A good night’s sleep can set the tone for your entire day. Getting the recommended amount of sleep each night can promote mental and physical healing and help avoid serious diseases. However, there is a vast portion of Americans who can’t get restful sleep each night because of sleep disorders. There are several types of sleep disorders like insomnia, narcolepsy, sleep apnea, and about 70 million Americans suffer from some form of sleep problem. To help with this issue, they may turn to a class of drugs called sedatives is used to promote sleep and relaxation. Medications with sedative effects have been used for decades in the United States, with varying levels of efficacy.
The first modern medicinal sleep aid was synthesized in the 1860s in the form of barbituric acid. Barbiturates were widely used throughout the first half of the 20th century. They were commonly prescribed to people with sleep disorders, military service members who needed sleep between missions and to offset the use of amphetamines during the day. They were the primary sleep aid until the public began to notice their adverse side effects in the 1950s. By the 1960s, a new sleep aid was synthesized and growing in popularity called benzodiazepines (or benzos). They were purported to be safer alternatives to the highly addictive barbiturates and became the most widely prescribed drug in the world by the 1970s.
Today, benzodiazepines are still commonly used, but we’ve come to realize they cause some of the same adverse effects as barbiturates, including intoxicating effects, dependence liability, and the risk of overdose. A relatively new type of sleep aid called non-benzodiazepines Z-drugs has grown in popularity during the past few decades. While they can help people get restful sleep, they also carry some of the same risks as benzodiazepines and barbiturates, including the risk of dependence and addiction.
If you have been prescribed a sedative, learn more about sedative addiction, its signs and symptoms, and how it can be treated.
Sedatives, more specifically Z-drugs, are a class of psychoactive drug that acts in the brain to cause sedation, hypnotic effects, and relaxation. Common examples of the drug include Ambien, Lunesta, and zaleplon. Z-drugs are in the larger class known as central nervous system (CNS) depressants, which calm you down by reducing excitability in the nervous system. Depressants include other medicinal sleep aids, such as barbiturates and benzodiazepines, as well as alcohol.
Depressants all similarly work in the brain and Z-drugs are no exception.
Excitability in the nervous system is regulated by a neurotransmitter called gamma-Aminobutyric acid (GABA) and its receptor in the brain. When the receptor is activated, it is responsible for controlling nervous system excitability, muscle tone, and calming you down when it’s time to rest. Depressants like Z-drugs bind to specific points on the GABA receptor and increase the efficiency of the naturally occurring GABA neurotransmitter.
In some cases, especially when abused or mixed with other drugs, Z-drugs can create intoxicating effects and a euphoric sense of relaxation. Plus, your brain can become used to the drug, causing dependence and tolerance to form. These factors give Z-drugs a high addiction liability. Generally, they are reserved for short-term, therapeutic use, since long-term use can lead to physical dependence.
Z-drugs were first introduced as sleep aids in the 1980s, and today, there are several popular brands of the drug available on the market in the U.S. and overseas. You may see some in advertisements, but overall, they are a relatively new drug class, though their use is increasing. Here are some of the most common sleep-facilitating Z-drugs on the market:
Ambien is a popular trade name for the drug zolpidem. It was first approved by the FDA for the treatment of sleep disorders in 1992 and has become one of the most commonly used on the market. Its half-life is longer than other Z-drugs, making it a more effective drug that helps you stay asleep longer, rather than helping you get to sleep and then wearing off.
Lunesta is another popular brand name among sleep aids and is the marketed name for the drug eszopiclone. Studies show that it is only slightly more effective than placebos in promoting sleep. It represents a mild sleep-aid option for those who need gentle help with getting to sleep.
Sonata is the brand name for the chemical zaleplon. Like Lunesta, it also has shown to be only slightly more effective than placebos in scientific studies. Because of its short half-life, it is exclusively used to treat insomnia, rather than other sleep disorders that wake you up in the middle of the night.
Zimovane is a brand name for zopiclone, a sedative that isn’t sold in the U.S. but is popular in the U.K. and Australia.
Sedative addiction is a serious disease despite that it comes from a common prescription drug. Addiction occurs when the rewarding effects of a drug alter your brain’s limbic system, which is tied to reward and motivation. When you become addicted to a sedative, your limbic system will be changed in such a way that it causes intense cravings and impulses to use the drug again. Addiction is difficult to overcome on your own, but it does come with a few warning signs.
Typically, your doctor will prescribe you a certain amount of the drug to use over a few nights or up to a few weeks. After that, you should stop using the drug, take a break, or reassess your sleep issue with your doctor. If you use the drug for too long or in high doses, you might start to develop a tolerance, which means you need more of the drug to achieve the same effects.
After tolerance builds, you may start to develop a chemical dependence. When your brain gets used to the chemicals you are introducing, you may begin to feel like you need the drug to maintain normalcy or to avoid uncomfortable symptoms. If you try and fail to cut back or stop, that could point to chemical dependence.
If you are worried about a loved one, there are some visible signs of sedative addiction, including:
Sedative Z-drugs can cause withdrawal symptoms that are potentially dangerous, including seizures and a medical complication called delirium tremens. Without medical help, these symptoms can become deadly, especially if you go through them on your own. Because withdrawal can be dangerous, sedative addiction treatment often starts with medical detoxification.
During medical detox, you will be treated and monitored 24 hours a day for about a week. During that week, you may be given medications that alleviate your symptoms, depending on your needs. You also will be monitored to avoid any dangerous medical complications like delirium tremens.
After detox, your clinicians will help you find the next level of care appropriate for your needs. In addiction treatment, you will sit down with a therapist and create a treatment plan based on your biological, psychological, and sociological needs. You may go through a variety of therapy options designed to help you make a lasting change toward recovery from active addiction. Through these therapies, you will learn to identify triggers and risky situations, address any underlying mental health problems, and develop a relapse prevention strategy.
CBS News. (2013, August 29). CDC: Nearly 9 million Americans use prescription sleep aids. from https://www.cbsnews.com/news/cdc-nearly-9-millon-americans-use-prescription-sleep-aids/
Cleveland Clinic. (2013, October 20). Sleep Disorders. from https://my.clevelandclinic.org/health/articles/11429-common-sleep-disorders
Huedo-Medina, T. B., Kirsch, I., Middlemass, J., Klonizakis, M., & Siriwardena, A. N. (2012, December 17). Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: Meta-analysis of data submitted to the Food and Drug Administration. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544552/
National Institute on Drug Abuse. (2018, August 09). Overdose Death Rates. from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates