Are Nonbenzodiazepine ‘Z-drugs’ for Insomnia Addictive?

Most Z-drugs are prescribed to treat insomnia, a sleep disorder that makes it hard to fall or stay asleep. Sleep deprivation can cause interruptions to quality of life. Over time, people feel desperate to get the sleep they need.

Z-drugs are also known as z-sedatives or hypnotics because they cause you to feel extremely calm to induce sleep. These drugs come in a variety of formulations, and they carry some potential risks.

When Are Z-Drugs Needed?

Most adults will have an episode of insomnia at some point in their lives, per Mayo Clinic. This may occur after a difficult or traumatic event in life, but it is expected to go away within a few days or weeks. Other times, insomnia can seem to spring from no discernable cause, but again, it usually passes within a few days.

In some people, insomnia can last for months at a time. If it does, it can significantly impact quality of life, making you feel very tired and irritable. Over time, lack of sleep can lead to a bevy of health issues.

Lifestyle changes, including sleep hygiene practices, are the first approach to sleep issues. Doctors will generally recommend that people employ various practices that support sleep, such as sticking to a set sleep schedule, fostering a supportive sleep environment, and engaging in relaxing activities before bed, such as meditating.

Nonbenzodiazepine medication, better known as Z-drugs, may be prescribed to help with sleep issues if lifestyle changes don’t help. Z-drugs are not benzodiazepines, though their effects are similar.

Z-drugs are not intended to manage insomnia on a long-term basis. They are meant to be a short-term solution. The underlying issues behind the insomnia must be addressed to manage insomnia on a sustained basis.

What Is the Abuse Potential for Z-drugs?

The Food and Drug Administration began tagging Z-drugs with a boxed warning so patients could be aware of the risks of using them. Abuse is one of the biggest risks of taking these medications.

You should not take more of your prescription than instructed or take it more often recommended. You should also avoid mixing it with alcohol or other substances. You should never take a Z-drug unless it has been specifically prescribed to you. Varying from prescribed use is abuse.

If you have been taking a Z-drug for longer than two weeks, you may be dependent on it. Don’t stop taking it suddenly as this could lead to dangerous withdrawal symptoms. Consult your doctor about how to safely stop using it. Doctors will usually recommend a gradual dose reduction.

Since Z-drugs can lead to withdrawal in people who become dependent on them, this reinforces their abuse potential. Even if a person wants to stop taking the drugs, the discomfort of withdrawal drives them back to regular use.

Commonly Prescribed Brands

A June 2013 article from the Journal of Toxicology says that Z-drugs were created as an alternative to benzodiazepines. Due to their side effects and abuse potential, benzodiazepines were causing concern among clinicians and health care professionals. Z-drugs were seen as a safer alternative to induce sleep and improve sleep quality.

Ultimately, Z-drugs presented with their own significant addictive potential that was not anticipated. They can lead to addiction in a similar manner that benzodiazepines can.

All Z-drugs are scheduled and can only be used with a doctor’s prescription.

The following forms are most often prescribed:

• Zolpidem: The brand name for this medication is Ambien or Ambien XR. Sleep medications like this should generally only be used for one to two nights. They should not be used for longer than a week or two.The Journal of Toxicology explains that zolpidem can be just as effective as benzodiazepines in treating sleep disorders. For most people, the dose is 10 mg before going to sleep, but a dose of 5 mg is recommended for the elderly.
• Eszopiclone: This drug is sold as Lunesta in the United States. If you have a prescription for this medication, you must only take it when you know you are about to go to sleep and can remain at rest for seven to eight hours.Sleeping issues should improve within a week to 10 days of receiving this prescription. Talk to your doctor if your sleep problems do not improve after taking the medication as directed.
• Zaleplon: The brand name for this medication is Sonata. It is prescribed in the short term for patients who have insomnia, as it promotes relaxation in the brain. The medication will not deepen your sleep or cause you to wake up fewer times.

Risks of Z-Drugs

Z-drugs are effective, but they are known to be habit-forming. The FDA has a box warning on all Z-drugs regarding their abuse potential.

These drugs come with the potential for side effects, and parasomnias are among the most concerning possible issues. Users are known to prepare meals, drive, have sex, or take part in other activities while they are asleep. They have no recollection of the activity later, per a September 2015 case study published by the Yale Journal of Biology and Medicine. This can lead to very serious accidents and injuries, including death.

Additional side effects include the following:

• Drowsiness that lasts after you wake up
• Reduced appetite
• Dizziness
• Memory loss
• Pain in the eyes

It is possible to overdose on Z-drugs. Call 911 or go a hospital right away if these occur:

• Respiratory issues
• Extreme confusion
• Loss of consciousness

Is Treatment Available for Z-Drug Abuse?

Many people seek out Z-drugs like Ambien for their abuse potential. They enjoy the relaxing, sedative effects of these medications, and they may combine them with alcohol or other drugs to enhance these effects.

Others start taking Z-drugs for legitimate medical reasons. They then find they can’t sleep without them, and they begin using them outside the bounds of their prescription.

With continued use, dependence can form, and this encourages the abuse cycle, leading to addiction. Thankfully, treatment is available to help.

Since dependence is an issue with chronic abuse of nonbenzodiazepine Z-drugs, you should not stop taking the drugs cold turkey. Consult with a physician prior to stopping use.

If you enter a comprehensive addiction treatment program, they will design a withdrawal plan for you. Generally, this involves reducing your dose slowly over time via a tapering schedule.

Your recovery from nonbenzodiazepine Z-drug abuse may include:

• Lifestyle changes. This will involve good sleep hygiene practices, such as going to sleep and waking up at the same time every time day, ensuring that your bedroom is as relaxing as possible, and learning new strategies to deal with stress. Lifestyle changes can promote better sleep so you will less tempted to turn to Z-drugs or other substances of abuse to induce sleep.
• Therapy. Oftentimes, sleep problems are linked with psychological issues. Therapy can address underlying conditions, such as a mental health issue, substance abuse, or an undiagnosed health problem.If you are dealing with a substance use disorder, you may benefit from cognitive behavioral therapy. In these sessions, you’ll identify underlying negative thoughts that led to your substance abuse, and you’ll learn how to tweak those thoughts in a positive direction.
• Outpatient or inpatient treatment. Either form of treatment may be more appropriate depending on your individual situation and level of substance abuse. At intake, your circumstances will be assessed to determine the best path forward.While Z-drugs are not benzodiazepines, they have similar effects, so treatment for addiction often follows a similar approach. UCLA’s Semel Institute for Neuroscience and Human Behavior says that treatment should approach recovery from many fronts for best results.
• Follow-up care. After you have successfully tapered from Z-drugs and undergone a primary treatment program, you’ll benefit from ongoing aftercare. This may involve periodic therapy sessions, support group participation, exercise, and other practices that support a healthy, sober life.