Sleeping pills hit the headlines

Published in Medicinewise Living

Date published: About this date

When it comes to sleeping pills, you need to understand the risks, use them safely and know when to avoid them.
Image: Ana Blazic Pavlovic / shutterstock.com

The Australian Olympic Committee (AOC) banned many prescription sleeping pills during the London Games to help protect Australia’s Olympic athletes — and with good reason. Side effects are common with sleeping pills like Stilnox, and can be dangerous for sportspeople and others who take them.

When it comes to sleeping pills, whether they’re on prescription, bought over the counter in a pharmacy, or a complementary medicine such as a herbal remedy, you need to understand the risks, use them safely and know when to avoid them.

Groggy when you wake up

Sleeping pills may help you fall asleep, but they can have ‘hangover’ effects that leave you feeling drowsy, lethargic, less alert or less able to focus the next day. They can even cause you temporary memory loss.

There are different types of sleeping pills. These side effects are particularly problematic with sleeping pills that contain a benzodiazepine as an active ingredient (such as temazepam), but can occur with those containing a ‘z-drug’ such as zolpidem (sold under brands including Stilnox). What’s more, these sleeping pills won’t let your body sleep as deeply as you need to, so you may not feel rested the next day, even if the effect of the pill wears off for you by morning.

Higher risk of accidents or injury

Sleeping pills that can make you feel groggy the next morning increase your chance of a fall or accident.

If you feel drowsy, don’t drive, operate machinery or do other hazardous tasks or activities. Talk to your coach or trainer to check you’re safe to exercise.  

You’re more likely to experience problems the longer you take sleeping pills; if you use more than the recommended dose; or take other medicines that can cause drowsiness too, including antihistamines, some pain relievers and cough and cold medicines.

Mixing sleeping pills with alcohol or drugs can amplify these risks further.

Getting hooked is the easy part

Dependence on sleeping pills doesn’t demand much effort. In fact, using sleeping pills for longer than 2 weeks is all it can take for your body to get used to them.

Once you’re hooked it can be difficult to stop them, both physically and psychologically, and you may need larger amounts for the same effect (known as ‘tolerance’). Stopping sleeping pills suddenly can cause rebound sleep problems or unpleasant ‘withdrawal’ effects, such as anxiety or irritability, increased sweating or nightmares.

Coming off them is not impossible, but get advice from your doctor so you can do it safely and deal with other factors, such as excessive caffeine intake, that may be contributing to your dependence.

Z-drugs are no safe bet

The newer class of sleeping pills often referred to as z-drugs are sometimes promoted as safer than other sleeping pills. Contrary to popular belief, hangover effects, memory loss and serious accidents are still possible with these medicines, as are issues with tolerance, dependence, withdrawal symptoms and rebound sleep problems.

There is no convincing evidence that the z-drugs zolpidem or zopiclone are safer or more effective for sleep than a benzodiazepine medicine.

Zolpidem has been linked to cases of amnesia, hallucinations, and other abnormal or unexpected changes in behaviour, such as rage. Potentially dangerous sleep-related events and behaviours have also been reported, usually with the person having no memory that they occurred — including sleepwalking, sleep-driving, and other bizarre behaviours while asleep, such as preparing food, binge eating, making phone calls and having sex. 

If you’re worried you may have had a side effect related to zolpidem or any other sleeping pill, seek medical advice. To report possible side effects call the Adverse Medicine Events (AME) Line on 1300 134 237 from anywhere in Australia (Monday–Friday, 9am–5pm AEST).

People with questions about their medicines or seeking general information about side effects can call NPS Medicines Line on 1300 633 424 (also Monday-Friday, 9am-5pm). 

Play it safe with sleeping pills

Talk with your doctor or other health professional if you’re thinking about starting sleeping pills or they’ve been recommended to you by your coach, team mates, family or friends.

Sleeping pills should only be taken when non-medicine therapies haven’t worked on their own, or your sleep problem is expected to be short-lived and the cause cannot be removed or readily addressed. Sleeping pills must never be shared with other people as this could lead to harm — what medicine is right for you may not be right for someone else, and vice versa.

If a sleeping pill is necessary, using it for the shortest time possible — ideally less than 2 weeks and not every night — will help protect you from developing the problems associated with these medicines.

Ways to sleep better without medicines

Behavioural therapies such as progressive muscle relaxation, cognitive therapy and good sleep habits are the best ways to manage sleep problems long-term. This is especially the case if your sleep problem lasts for more than a month or has no known cause.

While non-medicine therapies can take a few weeks to start working, they are as effective as benzodiazepines and z-drugs, but unlike these sleeping pills, they:

  • target the various psychological, behavioural and environmental issues that often contribute to sleep problems
  • let your body sleep as deeply as it needs to so you feel rested the next day
  • don’t cause the side effects, dependence and other possible harms of sleeping pills.

Non-medicine therapies can also continuing working for up to 2 years after therapy has stopped — a benefit you don’t get with sleeping pills.

Talk with your health professional about what non-medicine therapies best suit your situation. Your GP can provide these therapies or refer you to a specialist sleep clinic, sleep physician, psychiatrist or psychologist if required.

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