Key takeaways:

  • A common sleeping pill works by binding to the gamma-aminobutyric acid (GABA) receptors in the brain which are responsible for controlling cognition, behavior, and the body's response to stress
  • Taking multiple medications or drugs together always increases the risk for adverse interactions or effects. Sleeping pills when taken with alcohol, opioids, benzodiazepines, or other substances can amplify the effects of both substances, but also increase health risks and the chance of fatal overdose
  • [Ambien overdose] death is reported at doses higher than 2,000 mg, but a lethal dose may still occur at lower amounts. An overdose on Lunesta can happen at approximately 270mg and sonata at 200mg

Most sleeping pills belong to the category of drugs known as sedatives or hypnotics and are prescribed to people who have trouble getting to sleep or staying asleep. Abusing sleeping pills can lead to dependence and addiction.

Understanding sleeping pills

Most sleeping pills belong to the category of drugs known as sedatives or hypnotics and are prescribed to people who have trouble getting to sleep or staying asleep. Some sedative medications are controlled substances like Benzodiazepines, but these are not commonly prescribed for sleep. Instead, most doctors prescribe non-benzodiazepine medications to treat chronic insomnia or other sleep problems. 

Some of the most commonly prescribed sleeping pills are:

Ambien (zolpidem)

Sonata (zaleplon)

Lunesta (eszopiclone)

All non-benzodiazepine sleeping pills have similar effects despite not all sharing the same molecular make-up. A common sleeping pill works by binding to the gamma-aminobutyric acid (GABA) receptors in the brain which are responsible for controlling cognition, behavior, and the body's response to stress. [1] 

Benzodiazepines have the same effect on the brain, though sleeping pills are thought to have fewer side effects. While they carry a lower risk for abuse and addiction, some people do develop an unhealthy dependence on these medications.[3]

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Sleeping pill effects

Non-benzodiazepine sleeping pills are normally only prescribed for short-term use. They are often only used to treat cases of severe insomnia but are not always prescribed on a strict dosage schedule. This is so people can use them as a fast-acting method of sleep and so they can be used as needed.

Though people will often still only use z drugs to get to sleep, some people turn to them when feeling anxiety or depression as a way of ‘switching off’. This can lead to sleeping pills not being used as intended, which counts as abuse. 

When taken in higher doses than prescribed, sleeping pills can produce a similar drowsy effect to benzodiazepines. They can also cause hallucinatory effects when taken in high doses and the user resists the urge to sleep.

Other effects of z drugs include:

  • Reduced anxiety

  • Dreamless sleep

  • Lack of coordination

  • Dizziness

  • Lightheadedness

  • Hallucinations

As tolerance to sleeping pills builds, those with a dependence or addiction to the drug may often experience a compound or rebound insomnia which may be more intense than before they started taking the drug. This is another example of withdrawal symptoms from sleeping pills and a reason to seek out medical detox when quitting. 

There is also the risk of overdose from sleeping pills. While those who consume Z drugs with other substances are at greater risk, it is still possible to overdose from sleeping pills alone. Ambien, for example, is typically taken at a 10 mg dose. At 600 mg, a user is entering overdose limitations, and serious damage is likely. Death is reported at doses higher than 2,000 mg, but a lethal dose may still occur at lower amounts. An overdose on Lunesta can happen at approximately 270mg and sonata at 200mg.

Addiction to sleeping pills

Sleeping pills are widely available and are often used to treat moderate to chronic insomnia. Though their effects are relatively non-threatening, it is still possible for the brain and body to become dependent on them. This can lead people to become physically addicted to these medications. 

Unlike other illicit drugs, sleeping pills don’t usually cause the release of dopamine, meaning that most people aren’t using these medications to get high. Still, they can develop a high tolerance to these medications which can cause them to need higher doses to fall asleep. It is also possible for people to experience symptoms of withdrawal when they skip doses or try to cut back or stop taking the medication.

Withdrawal symptoms can occur when the use of sleeping pills or sedatives is stopped suddenly. Depending on the specific drug, symptoms can start within a few hours, but they may also be delayed, sometimes occurring even weeks after use has been discontinued. 

Typical symptoms of withdrawal include trouble sleeping, restlessness, anxiety, shivering, or circulation problems. [2] There are some instances where it is dangerous to stop taking sleeping pills without medical detox and monitoring, so it is always advised to consult with a physician before changing or stopping a medication.[3, 4]

Indicators that a Z drug dependence or addiction may have occurred include:[3, 4]

  • Being unable to sleep without the medication

  • Having several failed attempts to quit or cut back

  • Getting cravings for sleeping medications

  • Needing higher doses to fall asleep

  • Continuing to take pills despite negative consequences

  • Daytime drowsiness or problems concentrating or functioning

  • ‘Hangovers’ the day after taking a sleeping pill

  • Using sleeping pills off-label or during the day

These are just some of the negative criteria used to diagnose addiction as outlined in the DSM-5. Click here for the full list of criteria.

Who should avoid taking Z drugs?

There are certain circumstances whereby your doctor should not provide you with a sleeping pill prescription. Lying to a doctor if you have any of these symptoms in order to get sleeping pills can put you in great danger.

Your doctor will not normally prescribe you Z drugs if you have:

  • severe lung disease or breathing problems

  • sleep apnoea (breathing problems during sleep)

  • severe liver or kidney disease

  • severe and uncontrolled myasthenia gravis (a neuromuscular condition)

Your doctor may be cautious about offering you Z drugs if you have:

  • chest and lung problems

  • neuromuscular weakness, such as myasthenia gravis

  • a history of alcohol or drug abuse

  • a diagnosis of personality disorder

Your doctor should prescribe a reduced dose of these drugs if you have:

  • liver or kidney problems

  • porphyria (a rare, inherited illness)

There may also be risks associated with pregnant women and sleeping pill abuse, though there is insufficient research to confirm this. If in doubt, speak to your doctor before taking sleeping pills.

Common drug combinations with sleeping pills

Taking multiple medications or drugs together always increases the risk for adverse interactions or effects. Sleeping pills when taken with alcohol, opioids, benzodiazepines, or other substances can amplify the effects of both substances, but also increase health risks and the chance of fatal overdose. Respiratory failure is a common adverse interaction and can occur in people who take sleeping pills with alcohol or other sleep medication.

Sleeping pill addiction treatment

Breaking an addiction to sleeping pills can be hard without the right treatment and support. If you or someone you love is struggling to overcome an addiction to sleeping pills, reach out to a treatment provider for more information on treatment.