Sleeping Pill Misuse and Addiction: Signs, Risks, Symptoms, and Treatment

For many Americans, getting enough quality sleep isn't easy. According to the Centers for Disease Control and Prevention (CDC), about 30.5% of U.S. adults get less than the recommended seven hours of sleep per night.¹ Millions more struggle with chronic insomnia, sleep apnea, or difficulty falling asleep and staying asleep.^2,3

Prescription and over-the-counter sleeping medications can be effective short-term treatments for insomnia and other sleep disorders when used as directed. For many people, these medications provide much-needed relief after nights of poor quality sleep. However, sleeping pills also carry risks, particularly when they're taken for longer than recommended, used in higher doses, or combined with other substances.

What Are Sleeping Pills?

Sleeping pills are prescription and over-the-counter medications designed to help people address certain sleep-related conditions, including those where it’s difficult to fall asleep, stay asleep, or both.

Prescription Sleeping Medications

Several types of prescription medications are approved to treat insomnia, while other medications are commonly used off-label for this purpose. These include certain benzodiazepines and antidepressants, among other drug classes.³ However, when people refer to “prescription sleeping pills,” they’re often talking about a group of medications known as Z-drugs, which include:

• Zolpidem (Ambien) - Available in generic form, but widely marketed under brand names including Ambien, zolpidem is FDA-approved for short-term use in those who have insomnia characterized by problems falling asleep.⁴
• Eszopiclone (Lunesta) - Eszopiclone, which is more commonly known as Lunesta, is FDA-approved for the treatment of insomnia.⁵
• Zaleplon (Sonata) - Like zolpidem, zaleplon (or Sonata) is approved by the FDA for the short-term treatment of insomnia.⁶

All three of these medications enhance the effects of a chemical in the brain known as gamma-aminobutyric acid, or GABA. GABA helps the brain relax and avoid overstimulation by reducing activity in the central nervous system.⁷ This action can help people who struggle with insomnia fall asleep and stay asleep. However, Z-drugs also carry risks of misuse, physical dependence, and other potentially serious adverse effects, particularly when used improperly.^4,5,6

Over-the-Counter Sleep Aids

Many over-the-counter sleep aids contain antihistamines, such as diphenhydramine or doxylamine succinate. These medications work by blocking the effects of histamine, a naturally occurring chemical that helps promote wakefulness through its effects in the brain.⁸

Over-the-counter sleep aids that contain antihistamines include:

• Benadryl.
• ZzzQuil.
• Unisom Sleep Tabs.
• Tylenol PM/Advil PM.

Some people also use melatonin supplements to help address sleep problems. Melatonin is a hormone that helps regulate the body's sleep-wake cycle, and supplements may help promote sleep by reinforcing this natural signal.⁹ Taking too much melatonin, however, can lead to issues with alertness, vivid dreams, headaches, and further disrupted sleep patterns.⁹

What Is Sleeping Pill Misuse and Why Are They Misused?

The misuse of any medication, including sleeping pills, occurs when that medication is taken in a manner or dose other than prescribed, when it is taken by someone other than who it is prescribed to, or when it is used solely to experience feelings of euphoria or relaxation.¹⁰

Therefore, sleeping pill misuse can look like the following:

• Taking more sleeping pills at a time than prescribed
• Consuming sleeping pills differently than directed, such as by crushing and snorting tablets instead of swallowing them whole
• Taking sleeping pills more frequently than directed
• Mixing sleeping pills with alcohol or other drugs
• Continuing to take sleeping pills without medical supervision or follow-up

People misuse sleeping medications for many different reasons, including the following:

• Managing chronic sleep problems. Persistent insomnia can be physically and emotionally exhausting. Some people continue taking sleeping pills longer than recommended or in higher doses out of concern of not being able to sleep.
• Trying to outpace tolerance. With regular use certain sleeping medications may become less effective as the body adapts to their presence.¹¹ This is known as tolerance.¹¹ Some people respond to tolerance by consuming increasingly larger doses of the sleeping pills to achieve the desired effect, even when such doses exceed prescription guidelines.¹²
• Self-medicating mental health symptoms. People experiencing anxiety, depression, post-traumatic stress disorder (PTSD), or high levels of stress may misuse sleeping pills to help them relax or escape emotional distress.¹³
• Recreational use. Some sleeping pills can produce pleasurable or euphoric effects when misused, particularly at high doses or when taken in tandem with certain other substances. These effects can reinforce continued misuse of certain types of sleeping pills, including Z-drugs.¹³

Can You Become Addicted to Sleeping Pills?

Yes, you can become addicted to sleeping pills.^4,5,6 Certain prescription sleeping medications, including benzodiazepines and Z-drugs, have known misuse and addiction potential.^4,5,6

Addiction is a chronic, relapsing disease of the brain characterized by compulsive drug or alcohol use despite harmful consequences.¹² Continued misuse of sleeping pills can lead to sleeping pill addiction, which is known clinically as a sedative, hypnotic, or anxiolytic use disorder.¹²

Some sleeping pills can also cause physical dependence, which occurs when the body adapts to repeated use of a medication or substance.¹¹ If the use of the medication is stopped suddenly, withdrawal symptoms may occur as the body works to readjust.¹¹ A person can develop physical dependence without being addicted and vice versa, but the two conditions can also occur simultaneously.

The risk of developing a dependence on or addiction to sleeping pills often varies depending on several factors, including the type of sleeping pill being consumed and in what manner it is being misused.¹³

Risk Factors for Sleeping Pill Addiction

Several factors can increase the likelihood of developing problematic sleeping pill use or a sleeping pill addiction, including biological and environmental factors such as:¹³

• Personal or family history of substance use Individuals with a history of alcohol or drug misuse may be at increased risk for developing sleeping pill addiction.
• Mental health conditions Anxiety disorders, depression, PTSD, and chronic stress frequently occur alongside insomnia and may increase the likelihood of misuse.
• Long-term use Many prescription sleep medications are intended for short-term treatment. The longer they're used, the greater the risk of tolerance and dependence.
• Combining substances Using certain sleeping pills with alcohol, opioids, benzodiazepines, or other sedating medications can significantly increase the risk of dangerous central nervous system depression and overdose. Using sleeping pills in combination with other substances may also occur as a part of a broader pattern of substance misuse or addiction.

Signs and Symptoms of Sleeping Pill Addiction

Recognizing the potential warning signs of a sleeping pill addiction may allow treatment to begin earlier, which can improve the likelihood of positive treatment outcomes.

Someone with a diagnosable sleeping pill addiction must experience two or more of the following symptoms within a 12-month period:¹⁴

• Taking sleeping pills for longer periods of time or in larger amounts than originally intended or prescribed
• Persistent unsuccessful efforts to cut down or control sleeping pill use
• Spending a large amount of time obtaining, using, or recovering from the effects of sleeping pills.
• Experiencing strong cravings to use sleeping pills
• Recurrent use of sleeping pills results in failure to meet obligations or uphold responsibilities at work, school, or home
• Continued use of sleeping pills despite social or interpersonal problems that are occurring or worsened by sleeping pill use
• Giving up important activities because of use
• Continued use of sleeping pills in situations where it is physically hazardous to do so
• Continued use of sleeping pills despite use causing or exacerbating physical or psychological problems.

It’s important to note that tolerance and withdrawal can develop during appropriate medical treatment and do not necessarily indicate addiction.¹⁴ When these symptoms occur while taking certain sleep medications as prescribed, they are not counted toward a substance use disorder diagnosis.¹⁴

An addiction to sleeping pills is something that only a qualified professional can diagnose. If you are concerned that you or a loved one has a sleeping pill addiction, reach out for help from your doctor or therapist, or use our locator tool to find a provider.

Health Risks of Sleeping Pill Misuse

Both the regular use and the misuse of sleeping pills comes with the potential for several significant health risks, some of which can be life-threatening. These include:^4,5,6

• Complex sleep behaviors, including sleep-walking, sleep-driving, and engaging in other activities while asleep, which can result in serious injuries to oneself or others that can be fatal.
• Abnormal thinking and behavioral changes, such as reduced inhibition, bizarre behavior, depersonalization, and agitation.
• Worsening of depression or suicidal thinking that was pre-existing, or the new development of symptoms related to these issues.
• Overdose, which can occur when too much of a sleeping pill is consumed and can result in impaired consciousness, coma, cardiovascular or respiratory compromise, or death.

If you or someone you know is experiencing an overdose, call 911 right away. Administer naloxone if available and stay with the person until emergency services arrive.

Naloxone can be effective in reducing an overdose involving opioids, not sleeping pills. However, if you are unsure of what someone who is overdosing has consumed, administer naloxone as a precaution. Doing so will not cause them any harm, and it may save their life.

Sleeping Pill Withdrawal

Withdrawal is the term used to describe the physical and mental symptoms that develop when someone who has become physically dependent on an addictive substance either suddenly stops their use or drastically decreases their usual intake.¹⁵

The severity of the withdrawal symptoms a person develops depends on certain factors, such as the type of substance that was being used, how frequently, and in what dose.¹⁵

Common Withdrawal Symptoms

Symptoms associated with sleeping pills withdrawal can include:^4,5,6

• Mild dysphoria.
• Rebound insomnia.
• Nausea.
• Vomiting.
• Sweating.
• Muscle cramps.
• Tremors.
• Convulsions.

Withdrawal from Z-drugs is usually mild, but sudden discontinuation after prolonged or high-dose use can, in rare cases, lead to serious complications, including seizures.^4,5,6 Due to this risk, it is advised that people who have been taking Z-drugs speak with a healthcare provider prior to stopping their use rather than abruptly discontinuing it.

In some cases, benzodiazepines like temazepam (Restoril) or triazolam (Halcion) are prescribed for the short-term treatment of insomnia. If you have been using benzodiazepines for a sleep condition or any other purpose, do not attempt to quit abruptly.¹² It is strongly advised to seek care at a medically-supervised detox program where you can be supervised and monitored by medical professionals, as serious and potentially fatal withdrawal symptoms can develop.¹²

When to Seek Help

If your use of sleeping pills has become difficult to control, requires you to consume increasingly higher doses, or is beginning to interfere with your health, relationships, or daily life, it's important to seek professional help. Early intervention can reduce the risk of serious outcomes, including long-term health complications, severe withdrawal symptoms, and overdose.

The appropriate treatment providers can help determine if what you are experiencing is dependence, addiction, and/or any co-occurring disorders that may be contributing to your use. With the right care, many people successfully recover from problematic sleeping pill use and addiction.

Treatment for Sleeping Pill Addiction

The type of treatment you need will depend on details specific to your current needs and goals. After making the decision to get help, you can determine which level of care fits you best. In most cases, you do not need to make this decision alone, as qualified professionals employed at treatment facilities often help in the decision-making process.

• Medical detox – For some people, detox is the first part of recovery. During medically supervised detox, you'll receive 24/7 medical monitoring while your body clears sleeping pills from your system. Healthcare professionals help manage withdrawal symptoms and any complications to arise, making the detox process as safe and comfortable as possible.¹⁶
• Inpatient treatment – Inpatient treatment is often recommended for individuals with more severe substance use disorders or those who have experienced multiple relapses, but can be a good fit for many other reasons. During inpatient care, you live at the treatment facility full-time and receive around-the-clock support throughout your program.¹⁶
• Partial hospitalization program (PHP) – A PHP is the highest level of outpatient care available. While in a PHP, you will attend treatment at the facility several days a week for structured therapy and support, while returning home each evening.¹⁶
• Intensive outpatient program (IOP) – An IOP offers a relatively less time-intensive alternative to a PHP with fewer treatment hours each week. You'll participate in scheduled therapy sessions while continuing to live at home, making it easier to balance treatment with work, school, or family responsibilities.¹⁶
• Standard outpatient treatment – Outpatient treatment provides ongoing therapy and support on a schedule that fits your needs. Sessions are similar to traditional counseling appointments and can be tailored to help you maintain your recovery while managing daily life.¹⁶

Start Your Recovery Journey

If you’re ready to find addiction treatment for yourself or a loved one, we’re here to help. Browse top medical detox centers in the US, inpatient addiction treatment facilities, aftercare options, and more to start on the path to recovery. You can search for rehab by insurance carrier, location, amenities, and more for free. Don’t wait. Get help today.