Sleeping Tablets

These are sedatives which increase sleepiness allowing patients to either fall asleep more easily or sleep through the night instead of waking up. There are sedatives which can be obtained over the counter and others which require a script.

Over the counter medications including herbals such as chamomile, lavender, lemon verbena, rescue remedy etc do increase sleepiness and assist people to fall asleep. The more severe the insomnia the less likely they are to work without the addition of CBT-I.

Stronger medications are anti-histamines which can produce significant sleepiness but often leave patients with a hangover in the morning as they work for a long time.

Scripted medications are usually referred to as the benzodiazepine (BZ) types and the non-benzodiazepines. Valium was the original BZ drug in the 1960s and since then many variations have been developed. Todays BZs are very effective and safe and while long-term dependence is a concern there is no guarantee that everyone will become dependent.

There are 2 types of dependence - physical and psychological. While physical dependence is unusual psychological dependence can occur due to the reduction in anxiety created by taking the tablet and the increase in anxiety when the medicine is stopped - and it is the increase in anxiety which maintains the sleep difficulty. The best use is short-term or intermittently and not every night while undergoing CBT-I treatment. The z- drugs and the newest sleeping aids are more specific for sleep with less chance of physical dependence.

In some cases other medications such as anti-depressants and anti-psychotics are used to treat insomnia. While they can work quite well there is no good evidence for their efficacy and particularly none for long-term use.

Most importantly make sure that the diagnosis is correct as the dose tends to increase rather rapidly if the diagnosis is incorrect. The increasing dose often frightens the patient into believing that they are dependent.

If you are concerned about your use of tablets or wish to come off the sleeping tablets, plan a slow tapering of the meds along with CBT-I with your doctor. The evidence would indicate that nearly ¾ of patients can get off sleeping tablets using these principles.