How to safely wean yourself off sleeping pills

Life can be hard and it can be hard to sleep. Many Americans combat occasional or chronic insomnia by taking sleeping pills.

In 2020, 8 percent of Americans said they take sleep aids every day or most days to help them fall or stay asleep. As a sleep psychologist, I see a large number of such patients.

Most start by taking over-the-counter or prescription pills to counteract insomnia caused by short-term disruptions like travel, unusual stress and hospitalizations, or longer-term conditions like chronic insomnia (or another sleep disorder), depression, anxiety, etc. Hyperthyroidism.

Most of my patients want to come off their sleeping pills, but many are reluctant to try. They have different reasons why they want to quit, such as:

  • Your or your doctor’s concerns about over-reliance on medication.
  • side effects.
  • decreasing effectiveness.
  • Individual health aspects such as pregnancy, an upcoming operation or interactions with other medications.

They also have different reasons for continuing to take pills, including:

  • Relief in the certainty of a good night’s sleep and doubts about the ability to sleep without medication.
  • Great fear of bad sleep.
  • Failed attempts at reduction where they suffered from severe insomnia, anxiety or other withdrawal symptoms.

If, like my patients, you are trying to reduce or stop your medication but are feeling discouraged, resigned, anxious, and self-doubting, I want to assure you that there is hope.

There is no one-size-fits-all approach to reducing sleep medication use

Sleeping pills are not a single category. Hypnotic and sedative medications include different types of medications with different modes of action, duration of action, and challenges to coming off. There is no one-size-fits-all approach to reducing or stopping such diverse agents.

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Practical considerations also vary from drug to drug. Some pills must not be cut. Others can be cut, but some are too small to do this precisely. Some people need to switch medications to get off the first medication, or they need to figure out which of two or more medications to reduce first.

There are many other considerations. For example, if you’ve only been on a medication for a month, the tapering approach will likely be quicker (to avoid prolonged use) than the step-by-step approach outlined below for those who have been on medication for a long time.

Ways to prepare for reducing or stopping sleeping pills

There are some general principles that will help you succeed with tapering:

  • Work closely with your doctor to determine a safe rate and method.
  • Pharmacists can help, whether that be by splitting pills or assisting with liquid formulations or mixing to get split doses.
  • go slow The biggest mistake my patients make is walking too fast. They end up taking their full dose again, chastised and discouraged by the experience.

However, before you start tapering, you should know what medications you are taking. There is no point in coming off a pill if there is no suitable treatment for it underlying sleep Condition. There are many undiagnosed cases of undetected Restless Legs Syndrome, sleep apnea, depression, or other conditions that cause insomnia. Sleep medicine professionals are excellent at clarifying diagnoses.

I have a patient who has tried several times over a number of years to reduce her benzodiazepine intake. Each time, however, she suffered from uncontrollable insomnia. I used this metaphor to explain why it’s important to go slowly:

Imagine a swimming pool with a shallow end and a deep end. Imagine a ramp connecting the two, and it’s not a steep descent, it’s a gradual descent. When you get a good night’s sleep with the help of medication, you’re safe in the shallows — not outside of your depths. Her goal, however, is to be a competent and confident swimmer—to be able to sleep well without medication (or less).

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There are three reasons for a slow reduction:

  1. Going slow will minimize withdrawal symptoms, as well as insomnia, anxiety, and other symptoms that can accompany dose reductions. If you gradually reduce the amount by small amounts, your system will hardly register the change. They take one tiny step at a time down the ramp.
  2. The slow approach is a form of graded exposure therapy. Each new step on the ramp, each new dose reduction, allows you to minimize and maybe even overcome your anxiety before moving on to a more difficult step that may no longer feel more difficult because you’ve mastered the previous step. It also feels relatively safe to take small steps.
  3. A slow taper gives time to develop sleep skills to replace the medication. I’ve written about some of these skills. You may not have needed them because you were taking medication. By progressing slowly, you’ll learn your swimming skills at each new depth. If you get to the bottom, you’ll be an excellent swimmer.

Over the course of about a year, with the support of her doctor, my patient reduced her dose to a quarter.

Steps to stop or reduce the use of sleeping pills

Here’s a way to gradually reduce the dose, if your doctor approves. My patients usually find it easy and non-threatening. For the sake of simplicity, I’m assuming you’re taking a whole pill and don’t want to miss out on anything.

  1. Set step sizes and milestones. Decide if you want to cut down an eighth of a pill at a time, or a quarter, or some other fraction. Let’s say it’s an eighth. Your first milestone is seven eighths of a pill. You are working towards this milestone and only towards it at first.
  2. Gradually increase the number of nights per week that you take the milestone dose (e.g. seven eighths) versus the full dose (one pill). You can start with the lower dose once a week and gradually increase to seven times a week, always taking the higher dose on the evenings when you are not taking the lower dose. You don’t have to hit every number on the lower dose as you travel from zero to seven nights a week.
  3. Distribute the lower doses – for example every fourth night if you take the smaller dose twice a week.
  4. You can repeat weeks. For example, if you take the lower dose every other night and the higher dose the other nights, you can repeat this pattern for another week or two.
  5. Once you reach your first milestone (e.g. seven-eighths of a pill each night), that dose becomes your new high dose and further reduction (e.g. three-quarters of a pill) becomes your new low dose. You have finished taking a full pill. Flexibly repeat the pattern that led you to your first milestone to reach your second and subsequent milestones.
  6. Slow down the taper towards the end. An eighth of a pill reduction is initially only a 12.5 percent reduction, but a quarter of a pill reduction is a 50 percent reduction.
  7. Try not to reverse the rampbut if necessary, return to the stage you last slept well on and stabilize there before continuing the taper more slowly.
  8. Plan what you are going to do Log each evening into an editable calendar to keep track of where you are and keep your resolve.
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You should feel like you are in control. The goal is not perfect sleep or no anxiety; It’s confidence in your ability to get through difficult times. You set the pace.

We welcome your comments on this column below [email protected].

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