Sleeping Pill Addiction

What Are Sleeping Pills?

“Sleeping pills” is an informal term for prescription medicines, over-the-counter products, and supplements used to make sleep easier. They differ in evidence, regulation, intended use, and risks, so the key question is not simply whether a product causes drowsiness, but whether it safely addresses your sleep problem.

When Sleep-Medicine Exposure Needs Emergency Help

Call 911 if someone cannot be awakened, is breathing slowly or shallowly, or makes choking or gurgling sounds after taking a sleep product or an unknown pill. Give naloxone if available when an opioid overdose is possible, place the person on their side, and stay until help arrives. Naloxone reverses opioid overdose.^[1]

If you regularly take a benzodiazepine sleep medicine, get medical guidance before reducing or stopping it; abrupt stopping can cause dangerous withdrawal. This is separate from the FDA instruction to stop eszopiclone, zaleplon, or zolpidem and contact a clinician immediately if a complex sleep behavior occurs, such as sleepwalking or sleep driving while not fully awake.^[2][3]

Call 911 or go to an emergency room for a seizure or trouble breathing during benzodiazepine withdrawal. Contact a clinician if withdrawal symptoms occur or worsen, including hallucinations—seeing or hearing things others do not. Sudden stopping or rapid dose reduction can cause life-threatening withdrawal even when the medicine was prescribed.^[4]

What Causes Insomnia and When Does It Need Assessment?

Insomnia is more than an occasional bad night. It involves trouble initiating or maintaining sleep that also affects waking life. A careful assessment considers sleep timing, daytime habits, physical and mental health, other sleep disorders, and all medicines and substances being used. A sleep diary can reveal patterns and possible behavioral treatment targets.^[6]

Sleep complaints may occur alongside medical or psychiatric conditions, medication effects, irregular schedules, substance use, or another sleep disorder. Assessment helps distinguish insomnia that needs attention in its own right from other sleep problems. Reducing sleeplessness with a medicine is not the same as identifying and treating those contributing conditions.^[6][5]

Which Sleep Disorders Can Resemble Insomnia?

Several sleep disorders require a different approach:

• Obstructive sleep apnea causes pauses in breathing or shallow breathing during sleep. Loud snoring, witnessed breathing pauses, and marked daytime sleepiness are reasons to seek evaluation.^[5][6]
• Circadian rhythm sleep-wake disorders occur when a person’s internal sleep timing does not align with daily responsibilities, causing distress or impaired functioning.^[5]
• Restless legs syndrome can delay sleep because of an urge to move the limbs and uncomfortable sensations during rest.^[6]
• Insufficient sleep syndrome means a person can sleep but does not allow enough time for it because of routines or responsibilities.^[5]
• Parasomnias are unusual behaviors or experiences while asleep or partly asleep, particularly important when they cause injury or danger.^[5][6]
• Hypersomnia involves excessive daytime tiredness and difficulty staying awake rather than an inability to sleep.^[5]

A sleep specialist may be helpful when symptoms include loud snoring, witnessed breathing pauses, excessive daytime sleepiness, substantially shifted sleep timing, unusual nighttime behavior, or injury during sleep. Referral may also be appropriate when insomnia has not improved with initial treatment.^[6]

What Types of Medicines and Supplements Are Used for Sleep?

Prescription drugs, nonprescription products, and supplements should not be treated as interchangeable. Even within one class, medicines can differ in duration, supporting evidence, approved uses, and adverse effects.^[6][9]

Much of the comparison below comes from a systematic review, which searches for and evaluates studies using planned methods, and a network meta-analysis, which combines direct comparisons and comparisons through shared treatments. A placebo is a comparison treatment without the active medicine being tested. Here, “acute” refers to the review’s short-term treatment category.^[9]

Benzodiazepines Used for Insomnia

Examples studied or discussed: Prescription benzodiazepines used for insomnia or anxiety.

What the evidence supports: Acute studies show modest improvements in falling asleep, sleep duration, and nighttime awakenings.^[2]

Important limitations: Benefits may diminish within days to weeks, while dependence, withdrawal, impairment, and other risks persist. Regular use commonly requires careful reassessment.^[2]

Nonbenzodiazepine Hypnotics Used for Insomnia

Examples studied or discussed: Eszopiclone, zolpidem, zaleplon, zopiclone.

What the evidence supports: Eszopiclone, zolpidem, and zopiclone improved acute sleep quality compared with placebo; longer-term evidence favored eszopiclone over placebo in the network meta-analysis.^[9]

Important limitations: Eszopiclone, zolpidem, and zopiclone produced more adverse effects than placebo in some comparisons, and certainty was low or very low for several long-term findings.^[9]

Orexin Medicines Used for Insomnia

Examples studied or discussed: Lemborexant, daridorexant, suvorexant.

What the evidence supports: Lemborexant improved acute and longer-term outcomes compared with placebo in the network meta-analysis.^[9]

Important limitations: Long-term certainty was very low, and the review considered safety information for lemborexant inconclusive. Evidence should not be generalized across these medicines.^[9]

Sedating Antidepressants Used for Insomnia

Examples studied or discussed: Low-dose doxepin and medicines such as trazodone prescribed without an approved insomnia indication.

What the evidence supports: Doxepin was well tolerated in the network meta-analysis. Some antidepressants are prescribed for insomnia even without an insomnia indication.^[9][6]

Important limitations: Efficacy data for doxepin and important outcomes for several drugs prescribed without an insomnia indication were too limited for firm comparative conclusions.^[9]

Ramelteon for Insomnia

Examples studied or discussed: Prescription ramelteon.

What the evidence supports: Studied as a prescription insomnia treatment.^[9]

Important limitations: It did not show an overall material benefit in the network meta-analysis, and some other medicines performed better in certain comparisons.^[9]

Antihistamines Used as Sleep Aids

Examples studied or discussed: Diphenhydramine, doxylamine, hydroxyzine.

What the evidence supports: Doxylamine improved acute sleep outcomes compared with placebo in one network meta-analysis.^[9]

Important limitations: The class has limited efficacy and safety data for insomnia and can cause daytime drowsiness, impaired alertness, problems with thinking or memory, and difficulty emptying the bladder.^[10][6]

Melatonin and Herbal Sleep Products

Examples studied or discussed: Melatonin, valerian.

What the evidence supports: Melatonin may help some children and adolescents with chronic insomnia; limited valerian preparations have shown small benefits in some trials.^[11][10]

Important limitations: Melatonin did not clearly improve major sleep outcomes in adults in a 24-trial review. Valerian products and study methods vary too much for a firm general conclusion.^[11][6]

Why Are Barbiturates Rarely Chosen for Insomnia?

Barbiturates have been used for insomnia, but a clinical review does not recommend them because of their potential toxicity. Their historical use is not a reason to substitute them for another sleep treatment.^[6]

Regulatory status, evidence of benefit, and present-day availability are separate questions. A medicine’s approval for a use does not show that it is currently marketed, appropriate for a particular person, or supported for long-term treatment.

How Well Do Sleeping Pills Work?

Sleep medicines can improve symptoms, but the benefit and supporting evidence differ by product and treatment period. The major comparison discussed here included both prescription and nonprescription treatments, rather than prescription medicines alone.^[9]

The systematic review evaluated 170 randomized trials involving 47,950 adults with insomnia disorder. Randomized trials assign participants to treatment groups by chance. Of these, 154 double-blind trials with 44,089 participants contributed to the network meta-analysis comparing 30 interventions; double-blind means participants and investigators did not know which treatment participants received.^[9]

The review examined self-rated sleep quality, stopping treatment for any reason, stopping because of adverse events, and the proportion experiencing at least one adverse event—an unwanted health event during treatment.^[9]

What Benefits Do Short-Term Sleeping-Pill Studies Show?

For acute treatment, benzodiazepines, doxylamine, eszopiclone, lemborexant, seltorexant, zolpidem, and zopiclone improved sleep outcomes compared with placebo. Benzodiazepines, eszopiclone, zolpidem, and zopiclone also performed better than melatonin, ramelteon, and zaleplon in some comparisons.^[9]

These findings do not mean one medicine will work for everyone. The analysis combined different scales into standardized effects, so it does not provide a single number of minutes gained for each drug. “Acute” was the review’s treatment category; the abstract does not provide one uniform treatment duration covering every included trial.

Benefit also has to be weighed against tolerability. Benzodiazepines, eszopiclone, zolpidem, and zopiclone caused more adverse effects than placebo or certain comparator medicines in some analyses. Zolpidem and zopiclone caused more treatment discontinuations due to adverse events than placebo.^[9]

What Is Known About Long-Term Sleeping-Pill Benefits?

Eszopiclone and lemborexant improved longer-term outcomes compared with placebo. However, certainty for both findings was very low. Zolpidem produced more discontinuations due to adverse effects than placebo, and long-term information was unavailable or inadequate for many medicines.^[9]

Very low certainty means the estimated benefit may change substantially as stronger evidence emerges. It does not prove that these medicines are ineffective, but it limits confidence in precise comparisons or long-term predictions.

What Are the Benefits and Limits of Benzodiazepines for Sleep?

Meta-analyses cited in the 2025 joint benzodiazepine guideline found minor improvements in sleep onset, sleep duration, and nighttime awakenings. The guideline notes that short-term use is generally recommended not to exceed four weeks because long-term clinical benefit is poorly established and therapeutic effects can diminish while risks remain.^[2]

This guidance concerns benzodiazepines, not every prescription sleep medicine. Other drug classes have different evidence, although long-term information remains limited for many products.

What Are the Risks of Nonbenzodiazepine Sleep Medicines?

Nonbenzodiazepine sleep medicines should not be assumed to avoid benzodiazepine-like problems. Rebound insomnia, withdrawal, and misuse can occur with both groups. Related medicines such as zolpidem and zopiclone can also cause daytime drowsiness, memory problems, and other adverse effects.^[6][10]

Why Are Some Medicines Prescribed Off Label for Sleep?

“Off-label” prescribing means using an approved medicine for a purpose not included in its regulatory indication. Sedating antidepressants, antipsychotics, anticonvulsants, and anxiety medicines have been prescribed this way for sleep. That practice does not by itself show that the treatment is inappropriate, but evidence for insomnia and the balance of benefits and harms can differ greatly by medicine.^[6]

Are Over-The-Counter Sleep Aids and Supplements Safe?

Being available without a prescription does not establish that a product is safer or more effective for persistent insomnia.

What Are the Risks of Antihistamine Sleep Aids?

Diphenhydramine and doxylamine are antihistamines that can produce drowsiness. Some nighttime combination products include an antihistamine plus a pain reliever, making it important to check every active ingredient rather than looking only at the brand name.^[6]

Sedating antihistamines can cause next-day drowsiness and reduced alertness. They can also block a nervous-system chemical involved in memory, bladder function, and other processes, producing cognitive impairment or urinary retention. Their efficacy and safety for insomnia have not been as well studied as those of several prescription hypnotics.^[10][6]

Does Melatonin Help With Insomnia?

Melatonin is a hormone normally secreted at night.^[6] A systematic review identified 24 randomized placebo-controlled trials in chronic insomnia. In adults without a co-occurring condition, melatonin did not clearly improve time to fall asleep, total sleep time, or sleep efficiency—the percentage of time in bed actually spent asleep.^[11]

The review found possible benefits for children and adolescents, but it called for more age-specific safety and efficacy studies. In co-occurring insomnia, sleep onset improved across age groups, although the adult finding came from only one study. These results do not support treating pediatric and adult insomnia as the same problem.^[11]

Why Can Melatonin Products and Safety Risks Differ?

Melatonin supplements are regulated differently and less strictly than prescription or over-the-counter medicines. The National Center for Complementary and Integrative Health advises discussing supplements with a health care provider because they may interact with medicines or pose risks with medical conditions or surgery; consultation is especially important during pregnancy or nursing.^[12]

The amount in a product may also differ from its label. In a 2023 study of 25 over-the-counter melatonin gummy products, 22 were inaccurately labeled. One contained no detectable melatonin; in the others, measured amounts ranged from 74% to 347% of the labeled amount. This finding concerns the sampled gummies, not every melatonin formulation.^[12]

Keep medicines and supplements out of children’s reach and sight. Parents considering melatonin for a child should first consult a health care provider: long-term effects, appropriate use, and whether benefits outweigh possible harms remain uncertain. Possible benefits in pediatric trials are not a reason to assume unsupervised use is safe.^[12]

Does Valerian Help With Insomnia?

Valerian is an herbal product sold in varying preparations. Some clinical trials of weaker water-based or alcohol-based extracts found limited benefit, but differences among products, doses, and study methods prevent a firm conclusion about valerian products generally.^[10][6]

How Do Sleeping-Pill Dependence, Withdrawal, and Addiction Differ?

These terms describe different experiences. The benzodiazepine tapering guideline distinguishes physical dependence from benzodiazepine use disorder, which can help frame concerns without assuming that appropriate prescribed use is a substance use disorder.^[2]

• Tolerance means a medicine’s effect becomes smaller with repeated use, or more is needed to produce the previous effect. Benzodiazepine sleep benefits may diminish within days to weeks as the body adapts.^[2]
• Physical dependence means the body has adapted to regular exposure and may produce withdrawal if the medicine is reduced or stopped. It can occur during prescribed use and does not automatically mean addiction or a use disorder.^[2]
• Withdrawal consists of new symptoms caused by reducing or stopping a medicine, rather than merely the return of the original sleep complaint. Benzodiazepine withdrawal symptoms can persist for weeks.^[6]
• Rebound insomnia means sleep becomes temporarily worse than it was before treatment. It is particularly associated with abrupt discontinuation of shorter-acting benzodiazepine-related sleep medicines, but it can occur with benzodiazepines and nonbenzodiazepine hypnotics.^[6]
• Misuse concerns arise with patterns such as frequently requesting early refills or increasing the dose or number of pills. These call for assessment rather than an assumption that physical dependence itself is misuse.^[2]
• Substance use disorder is diagnosed using clinical criteria, not physical dependence alone. The 2025 national survey used criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, a diagnostic manual, to estimate these disorders.^[2][8]

Possible signs that warrant assessment include repeatedly seeking early refills, increasing the dose or number of pills without agreement, and other concerning changes in use. These signs prompt a closer look; no single behavior proves a use disorder.^[2]

What Are the Side Effects and Interactions of Sleeping Pills?

The practical safety question is whether a medicine’s expected benefit remains greater than its risks for a specific person. That balance can change with age, health conditions, other medications, pregnancy, sleep improvement, or continued adverse effects.^[2][6]

How Do Guidelines Compare Prescription Sleep Medicines?

Safety differs by medicine, dose, formulation, and person. The January 2025 Department of Veterans Affairs and Department of Defense (VA/DoD) guideline addresses chronic insomnia and obstructive sleep apnea, including considerations for Veterans and active-duty personnel. It favors nonmedication treatment first and gives a weak recommendation for selected medicines when medication is offered—meaning the balance of benefits, harms, and preferences calls for individual judgment.^[13]

Comparative studies help assess treatment burden but cannot identify every hazard. Fewer treatment dropouts or reported adverse events do not establish that a medicine has no serious risks. The guidance below highlights important considerations rather than reproducing every product label.^[9][13]

When Do Z-Drugs Cause Sleepwalking or Sleep Driving?

The Food and Drug Administration (FDA) warns specifically about eszopiclone, zaleplon, and zolpidem, often called Z-drugs. These prescription medicines slow activity in the brain to help with sleep. In 2019, the FDA required warnings in their labeling and patient Medication Guides about rare complex sleep behaviors that have resulted in serious injuries or death; its March 2024 patient guidance reiterates that warning.^[3]

Complex sleep behaviors are activities performed while not fully awake, such as sleepwalking, driving, cooking, or taking other medicines. People may not remember them afterward. They can occur after the first dose or continued use, including at low doses. The VA/DoD guideline notes that they have occurred in people with and without a history of these behaviors.^[3][13]

If a complex sleep behavior occurs after taking eszopiclone, zaleplon, or zolpidem, the FDA says to stop taking that drug and contact a health care professional immediately. This specific safety action differs from ordinary benzodiazepine withdrawal precautions: someone likely to be physically dependent on a benzodiazepine should not abruptly discontinue it and needs an individualized reduction plan.^[3][2]

The FDA also advises not combining these Z-drugs with other sleep medicines, including over-the-counter sleep aids, and not drinking alcohol before or while taking them. Next-day drowsiness can occur. More broadly, the FDA cautions that all insomnia medicines can impair driving and other activities requiring alertness the morning after use. Read the Medication Guide and discuss questions before starting treatment.^[3]

In the comparative review, eszopiclone and zolpidem had more participants reporting adverse events than placebo, and zolpidem had more discontinuations because of adverse events.^[9] The VA/DoD discussion also identifies increased unpleasant taste, sleepiness, and muscle pain with eszopiclone versus placebo. It notes that Z-drugs are considered potentially inappropriate for older adults under the 2023 Beers Criteria, guidance identifying medicines that warrant particular caution in this population.^[13]

Formulations matter. In one trial involving 1,018 participants, zolpidem extended release—a formulation that releases medicine over time—at 12.5 mg, taken at least three nights weekly for 24 weeks, produced more sleepiness, anxiety, attention problems, and overall adverse events than placebo. This result concerns that formulation and regimen, not every zolpidem product.^[13]

What Are the Safety Considerations for Orexin Sleep Medicines?

Daridorexant, lemborexant, and suvorexant belong to the prescription class called dual orexin receptor antagonists. The VA/DoD guideline suggests these options when medication is offered for chronic insomnia. However, the earlier comparative review considered lemborexant safety data inconclusive despite sleep benefits. Daridorexant and suvorexant had fewer adverse-event-related discontinuations than zopiclone in low-certainty comparisons, which does not establish overall safety superiority.^[13][9]

A 2024 safety review discussed in the guideline included 11 randomized trials with 7,703 patients. It found no demonstrated differences between these orexin medicines and placebo in serious adverse events or adverse events leading to discontinuation. Excessive daytime sleepiness was more frequent with suvorexant than placebo; no difference was demonstrated for lemborexant or daridorexant. Uneven trial numbers and few events limited confidence in some findings.^[13]

These findings are not proof of equal safety. The guideline does not recommend these three medicines in severe liver impairment, meaning markedly reduced liver function, and its considerations for moderate impairment differ by medicine. Ask how liver health, next-day alertness, and the exact product affect your options rather than assuming class members are interchangeable.^[13]

What Should You Know About Doxepin for Sleep?

Doxepin is an antidepressant also used at low doses for insomnia. It was well tolerated in the comparative review, although evidence for efficacy and other important outcomes was scarce.^[9] The 2025 VA/DoD guideline suggests doxepin as an option and distinguishes its low-dose safety profile from the adverse effects associated with higher doses used for depression.^[13]

Doxepin can have anticholinergic effects: it blocks nervous-system signals involved in functions such as memory and bladder emptying. These effects can add to those of other medicines with the same action. Older adults are particularly sensitive. The guideline cites advice to avoid doxepin doses above 6 mg daily in older adults because of sedation, anticholinergic effects, and blood-pressure drops on standing, while noting low-dose safety comparable to placebo.^[6][13]

Heart disease and a history of suicidal thoughts or behavior also deserve discussion before doxepin is prescribed. The guideline highlights antidepressant suicide warnings and greater concern in people with that history. Doxepin is not a controlled substance—a medicine subject to special prescribing controls—but that status does not remove these safety considerations.^[13]

What Should You Know About Ramelteon for Sleep?

Ramelteon is also not a controlled substance, but it may impair daily activities, including driving. The VA/DoD guideline found insufficient evidence to recommend for or against it for chronic insomnia. Its reviewed evidence came from adults age 65 or older and showed some improvements in falling asleep, but inconsistent benefits across sleep outcomes and no demonstrated improvement in daytime functioning in one trial.^[13]

In the earlier comparative review, some benzodiazepine groups and eszopiclone had fewer acute-treatment discontinuations for any reason than ramelteon. Stopping for any reason is not a specific measure of harm. A useful question is whether ramelteon produces enough noticeable sleep benefit to justify continuing it, alongside a review of unwanted effects and driving demands.^[9][13]

What Are the Risks of Trazodone and Other Off-Label Sleep Medicines?

Prescribing a medicine for sleep does not by itself establish an insomnia-specific evidence base. The comparative review identified tolerability or long-term evidence limitations for several treatments used off label.^[6][9]

For chronic insomnia, the 2025 VA/DoD guideline weakly recommends against trazodone, antipsychotic medicines, benzodiazepines, and diphenhydramine. This recommendation concerns insomnia treatment, not every possible use of these medicines.^[13]

The guideline reports more morning grogginess, dry mouth, and thirst with trazodone than placebo in two studies. It also highlights drug interactions and the FDA boxed warning—a prominently displayed serious-risk warning—about increased suicidal thoughts and behaviors in pediatric and young adult patients through age 24.^[13]

Ask a pharmacist or prescriber to review the current label for your exact product and formulation. Useful questions include whether your health conditions or other medicines make it unsuitable, which symptoms need prompt attention, and how to continue, change, or stop it safely.

The benzodiazepine withdrawal guidance is not a stopping plan for every other sleep medicine.

Can Sleeping Pills Affect Driving and Alertness the Next Day?

Benzodiazepines and related drugs can cause daytime drowsiness, memory problems, falls, fractures, and motor vehicle accidents. Sedating antihistamines can also impair alertness the next day.^[10] The American Society of Addiction Medicine also identifies cognitive impairment, falls, and motor vehicle crashes among benzodiazepine-associated adverse events.^[7]

Someone who feels sedated, confused, unsteady, or unable to concentrate after taking a sleep product should avoid driving or other hazardous activity and contact a clinician or pharmacist for advice.

Why Is Mixing Sleep Medicines With Opioids or Other Sedatives Risky?

Combining benzodiazepines with opioids—a drug group that includes prescription pain relievers—increases overdose risk. The 2025 joint guideline calls for more frequent risk–benefit assessment when a person takes both, has a substance use disorder, or has additional medical or mental health risk factors.^[2][7][14]

Substance use can affect benzodiazepine risk assessment. Before using a sleep product, give a clinician or pharmacist a complete list of prescription drugs, over-the-counter medicines, supplements, alcohol use, and other substances. Ask them to check all active ingredients in nighttime combination products, which may include both an antihistamine and a pain reliever.^[2][6]

What Sleeping-Pill Risks Matter for Older Adults?

For adults age 65 or older, the joint guideline recommends tapering benzodiazepines in most cases unless compelling reasons support continuation. This is not an instruction to stop suddenly. It is a reason for an individualized review of benefit, falls, cognition, other medicines, and withdrawal risk.^[2]

Sedating antihistamines also deserve attention when thinking or memory problems or difficulty emptying the bladder are concerns. They block nervous-system signals involved in these functions, and they can reduce alertness.^[6][10]

How Do Breathing Problems Affect Sleeping-Pill Safety?

Obstructive sleep apnea is an important risk factor during benzodiazepine assessment. A person with loud snoring, witnessed breathing pauses, or marked daytime sleepiness should discuss evaluation rather than relying only on a sedative for the sleep complaint.^[2][6]

How Can Mental Health Conditions Affect Sleep-Medicine Decisions?

Sleep disruption can worsen some psychiatric conditions. During benzodiazepine reduction, the guideline advises particularly close monitoring in people with bipolar disorder, a mood condition that can involve episodes of unusually elevated or irritable mood and increased energy, called mania. Disturbed sleep can trigger these episodes.^[2]

Persistent insomnia may also occur with psychiatric, medical, or other sleep conditions. Assessment should consider whether the insomnia symptoms are severe or need attention in their own right, rather than treating every sleep complaint as the same problem.^[6]

What Should You Know About Benzodiazepine Sleep Medicines During Pregnancy?

Benzodiazepine use during pregnancy has been associated with miscarriage, preterm birth, and low birth weight, although the guideline states that causation remains unclear. Exposure before birth was not associated with major birth defects in the evidence it reviewed.^[2]

Among newborns exposed to benzodiazepines late in pregnancy, approximately 20% to 40% developed neonatal withdrawal—withdrawal symptoms after birth. A syndrome observed after third-trimester exposure may reflect drug toxicity and includes low muscle tone, lethargy, feeding difficulty, apnea (pauses in breathing), and central nervous system depression (slowed brain and nervous-system activity).^[2]

Pregnancy decisions should weigh the pregnant person’s health together with fetal and newborn considerations. These associations and newborn risks call for an individualized discussion, not abrupt discontinuation by someone who may be physically dependent.^[2]

How Does Cognitive Behavioral Therapy for Insomnia Work?

Cognitive behavioral therapy for insomnia, abbreviated CBT-I, is a structured treatment that changes the thoughts and behaviors that keep insomnia going. It is not simply a list of sleep-hygiene tips.

CBT-I has been studied in younger and older adults with chronic insomnia, including people with co-occurring conditions. It is commonly delivered over six to eight sessions, although brief and internet-based versions have also shown benefit. It can help people who are taking hypnotics and may support reduced medication use.^[6]

What Does CBT-I Teach You to Do?

A 2024 component network meta-analysis included 241 randomized trials and 31,452 adults. It identified cognitive restructuring, sleep restriction, stimulus control, and an additional group of cognitive and behavioral methods as associated with better remission outcomes. Here, remission meant reaching a satisfactory state after treatment, rather than a guarantee of perfect sleep every night.^[15]

Cognitive restructuring helps a person identify and challenge unhelpful thoughts and beliefs about sleep.^[13]

Stimulus control rebuilds the association between bed and sleep rather than bed and prolonged wakefulness. The Department of Veterans Affairs program describes it as recognizing behaviors that reinforce wakefulness and learning techniques to change them.^[5]

Sleep restriction limits time in bed to actual sleep time, then gradually increases time in bed as sleep efficiency improves.^[13] It is a component of structured CBT-I, rather than a general recommendation to deprive yourself of sleep.

In the component analysis, it was associated with better self-reported sleep quality, a greater proportion of time in bed spent asleep, and less time awake after initially falling asleep.^[15][5]

The review grouped additional cognitive and behavioral methods under the research label “third-wave components,” but its abstract does not describe the individual techniques included in that category. Separately, the benzodiazepine tapering guideline discusses mindfulness practices—practicing awareness of present experiences—as a possible support during medication reduction. That guidance does not establish which techniques accounted for the component review’s findings.^[15][2]

How Much Can CBT-I Improve Chronic Insomnia?

In the component analysis, an in-person package combining cognitive restructuring, third-wave methods, sleep restriction, and stimulus control was compared with in-person sleep education. Using the studies’ typical education-group remission rate of 14%, the combined treatment was associated with a remission rate about 33 percentage points higher.^[15]

In practical terms, that model corresponds to roughly 47 people in 100 reaching remission with the combined program versus 14 in 100 with education alone. About three people would need the full treatment package for one additional remission compared with education, although individual results and real-world programs may differ.^[15]

The analysis cannot prove that every component has the same value in every package. Interactions among components might have gone undetected, and the authors called for further large trials. Sleep-hygiene education alone was not identified as essential, emphasizing that CBT-I is more than advice about caffeine, screens, or bedtime routines.^[15]

How Can Therapy Support Sleep-Medicine Changes?

A systematic review cited in the benzodiazepine tapering guideline found that gradual reduction combined with psychosocial treatment was more effective than gradual reduction alone. Relevant support may include CBT-I, other cognitive behavioral therapy, mindfulness, or help managing withdrawal-related sleep disruption.^[2]

Evidence was insufficient to draw conclusions about medicines—including melatonin—used specifically to help people discontinue benzodiazepines. The studies had low or very low quality and substantial risk of bias, meaning limitations in how studies were designed or conducted could distort their results.^[2]

How Can You Safely Continue, Change, or Stop a Sleep Medicine?

Do not make the decision solely from how long you have taken a medicine. A useful review considers whether it still provides meaningful benefit, what adverse effects are occurring, why it was started, whether the original problem remains, and what may happen if it is continued or reduced.

The 2025 joint benzodiazepine guideline recommends ongoing risk–benefit assessment and shared decision-making. Tapering is generally considered when the risks of continuing outweigh the benefits, but the plan should be individualized and adjusted to the person’s response.^[2]

Why Can Suddenly Stopping a Benzodiazepine Sleep Medicine Be Dangerous?

A person likely to be physically dependent on a benzodiazepine should not stop it abruptly. Two small randomized trials involving 70 participants compared seven- to eight-day reduction with abrupt cessation. Complete discontinuation and several other outcomes did not differ, but those in the reduction groups reported less severe withdrawal and insomnia from four days through as long as four weeks.^[2]

The trials were small and had unclear risk of bias. They do not establish one ideal schedule. The guideline therefore supports gradual, patient-centered reduction rather than a universal timetable.^[2]

When Does Sleep-Medicine Treatment Require More Support?

For adults reducing regular benzodiazepine use, the joint guideline says outpatient care is often appropriate. Inpatient care may be needed when there is an immediate risk of serious harm, health conditions that cannot be safely managed outside a hospital, or severe or complicated withdrawal. This guidance concerns benzodiazepines; it is not a universal placement rule for every sleep product.^[2]

People with a substance use disorder or another psychiatric condition may need additional support, including intensive outpatient, partial hospitalization, or residential services. Ask which setting can address your particular medicine, withdrawal risks, other substance use, mental health, and daily support needs.^[2]

How Can Family or Friends Help With Sleep-Medicine Concerns?

With the person’s agreement, a family member or trusted friend can join a medication-review visit. The benzodiazepine guideline recommends shared decisions with patients and their care partners whenever possible.^[2]

Practical help can include organizing medicine containers for the appointment, writing down observed sleep or daytime problems, and helping prepare questions. Focus on specific concerns instead of assuming that physical dependence proves addiction. Do not turn concern into a demand to abruptly stop a regularly used benzodiazepine; withdrawal planning needs clinical guidance.^[2]

What Should You Discuss at a Sleeping-Pill Review Appointment?

Bring the medicine containers or an accurate list so the discussion can cover:

• The exact product, strength, and how often it is taken
• When it was started and what problem it was meant to treat
• How long it now takes to fall asleep and how often you awaken
• Daytime alertness, memory, balance, driving, and falls
• Missed doses and any symptoms that followed
• Early refills, dose increases, or concern about loss of control
• Alcohol, opioids, cannabis, antihistamines, supplements, and other sedatives
• Snoring, breathing pauses, limb discomfort, unusual sleep behaviors, or shifted sleep timing
• Mental health symptoms, pregnancy, or plans for pregnancy
• Previous attempts at CBT-I or medication reduction

A sleep-wake diary recorded day by day can make the visit more useful by tracking bedtime, estimated sleep onset, awakenings, final waking time, time out of bed, naps, and next-day functioning. Sleep-wake diaries are a central assessment tool because they show sleep timing and variability.^[6]

How Common Are Sleep-Medicine Use and Misuse in the United States?

Sleeping-pill statistics require careful interpretation because survey categories do not correspond exactly to “sleeping pills.” The 2025 National Survey on Drug Use and Health tables cited below measure misuse and substance use disorders; they do not establish how many people currently use prescription sleep medicines as directed, over-the-counter sleep aids, or supplements.^[14][8]

For ordinary use, the Centers for Disease Control and Prevention (CDC) reported that 8.4% of U.S. adults age 18 or older in 2020 took medication to help fall or stay asleep every day or most days during the preceding 30 days. The question included prescribed and over-the-counter medicines. This is a 2020 estimate, published in January 2023, not a 2026 prevalence estimate.^[16]

The National Health Interview Survey used self-reported household interviews representing the civilian population not living in institutions. In 2020, 6.3% reported taking sleep medication every day, 2.1% most days, 10.0% some days, and 81.6% never in the preceding 30 days. These figures measure use frequency, not misuse, physical dependence, or a substance use disorder, and do not separate individual medicine classes.^[16]

In the 2025 National Survey on Drug Use and Health, an estimated 4.237 million people age 12 or older—1.5% of that population—reported past-year misuse of prescription tranquilizers or sedatives. This included 3.293 million people, or 1.1%, reporting past-year benzodiazepine misuse.^[14]

In the 2025 National Survey on Drug Use and Health, an estimated 1.679 million people age 12 or older, or 0.6%, met past-year criteria for a tranquilizer or sedative use disorder. That included 1.368 million with a tranquilizer use disorder and 482,000 with a sedative use disorder; categories may overlap, so they should not be added together.^[8]

These figures measure misuse and survey-estimated substance use disorder categories, not all prescribed use, all insomnia treatment, or all sleeping pills. The tables also are not limited to sleep-related use of these medicines. Misuse is therefore neither a measure of ordinary adherence nor proof of a substance use disorder.^[14][8]

How Do Counterfeit Pills Increase Overdose Risk?

Our sleeping-pill overdose guide explains emergency warning signs. If a suspected overdose is happening now, call 911.^[1]

Pills obtained illicitly or without a prescription may not contain what they appear to contain. A Centers for Disease Control and Prevention (CDC) report examined overdose deaths during July 2019 through December 2021 in participating jurisdictions; it did not test all pills or estimate current prevalence among people who use sleep medicines.^[17]

In 29 states and the District of Columbia, the share of overdose deaths with counterfeit-pill evidence rose from 2.0% in July–September 2019 to 4.7% in October–December 2021. In the report’s separate 2021 analysis of 34 states and the District of Columbia, illicitly manufactured fentanyls—potent opioid drugs made illegally—were the only drugs causing death in 41.4% of deaths with counterfeit-pill evidence.^[17]

One indicator used to identify possible counterfeit pills was a pill appearing to be alprazolam, a named medicine, when testing after death detected no alprazolam. This was evidence about the pill’s apparent identity, not a finding that prescribed alprazolam caused those deaths.^[17]

For prescription medicines, take only pills prescribed to you, and avoid pills obtained illicitly or without a prescription.^[17] If someone cannot be awakened, has slow or shallow breathing, makes choking or gurgling sounds, or has discolored lips or nails, treat the situation as a possible overdose.^[1]

Call 911, give naloxone if available, place the person on their side, and stay until help arrives. Naloxone is a life-saving medication that can reverse opioid overdose. The CDC states that anyone can carry it and that it is available over the counter in all 50 states.^[1]

Counterfeit pills can expose someone to opioids without their knowledge. The CDC counterfeit-pill report therefore highlights having naloxone available as one overdose-prevention measure for people who use these pills.^[17]

Where Can You Start Getting Help for Sleep-Medicine Concerns?

If sleep trouble is occasional and mild, start by recording sleep timing, naps, caffeine or alcohol use, medicines, and daytime effects. Review whether your schedule allows enough time for sleep and whether symptoms point toward a shifted body clock rather than insomnia.

If insomnia persists or impairs daytime life, ask a primary care clinician, behavioral health professional, or sleep specialist about a structured assessment and CBT-I. Mention snoring, breathing pauses, irresistible leg sensations, unusual sleep behaviors, or excessive daytime sleepiness because these may change the evaluation.

If you take a prescription or over-the-counter sleep product, review its exact ingredients with a pharmacist or clinician. Ask what benefit it is expected to provide, how improvement will be measured, what next-day effects matter, and when the decision should be reassessed.

If you regularly take a benzodiazepine and want to reduce or stop it, arrange a shared discussion rather than stopping abruptly. Ask about physical dependence, withdrawal risk, behavioral support, and how the plan would be adjusted if sleep or mental health symptoms worsen.^[2]

If medicine use feels difficult to control, say so directly when discussing sleeping-pill treatment. Bring information about actual use, early refills, other substances, withdrawal symptoms, and previous attempts to change. Assessment can distinguish expected dependence from misuse or a use disorder and help identify appropriate support.

Improvement does not have to mean perfect sleep every night. Meaningful progress may include falling asleep more easily, spending less time awake, feeling steadier and more alert during the day, reducing fear about sleep, or using medication with a clearer benefit and lower burden.

For U.S. substance-use treatment information and referrals, call 1-800-662-HELP (4357). SAMHSA’s National Helpline is free and confidential, operates around the clock in English and Spanish, and provides referrals rather than counseling.^[18]

If you have thoughts of suicide or urges to hurt yourself, call or text 988 or chat at 988lifeline.org in the United States. Call 911 for a life-threatening situation.^[19]

This information is educational and does not replace medical advice from a qualified healthcare professional.