What can help when trying to stop taking sleeping pills and sedatives?

Dependency can develop quickly if benzodiazepines or Z drugs are used for too long or at too high a dose. Because of this risk, it's important to keep the dose as low as possible and to only take the medication for as short a time as possible. People can even become dependent after just a few weeks. But it's quite common for these drugs to be taken for several months, or even years.

The German Centre for Addiction Issues (DHS) estimates that 1.5 to 1.9 million people in Germany are dependent on benzodiazepines. Women, and particularly older women, appear to be especially likely to use these medications.

Not everyone notices the symptoms of dependence while taking these medications. So an important first step is to realize that you have got used to the medication or may even already have a dependence. It can be physically and mentally very hard to stop taking medication that you are dependent on. A lot of patience and strength is needed to get through difficult phases without using the medication.

Researchers from the Universities of Queensland and Bond in Australia wanted to find out which approaches can help people to stop taking benzodiazepines. They analyzed 35 studies involving over 16,000 participants that tested the benefits of the following interventions:

• Gradual dose reduction ("tapering") – with and without substitute medication
• Brief motivating contacts with doctors – such as a talk or a letter
• Therapeutic support, for example behavioral therapy

When the studies started, all of the participants had been taking benzodiazepines regularly for longer than three months and were monitored in an outpatient setting.

Withdrawal symptoms can occur when people suddenly stop using sleeping pills or sedatives. Depending on the specific drug, symptoms can start within a few hours, but they may also start later – sometimes even weeks after you stop taking the drug.

Typical withdrawal symptoms include trouble sleeping, restlessness, anxiety, shivering, and feeling dizzy and faint. So they're similar to the symptoms that the sedative was originally meant to get rid of. This may set off a vicious circle: Many people start using the sleeping pills or sedatives again to relieve these symptoms. To avoid such relapses, it's important to try to keep withdrawal symptoms to a minimum when you stop taking the medication. That is why it's common to gradually reduce the dose over several weeks, before you can stop taking the medication completely. There is no good-quality research on the best length of time for outpatient withdrawal. Experts recommend a time frame of two to four months.

Research hasn't shown that it's easier for people to stop taking benzodiazepines if they take a substitute medication while reducing the benzodiazepine dose. Further research is needed to determine whether certain substitute medications – such as antidepressants or antihistamines – might help.

Three studies found that even simple approaches can have a positive effect: More people stopped taking benzodiazepines if their doctor gave them written information advising them to stop. In some of the studies, people received booklets with information about self-help strategies as well. More recent studies also suggest that the letters are especially helpful if the recipients are addressed by name.

The studies also suggest that more people can stop taking sedatives if they are well-informed about the issue of medication dependence and the steps they need to take. Professional psychological support is also useful. Cognitive behavioral therapy (CBT) is apparently the most successful form of psychological support here.

In general, it's important to talk to a doctor or contact an addiction counseling center if you feel like you have lost control over your medication use. Medical, psychological or psychotherapeutic support can help you find ways to successfully stop taking benzodiazepines.