of sleeping pills grind up tablets for the purposes of insufflation (snorting).
Pharmacological Actions of Sleeping Pills
Benzodiazepines, nonbenzodiazepines and barbiturates all work by increasing the effectiveness of the neurotransmitter GABA, which acts by binding to GABA receptors in the brain and CNS to decrease the communication between neurons, having a calming effect on many brain and body functions. The lesser the excitability of neurons, the smaller the amount of excitatory information which is transmitted throughout the CNS, leading to muscle relaxation and decreased anxiety; this relaxing effect can lead to drowsiness and sleep – hence these substances’ efficacy as sleep aids – but also to intoxicating effects which some people find enjoyable, hence their frequent recreational use and abuse.
What is Sleeping Pill Addiction?
Addiction to anything – whether it be a substance of abuse or a specific type of behaviour – is fundamentally a disorder of the brain’s reward system. The repeated exposure to an addictive stimulus – such as the effects of certain sleeping pills – can cause an adjustment to reward centres in certain parts of the brain in which that exposure, and the engagement in rewarding behaviour (such as taking sleeping pills) can cause the increased production of chemicals such as dopamine which are associated with pleasure and reward. As that exposure is repeated further, an individual comes to associate their behaviour with positive sensations and feelings, and may feel compelled to repeat it; moreover, the absence of the rewarding stimuli in question leads to a diminution in the effects of dopamine and associated chemicals, resulting in negative feelings and low moods which the user may seek to dispel by returning to the addictive behaviour.
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The use of various substances – including benzodiazepines, nonbenzodiazepines and barbiturates – can also result in the manifestation of physical dependence, a phenomenon whereby the regular presence of a substance in a person’s system causes that system to come to rely upon the substance in order to function normally. If a dependent individual suddenly stops taking that substance, their brain and body may be thrown into a period of abnormal functioning – during which various unpleasant and potentially dangerous withdrawal symptoms may arise – until the individual’s system is able to re-normalise over time.
Addiction and dependence are closely related, and often mistaken for each other, but are distinct phenomena and each may manifest without the other.
How Addiction Typically Develops
Obviously, an addiction to any substance will only develop if a person takes that substance, so any substance addiction begins with an exposure to the substance in question. In the case of sleeping pills, many addicts begin by being prescribed pills to treat sleep disorders (or other conditions) and then develop addiction and possibly dependence by continuing to take over time, possibly disregarding a doctor’s instructions relating to how long these drugs should be taken for, and recommended dosages. Such individuals may be driven by a genuine need for the sleep-inducing qualities of these drugs, but may also come to enjoy the effects of sleeping pills and begin to take them for that purpose, which constitutes abuse. The longer someone takes sleeping pills, and the higher the dosages they consume (with many affected people coming to take significantly greater doses than recommended, as they develop tolerance: becoming used to certain levels of a substance in the system, and requiring more and more of that substance in order to obtain the desired effects) the more likely they are to develop an addiction to them.
People taking sleeping pills purely recreationally, meanwhile, are unlikely to have been given proper instructions regarding dosages and duration of use, which could lead them to consume such drugs much more frequently and in much greater quantities than is advisable, giving rise to a significant risk of addiction. However, it is also the case that recreational sleeping pill consumption may take place infrequently enough that addiction is not a substantial risk, while taking sleeping pills according to a prescription could potentially entail much more frequent consumption: it should not be assumed that someone using sleeping pills recreationally is more likely to develop an addiction that someone taking them for their intended purposes.
Who is Most at Risk of Sleeping Pill Addiction?
Anyone who takes habit-forming sleeping pills more than occasionally – whether medically or recreationally – is at risk of developing an addiction to them. Logically, people suffering from insomnia and other sleeping problems are more likely than the average to develop an addiction to sleeping pills since they are more likely to take them in the first place, but recreational users and individuals taking drugs used as sleep aids for other purposes (such as to combat anxiety, or in the treatment of certain substance use disorders) are also similarly more in danger of becoming addicted to them than the average individual.
Sleeping Pills Addiction Causes and Risk Factors
Addiction is a well-studied phenomenon, but its exact causes – in terms of why one person might develop an addiction while another very similar person, in very similar circumstances, may not – are not yet fully understood. However, a number of factors have been identified which increase the likelihood that an individual will become addicted to sleeping pills, including:
- a family history of substance abuse and addiction
- a family history of mental health disorders
- personal experience of substance abuse
- suffering from a chronic and/or debilitating sleep disorder
- easy access to sleeping pills
- associating with a peer group within which sleeping pill abuse or other substance abuse is commonplace
- low self-esteem
- social isolation and withdrawal
- risk-taking and/or pleasure-seeking behaviour
- experiencing childhood abuse
- traumatic or otherwise challenging life events
Co-Occurring Disorders with Sleeping Pills Abuse
When a mental health disorder cooccurs alongside a substance use disorder, the condition is known as dual diagnosis. Dual diagnosis is fairly common in cases of addiction, including sleeping pill addiction, because mental health issues frequently cause and/or result from substance abuse: for example, someone suffering from poor mental health may abuse sleeping pills as a means of self-medication or escapism, while sleeping pill abuse itself can cause various mental health disorders as a direct result of the impact of the substance on the brain and/or as a consequence of the deterioration of life circumstances typically caused by addiction.
Dual diagnosis frequently complicates addiction treatment, and typically requires specialist care.
Signs and Symptoms of Sleeping Pills Abuse
It can sometimes be difficult to identify sleeping pill abuse, partly because of the stigma associated with substance abuse and addiction which often makes those affected by it take great care to try to conceal their condition, and partly because sleeping pills’ legal status and comparative social acceptability mean that their presence in medicine cabinets may raise few eyebrows (at least compared with evidence of the use of harder illegal substances). However, certain signs may indicate that someone you know is using sleeping pills, including:
- frequent signs of intoxication, including euphoria, drowsiness, impaired motor control, slurred speech and an inability to focus
- preoccupation with obtaining and consuming sleeping pills
- mood swings
- impaired memory
- financial difficulties
- impaired performance at work or in academia, including frequent absenteeism
- frequent sleepiness and sleeping for longer than is typical
- a loss of interest in previously enjoyed activities
- growing distant from loved ones and friends
- the manifestation of withdrawal symptoms after stopping taking sleeping pills
- “doctor shopping” (visiting a number of doctors in order to obtain multiple prescriptions)
- decreased care paid to appearance and hygiene
- changes in eating habits
- changes in sex drive
Dangers and Effects of Sleeping Pills Addiction and Abuse
Numerous dangers to mental health are associated with sleeping pill addiction and abuse, including:
- muscle weakness
- nausea and vomiting
- unsteady gait
- mood swings
- mental confusion
- uncontrollable shaking
- excessive drowsiness
- dangerously slowed breathing
- bradycardia, or slow heart rate
Sleeping Pills Abuse and Addiction Among Young People
Because of a number of factors including the comparatively widespread availability of sleeping pills, their low cost compared with many other substances of abuse, and the enjoyable nature of some of their effects, sleeping pills are frequently abused by young people, including children of school age. Any substance abuse, including sleeping pill abuse, can have especially profound consequences for young people, affecting their physical health, emotional and intellectual development, and life prospects.
If you suspect that a young person close to you might be abusing sleeping pills, contact an addiction specialist to discuss your concerns and to get advice on how best to approach the matter.
Signs and Symptoms of Withdrawal
Just as any individual user of sleeping pills is unique, so too is every instance of withdrawal, and not every individual going through withdrawal will experience all of the same symptoms; moreover, although benzodiazepines, nonbenzodiazepinesand barbiturates have similar effects, they are not identical (indeed, the properties of individual drugs within the same class can also vary). However, some common symptoms of sleeping pill withdrawal include:
- agitation and irritability.
- suicidal ideation
- in severe instances, convulsions or seizures
Withdrawal from sleeping pills can be extremely dangerous, both from seizures potentially resulting in death and as a result of the increased risk of suicide associated with the condition. Because of this, it is imperative that if you have a sleeping pill dependence you do not attempt to go through withdrawal without medical help.
Duration of Withdrawal
Because every instance of sleeping pill withdrawal is unique, affected by numerous factors including the duration and severity of the addiction, the dosages consumed, the specific drugs being taken, and the personal circumstances and physiology of the addict, it is only possible to give a rough guide to how long withdrawal may last.
Usually, withdrawal symptoms will begin anywhere between six and 24 hours after the last dose, and may reach their peak anywhere from two to seven days after that; while most cases of withdrawal will subside after a couple of weeks, some users go on to develop post-acute (or protracted) withdrawal syndrome (PAWS) which may last months or even years.
Sleeping Pills Detox Process
Detoxification (detox) from sleeping pills is a vital part of sleeping pill addiction treatment, as no treatment can expect to be successful in the long term if the addict is still experiencing the effects of sleeping pill intoxication and/or dependence. How detox is carried out may vary considerably from one treatment facility to another, but fundamentally consists of a period of abstinence during which the addict’s system is cleansed of sleeping pills and any other substances of abuse. Withdrawal symptoms may manifest during this time, which may be alleviated at least in part by medication.
Detox carried out in a treatment facility will be managed and monitored by trained medical professionals for the safety and comfort of the addict; going through detox independently poses a significant risk to the life of the withdrawing addict.
How Sleeping PillAbuse Affects the Brain and Body
As well as the risk of addiction and dependence, and overdose, the abuse of sleeping pills can have a number of long-term effects on an individual. Permanent cognitive impairment and behavioural and emotional problems can result from neurological damage, while psychosis, paranoia, depression, anxiety and other mood and mental health disorders are also associated with sleeping pill abuse. Respiratory and circulatory damage, damage to organs including the liver, anhedonia, sexual dysfunction, hypertension and hypotension, weight gain or loss, impaired motor control, depersonalisation and long-term sleeping problems are also possible consequences of the abuse of sleeping pills.
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Overdosing on Sleeping Pills
Sleeping pills are a factor in a significant proportion of fatal overdoses, both intentional and accidental. Overdoses (whether intended or not) commonly result from mixing sleeping pills with other substances, especially including alcohol, but also follow the consumption of sleeping pills alone.
Typical symptoms of a sleeping overdose can include slurred speech, hypotension, drowsiness, ataxia, nystagmus, respiratory depression, cardiorespiratory arrest and coma; if you observe any of these symptoms affecting someone you know to have taken sleeping pills, contact the emergency services immediately.
How to Find Help for Recovery from Sleeping Pills Addiction
One silver lining to the tragic proliferation of sleeping pill use and addiction in the UK has been a significant growth in the number and capability of facilities around the country now treating the condition. Sleeping pill addiction treatment is increasingly sophisticated, and thousands of sleeping pill addicts have been able to access help and overcome their addictions to return to healthy and happy lives.
Treatment facilities, both public and private, can vary considerably in terms of the type of treatment provided and their rates of success. If you are considering entering treatment for a sleeping pill addiction, speak with an addiction specialist about your particular situation, any constraints you may have regarding your ability to enter into treatment, and your personal preferences, if any, for treatment methodologies or locations.
Facts and Statistics on Sleeping Pills Abuse & Addiction
- According to a 2014 report by scientists from King’s College London, over 1.6% of Britons take sleeping pills every day. Two-thirds of the subjects interviewed by the report’s authors had been taking benzodiazepines continuously for more than a year.
- In 2012, 15.3 million NHS prescriptions were written for sleep medication, including 5.4m for zopiclone and 2.8m for temazepam.
- Nuffield Health statistics suggest that British adults miss out on a collective 378 million hours of sleep each week.
- The NHS spends at least £50m each year on sleeping pills.
- A survey conducted in 2017 for insurer Aviva suggested that up to 16 million UK adults suffer from insomnia.
If you are suffering from a sleeping pill addiction, you are exposing yourself to very serious physical and mental health risks, including the danger of death by overdose. The sooner you are able to reach out for help, the sooner you can begin to access that help, and the sooner you can set out on the path to your recovery.
Get in touch with your GP and/or an addiction specialist to discuss your situation and the various treatment options which may be available to you. Don’t let your addiction continue to dominate – and endanger – your life, and cause harm to those around you: reach out for help today, and start leading the life you want and deserve.
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