Are Your Sleeping Pills Even Working?
Prescription sleep medications may not be the best option for getting consistent, quality sleep.
Sleep feels like a hot commodity in our fast-paced world, especially now that summer social plans are back in full swing. If you can never seem to get that elusive seven to eight hours per night, you’re in good company—30-40% of adults have symptoms of insomnia, meaning they struggle to fall or stay asleep on a consistent schedule. For one in five of those people, their sleep problems persist for several months or longer, classifying their insomnia as chronic.
Sleeplessness can seriously impact your quality of life beyond just making you feel tired during the day. It can contribute to mental health conditions like depression and anxiety and worsen the impacts of cardiometabolic conditions like hypertension and diabetes. So, it’s no wonder that nine million Americans take prescription medication to help them get some much-needed sleep.
But are your sleeping meds actually… well, helping? Maybe not as much as you’d think. New research published in BMJ Open has found that long-term use of insomnia medications does not improve sleep quality over a period of one to two years, in a cohort of middle-aged women.
Relying on sleeping pills isn’t the optimal way to fix your sleep schedule, especially if you’re not checking in regularly with your doctor. “When patients are taking prescription insomnia medications, they should be reassessed for safety and to make sure that they remain helpful,” says David Neubauer, M.D., a board member for the National Sleep Foundation and associate director of the Johns Hopkins Sleep Disorders Center in Baltimore. There are other options—including cognitive behavioral therapy for insomnia—that might be a better long-term solution.
How Would I Know If I Have Insomnia?
A study in the Journal of Clinical Sleep Medicine classifies the following things as signs of insomnia: difficulty falling and staying asleep (despite having the opportunity to do so), tiredness that affects your daily life, and the persistence of these symptoms at least three nights a week for one month or more. Chronic insomnia disorder is present when this continues for at least three months.
If you find yourself nodding off during the day even though you went to bed at 10 p.m., staying up at night unable to calm down your brain, or feeling foggy-headed and exhausted most days of the week, these are all signs that you might have an ongoing sleep issue.
Treatments for Insomnia: Medications vs. Psychotherapy
Medications are not usually the first-line treatment option for people with insomnia, or at least not the most reliably effective. “The primary treatment recommendation is cognitive behavioral therapy for insomnia (CBT-I), which includes instructions for good sleep habits and the scheduling of bedtime and rise time, along with cognitive therapy to address the sleep problems and their consequences,” Dr. Neubauer explains. Science backs this up: A study in BMC Family Practice found that CBT-I can work just as well as medications to help cure insomnia, and it might work better on a long-term basis.
On the Rx side of things, people use a variety of prescription medications to relieve insomnia symptoms. The most common include benzodiazepines, Z-drugs, and anxiety and depression medications that are sometimes used off-label for sleep. These medications are not without risk—they can include side effects such as drowsiness, disorientation, and risk for addiction. There is some concern among the medical community (yet to be reliably proven in research) that benzodiazepines might also increase risk for cognitive impairment when used in an ongoing way.
Doctors don’t prescribe these medications in all circumstances. “The typical guidance for treating insomnia disorder is to recommend CBT-I initially and to consider the use of medications as an option for selected patients,” Dr. Neubauer says. The chosen medication will really depend on your symptoms and the root cause of your sleeplessness. For example, someone with generalized anxiety disorder (GAD) that affects their sleep might find relief from an SSRI or other mental health medication.
What’s the Best Long-Term Sleep Solution?
Sleep medications can be a lifesaver in a pinch, but there’s not a lot of evidence to support their use on a regular, extended basis. “The medications have been shown to help in the short-term but were never studied among long-term users,” says Daniel Solomon, M.D., author of the BMJ Open study and chief of the Section of Clinical Sciences in the Division of Rheumatology at Brigham & Women’s Hospital in Boston.
Dr. Solomon and his team used a one- and two-year follow up to check in with women who were taking prescription medications for insomnia. They compared the sleep quality of these women to a control group who weren’t taking these medications. “We did not observe any improvement compared with women who did not use these medications in their reports of sleep disturbances,” he explains—meaning the women on medications were not sleeping better on a consistent basis.
This makes sense, Dr. Neubauer says. “The findings of this study certainly are consistent with guidelines for the treatment of insomnia,” he notes. Here’s the thing: People who try these medications often start sleeping better immediately, and they don’t usually need a continued prescription. “Often people find that using a sleep-promoting medication for several days to a few weeks is sufficient to help them get back to a regular routine with adequate sleep,” Dr. Neubauer says. “Patients may reserve the medication use for particularly difficult nights over a longer period of time.” If you do continue using medication consistently, it’s best to do so with regular monitoring by your doctor.
This study (like any other) had its limits—the data only included annual check-ins with participants, and researchers were not able to prove definitively that the sleep medications were linked to poor sleep. Still, it provides evidence that longstanding sleep medication use might not be the most effective option to help with chronic insomnia.
The takeaway? CBT-I and other non-pharmacological approaches might be your best alternative for getting more sleep. “CBT-I should be employed whenever possible,” Dr. Neubauer says. “Patients should be encouraged to follow good sleep habits.” These include sleeping on a consistent routine (no late-night Netflix binges), reserving your bed for sleep and sex, avoiding screens before bedtime, and limiting caffeine and alcohol consumption.
Of course, it’s worth noting again that every person is different, and their treatment needs will differ depending on your symptoms, concurrent medication use, and additional health concerns. Ask your primary care doctor for their advice on seeing a sleep specialist, who can work with you to craft a customized plan of action. Then (fingers crossed) you’ll be on your way to deep, restful sleep.
Insomnia Prevalence: American Journal of Managed Care. (2020.) “Insomnia Overview: Epidemiology, Pathophysiology, Diagnosis and Monitoring, and Nonpharmacologic Therapy.” https://www.ajmc.com/view/insomnia-overview-epidemiology-pathophysiology-diagnosis-and-monitoring-and-nonpharmacologic-therapy
Insomnia Health Effects: Current Psychiatry Reports. (2014.) “Insomnia and Its Impact on Physical and Mental Health.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972485/
Long-Term Use of Sleep Medications: BMJ Open. (2021.) “Prescription medications for sleep disturbances among midlife women during 2 years of follow-up: a SWAN retrospective cohort study.” https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2020-045074
Signs of Insomnia: Journal of Clinical Sleep Medicine. (2007.) “Insomnia: Definition, Prevalence, Etiology, and Consequences.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978319/
CBT-I Effectiveness: BMC Family Practice. (2012.) “Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481424/
Benzodiazepines & Z-Drugs: Drugs in R&D. (2017.) “Benzodiazepines and Z-Drugs: An Updated Review of Major Adverse Outcomes Reported on in Epidemiologic Research.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5694420/