Though cognitive behavioral therapy (CBT) is considered the best and safest treatment for insomnia, sometimes medication is also needed to help people get on track with their sleep. But how will you know if you’re using the pills appropriately or developing a dependency on them? Shalini Manchanda, M.D., director of the IU Health Sleep Disorders Center, explains what sleeping pill dependency is, and how you can prevent it.
When Sleeping Pills Are Warranted
When people have trouble sleeping, the first line of defense should be to get on a consistent sleep-wake schedule, to develop a soothing bedtime routine, and to make sure their bedroom is cool, dark, and quiet—all of which can facilitate a restful nightly slumber. If those strategies don’t lead to better sleep, the next step should be to visit a sleep specialist. That medical professional can assess your symptoms and health history (and rule out any other health condition as an underlying problem), and work with you to develop a sleep program that incorporates CBT.
For many people, a behavioral sleep program may be enough. But for others, sleep medications may be needed in addition to the behavioral techniques. “New guidelines recently released by the American Academy of Sleep Medicine indicate that prescription sleep medications can be used to help patients over the initial hump of treatment while they are working on cognitive behavioral therapy,” says Dr. Manchanda. “Then once patients have mastered the CBT, we gradually wean them off the medication.” In most cases, this is effective.
How Dependency Develops
Some of the most common medications that physicians use to treat insomnia are nonbenzodiazepine drugs such as eszopiclone (brand name Lunesta), zaleplon (brand name Sonata), zolpidem (brand name Ambien), and temazepam (brand name Restoril). These medications do not lead to chemical addiction, but they can be habit forming. The problem occurs when patients begin using these sleeping pills as a crutch—unchecked by a sleep specialist—and then they feel they can only fall asleep if they have the medication. “While sleeping pills don’t actually cause a physical addiction—and patients are not going to go through a chemical withdrawal when they stop taking them—sleeping pills can cause an emotional, psychological dependence in which people feel that they can’t fall asleep without them,” says Dr. Manchanda.
Preventing The Problem
The best way to avoid dependency is to work closely with your doctor and to keep up with your behavioral therapies. To that end, Dr. Manchanda does not recommend patients use over-the-counter sleep aides (which she notes can cause long-term problems), and she suggests that people see a sleep specialist, if possible, rather than their primary care physician for sleep troubles. “In a sleep clinic setting we can monitor a patient’s medications and overall sleep program at a close level—and hold them accountable,” she explains. “And when medication is coupled with cognitive behavioral therapy, we can help patients slowly wean off medication without any disruption to their sleep.”
-- By Rachel Rabkin Peachman