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    Eric J. Olson, M.D.


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Question

Sleeping pills: How can I avoid becoming dependent?

I'm considering taking prescription sleeping pills to treat my insomnia. What can I do to avoid becoming dependent on them?

Answer

from Eric J. Olson, M.D.

You can take steps to reduce your risk of becoming dependent on prescription sleeping pills. The first step is to be sure that you've looked at all your options for treating insomnia. For example, consider:

  • Before seeking a prescription for sleeping pills, make sure you have a thorough medical exam. Your doctor might be able to find specific causes for your insomnia and help you avoid taking prescription sleeping pills.
  • Behavior therapies. Behavior therapies are generally recommended as the first line of treatment for people who have insomnia. These treatments teach you new sleep behaviors and ways to improve your sleeping environment. If further treatment is needed, your doctor might prescribe both cognitive behavioral therapy and prescription sleeping pills for about a month. If sleep improves, cognitive behavioral therapy continues as the medication is slowly tapered off or used only as needed.

If you will be using prescription sleeping pills, take a few precautions:

  • Discuss your options with your doctor. Let your doctor know that you're concerned about becoming dependent on sleeping pills. He or she can take that into account when selecting a medication. For example, benzodiazepines — drugs sometimes prescribed for sleep problems — are more likely to be habit-forming than are nonbenzodiazepine drugs..
  • Carefully follow your doctor's instructions. If you start taking a prescription sleeping pill, carefully read the medication guide. Don't increase the dose or stop taking the medication without talking to your doctor. Some medications must be stopped gradually.
  • Follow-up with your doctor. If you're taking sleeping pills for more than a few weeks, be sure to schedule follow-up appointments with your doctor at least every six months.
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References
  1. Smith HS, et al. Personalized pharmacotherapy for treatment approaches focused at primary insomnia. American Journal of Therapeutics. 2011;18:227.
  2. Bonnet MH, et al. Treatment of insomnia. http://www.uptodate.com/home. Accessed Aug. 2, 2013.
  3. Sullivan SS. Insomnia pharmacology. Medical Clinics of North America. 2010;94:563.
  4. Chung SD, et al. Zolpidem use and the risk of injury: A population-based follow-up study. PLoS One. 2013;8:e67459.
  5. Buysse DJ, et al. Insomnia. Journal of the American Medical Association. 2013;309:706.
  6. Side effects of sleep drugs. U.S. Food and Drug Administration. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm107757.htm. Accessed Aug. 5, 2013.
  7. How is insomnia treated? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/inso/treatment.html. Accessed Aug. 6, 2013.
  8. Clinical guideline for the evaluation and management of chronic insomnia in adults. Philadelphia, Pa.: University of Pennsylvania Health System. http://www.aasmnet.org/Resources/ClinicalGuidelines/040515.pdf. Accessed Aug. 5, 2013.
AN02216 Sept. 28, 2013

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