Key points
- Benzodiazepines and “Z-drugs” (zolpidem, zopiclone): tolerance and dependence are possible after one to two weeks[1].
- Zolpidem and zopiclone have no advantage over benzodiazepines in effectiveness or safety[1].
- CBT-I is the recommended first-line treatment for chronic insomnia in adults[2][3].
- Never stop abruptly: coming off needs planning with your doctor, and has to be very gradual[1].
Which medicines are we talking about?
- Benzodiazepines: lormetazepam (Loramet, Metatop), lorazepam (Temesta), alprazolam (Xanax), bromazepam (Lexotan), diazepam (Valium)...
- “Z-drugs”: zolpidem (Stilnoct) and zopiclone (Imovane). They work in the same way as benzodiazepines and have no advantage over them in effectiveness or safety[1].
- Other products sometimes used for sleep: certain sedating antidepressants (trazodone, mirtazapine), antihistamines, quetiapine, melatonin and herbal remedies. There is little evidence for their use in insomnia, and some are advised against: using quetiapine outside a psychiatric disorder has no scientific basis, and the Belgian guideline advises against herbal medicine (valerian, passionflower)[1].
What they do, and where they fall short
A sleeping pill helps you fall asleep or stay asleep on the night you take it. But the Belgian medicines formulary describes several limitations[1]:
- Tolerance: the effect fades after one to two weeks.
- Dependence, both psychological and physical, is possible from as early as one to two weeks of treatment.
- Residual effects the next day: drowsiness, problems with memory and concentration, impaired driving.
- Changes to sleep: less deep sleep and less REM sleep.
- With alcohol or other medicines that make you drowsy, the sedation becomes dangerously stronger.
After the age of 65
The risk of confusion and of falls, which can lead to hip fracture, goes up. The Belgian guideline sees no place for a sleeping pill as a first-line option in older people: the benefit is too small to justify the risks[1].
Why CBT-I is recommended first
European and American guidelines put CBT-I first for chronic insomnia in adults[2][3]. It works on what keeps insomnia going (the habits picked up to compensate, the worry about sleep) rather than on the symptom of a single night. In Belgium, the general practice guideline also starts with a non-drug approach tailored to each person[1].
You don't have to stop your medication to start CBT-I. If you take a sleeping pill, talk to your doctor: they decide with you what happens next.
Stopping a sleeping pill: never on your own
Never stop abruptly
Stopping suddenly after long-term use can cause withdrawal: anxiety, insomnia, nightmares, perceptual disturbances and, rarely, seizures[1]. Never change your medication without talking to your doctor.
After long-term use, stopping is done very gradually, over several weeks or even several months, following a plan agreed with your doctor and adjusted to how you are finding it[1]. In Belgium, some patients can join a supported withdrawal programme for benzodiazepines and Z-drugs, with their doctor and pharmacist[1].
In pregnancy too, stopping abruptly is strongly advised against: talk to your doctor or midwife[1].
Keeping a record of what you take
To prepare for your appointment, nothing beats an accurate record: which medicine, what strength, how many tablets, which nights. The ReSomnia sleep diary lets you note each evening the name on the box, the strength and the number of tablets (in halves), and copy the previous day's entry in a single tap. Your doctor or clinician can then see how things change night by night, alongside your sleep.