(Thursday, 23rd Oct, 2014)
Sleeping pills (Hypnotics)
When are sleeping pills needed?
Sleeping pills are used in the treatment of insomnia (difficulties in sleeping). If you feel that problems with sleep are having an impact on your life, it is worth discussing this with your doctor. They will work with you in identifying and dealing with the underlying causes of the problem.
To decide on the right approach for your situation, your doctor will explore the possible reasons for your sleep difficulties. In many cases, simple steps may improve the situation. However, in more severe cases, medication will have a role to play in tackling sleep problems.
Certain important measures (known as sleep hygiene), including reducing caffeine and alcohol intake, avoiding stimulating activities before bed-time and having a bed-time routine, are very effective in many cases. There may also be relaxation techniques that might be helpful.
Any underlying medical causes of the problem such as pain or stress-related conditions should be treated.
In general, sleeping pills will only be prescribed by your doctor if the sleep problem is severe, disabling or causing intolerable distress. Sleeping pills should usually be taken for a short period of time (ideally less than two weeks) and preferably intermittently.
What are the different types of sleeping pills?
Sleeping pills can be classified into two groups benzodiazepine and non-benzodiazepine drugs.
Benzodiazpines are widely used for short-term sleep difficulties because they have few side effects. However, some of the longer-acting drugs in this category can result in drowsiness and hangover effects the following day. Their effects can be cumulative, particularly in older people. When these drugs are stopped after short-term use, sleeplessness can recur. Withdrawal symptoms are possible after long-term use.
Short-term use is recommended with this group of sleeping tablets because there is a risk of developing both tolerance and dependency. Tolerance means that the body becomes accustomed to the drug and it loses its effect. Dependency is a well recognised problem, particularly with the benzodiazepine drugs. The risk of dependence increases the higher the dose and the longer the treatment.
Judgement and dexterity may be impaired in people taking benzodiazepine sleeping pills and those taking them should be careful about driving and other precision tasks.
The brand names available in Ireland by prescription in this category are:
Dalmane, Euhypnos, Halcion, Mogadon, Noctamid, Normison, Nortem, Rohypnol, Somnite, Tenox, Trilam.
Many of the non-benzodiazepine drugs are newer compounds which act in the same way as benzodiazepines, but are more selective in how they work on the brain. That means that there may be less likelihood of 'hangover' effects on wakening.
The brand names available in Ireland by prescription are:
Heminevrin, Sonata, Stilnoct, Tricloryl, Zilese, Zimovane, Zopitan, Zorclone.
Do sleeping pills interact with other drugs or medical conditions?
Sleeping pills may interact with alcohol and some anti-epilepsy medications (anticonvulsants).
Your doctor will be aware that special precautions are needed if sleeping pills are to be given to people with chronic liver or kidney disease, older people, pregnant and breastfeeding women. These issues will be discussed with you if relevant.
How do I stop sleeping pills?
If you have taken a short course of sleeping pills, as prescribed by your doctor, you can just stop when the course is completed. You may notice some difficulty in sleeping for a few nights after stopping. This is known as rebound sleeplessness. Your sleep pattern should then settle down.
If you have been taking sleeping pills for a longer period of time (months or years), it is not advisable to stop suddenly as you are likely to suffer withdrawal effects. Discuss your intention to stop with your doctor who will suggest gradually reducing the strength of the tablets and organise any other support you may need.
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Last Reviewed: 6th October 2000