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Sleep disorders and problems (insomnia)

Sleep disorders and problems (insomnia)

Insomnia: Coming off sleeping pills and sedatives

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Sleeping pills and sedatives (such as and Z-drugs) should only be taken for a few weeks because you might become dependent on them. If you've been taking them for a while and want to stop, it's best to come off them gradually with the help of a doctor. You may find psychological support useful too.

If you take or Z-drugs (benzodiazepine receptor agonists, otherwise known as BzRAs) for too long or if the dose is too high, you can become dependent on them. This can happen after just a few weeks and you might not even notice it. So it's important to take the lowest dose possible, for the shortest time possible. Doctors usually recommend that you only take them for four weeks at the most – including the time when you gradually reduce the dose and then stop taking the medication altogether.

But it's quite common for people to take sleeping pills and sedatives for several months or even years. Then they have problems stopping – especially because they're often worried about withdrawal symptoms. Coming off or Z-drugs can be a real challenge, both physically and mentally. But it's usually doable with the help of a doctor and sometimes psychological support too.

How can you stop taking sleeping pills and sedatives?

The key thing is to decrease the dose gradually before you stop taking them altogether. It is important to do this gradually to try to prevent withdrawal symptoms. These can occur if your body has become used to a substance and suddenly doesn't get it anymore. The withdrawal symptoms are very similar to the original sleep problem symptoms, and can actually make you want more medication again. This can trigger a vicious circle if people start using sleeping pills or sedatives again to reduce the symptoms.

It is best to talk to your doctor about the right time to start coming off the medication, and how gradually you should decrease the dose. A medication schedule can be useful here.

How do people manage to stay off the medication?

People who use or Z-drugs for a long time are likely to have problems. It can be particularly hard in elderly people because their bodies take longer to break down the substances in the medication. Also, they often take a lot of different medications or have various illnesses. Some of the side effects of and Z-drugs include reduced ability to think straight and increased risk of falling because the muscles become too relaxed. Often, the person's body has already got used to the medication – or is already dependent on it. Then it's really important that they come off the medication carefully.

If you've been taking or Z-drugs for a long time and want to stop, you should talk to your family doctor first. If you think your medication-taking is out of control, you can turn to an addiction counseling center for help too. They usually draw up a withdrawal plan for you, based on the type of medication, the dose, how long you've been taking it and your personal situation.

Various studies have shown that even quite simple things can help people come off . For instance, more people stopped taking them if they had support and advice from their doctor.

But the research hasn't shown that taking other medication during the dosage-reduction process makes it easier for people to stop their benzodiazepine use or lessens their withdrawal symptoms. More research is needed to find out whether taking certain medications (such as antidepressants, antihistamines and melatonin) can help people stop taking sleeping pills and sedatives.

How can psychological support help?

Various studies suggest that more people manage to stop taking if they have psychological support too. The most successful type seems to be cognitive behavioral therapy (CBT). CBT is a talking therapy that aims to identify and then change thoughts and ideas that have a negative effect. Relaxation exercises are often used in psychological treatment too.

Research suggests that cognitive behavioral therapy can help people come off sleeping pills. To help you stay off this medication, you can assess and improve your sleeping habits and incorporate relaxation techniques like autogenic training into your daily routine.

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Takaesu Y, Utsumi T, Okajima I et al. Psychosocial intervention for discontinuing benzodiazepine hypnotics in patients with chronic insomnia: A systematic review and meta-analysis. Sleep Med Rev 2019; 48: 101214.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Insomnia: Coming off sleeping pills and sedatives

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Updated on August 1, 2024

Next planned update: 2027

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Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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