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Insomnia, Sleeping Pills, and CBT-I

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Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.

 
 

What are the Risks Associated with the Use of Sleeping Pills? |
Why CBT-I is the Gold Standard | What’s the Takeaway?

 

Overview

Insomnia is a common sleep problem experienced by many people globally. Estimates suggest that 30 to 40 percent of American adults experience one or more insomnia symptoms in a year.[1]

For many people experiencing insomnia, sleeping pills may appear to be the panacea for their troubles at first glance. Just pop a tablet, and within minutes you’re fast asleep. 

While there are times these pills are necessary, few people recognize the risks associated with their use.

This article will discuss some hazards associated with sleeping pills and emphasize why cognitive behavioral therapy (CBT-I) may be a better option for treating insomnia.

 

What are the Risks Associated with the Use of Sleeping Pills?

Although sleeping pills are beneficial in many situations, they are associated with hazards and side effects. It’s why sleep experts do not recommend them as the first-line treatment for insomnia.[2]

More often than not, your doctor will advise some behavioral and lifestyle changes before prescribing sleep pills. Here are some of the hazards linked to the use of sleep pills. They include:

  • Rapidly Developed Tolerance: Some people may continue to use sleeping pills longer than recommended, even though most sleeping medications are only for short-term usage (a few weeks or less). Long-term use of prescription sleeping tablets acclimates the body to the drugs, requiring higher doses to get the same sedating effect.[3] When this occurs, some individuals wind up increasing the number of sleeping pills they take or abusing it. Typically, this leads to greater severity of undesirable side effects like respiratory depression and even death.[3]
  • Addiction: It might be challenging to stop using sleeping pills, especially if you’ve been taking them for an extended period. Some patients develop “rebound insomnia,” in which their sleep issues intensify after they stop using the medication.[3] Furthermore, addiction to sleeping pills can lead to problems with motor coordination, dizziness, forgetfulness, and even euphoria.[3] It’s also possible to develop a mental reliance on the drug. A fear or anxiety of sleeplessness may set in, and you may worry that you will not get to sleep without the pills. 
  • Impaired Daytime Activity: According to recent research, individuals who take particular formulations of the sleeping medicine known as zolpidem (Ambien) may still have sufficient amounts of the drug in their bodies the following morning to impair tasks such as driving. [4,5] Individuals who are particularly at risk are pregnant women and those who use a prolonged-release form of the drug. Because of this, the Food and Drug Administration (FDA) compelled pharmaceutical companies to reduce the dose indicated for women.[5] It also suggested that medical professionals reduce the amount prescribed for men. 
  • Parasomnias: Experts have suggested that sleeping pills can cause erratic behavior during sleep.[6] Parasomnia is a term used to describe strange sleeping activities, such as sleepwalking and bedwetting. Research shows that sleeping pills can cause odd behaviors like sleepwalking, sleep talking, and sleep driving.[6] Furthermore, increasing the dose of these drugs can make these behaviors more likely, so it’s essential only to take medicine exactly as your doctor tells you.

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Why Cognitive-Behavioral Therapy for Insomnia (CBT-I) is the Gold Standard

Cognitive Behavioral Therapy (CBT-I) has been proven to be an effective treatment option for various mental health conditions, including insomnia. 

Many experts, including the American College of Physicians, recommend CBT-I as the first treatment for insomnia. Also, research has shown that CBT-I is more effective than sleeping pills in the long-term management of sleep disorders. Here are some other reasons you opt for CBT-I rather than sleeping pills: 

1) Can Address Underlying Causes of Insomnia 

Sleeping pills are beneficial because they help you fall asleep, but they do nothing to fix the underlying issue. Conversely, CBT-I seeks out and treats the underlying causes of sleep disturbances. This suggests that CBT-I aids patients in building long-term coping mechanisms for their sleep issues.

2) Minimal Side Effects 

CBT-I is associated with fewer side effects when compared to sleep medications.[7] Although it can be difficult and uncomfortable to talk about traumatic events, emotions, and feelings that may be the source of your sleeplessness. If you work with a CBT-I specialist, you can lessen the likelihood of adverse side effects. This is because these professionals are taught to help patients overcome temporary hurdles.

3) Long-Term Benefit 

While sleeping pills can provide short-term relief for insomnia, they do not offer long-term benefits. Studies have shown that individuals who rely on sleeping pills to manage their sleep disorders often experience a rebound effect when they stop taking the medication.[3] This can lead to worse insomnia than before. Conversely, CBT-I offers long-term benefits as individuals learn to manage their sleep disorders without needing medication.[8]

4) Tailored to Individual Needs 

CBT-I can be adjusted to meet each patient’s requirements. Hence, it can be tailored to the patient’s needs, preferences, and nighttime routine. Yet, sleeping drugs offer a one-size-fits-all approach that may only work for some.

5) Improved Mental Health 

Sleep problems are often linked to other mental health problems, like depression and anxiety. CBT-I has been shown to not only enhance the quality of sleep but also to help individuals manage these underlying mental health conditions.[9] Sleeping pills do not offer this added benefit.

 

What’s the Takeaway?

While sleeping drugs can provide short-term relief for sleep disturbances, CBT-I is a more effective long-term treatment. It’s a tailored, safe, and effective therapy method that targets thoughts, behaviors, and beliefs without the risk of side effects or dependence. CBT-I is a viable treatment option if you are battling a sleep issue.

 

References:

  1. Dopheide, J. A. (2020). Insomnia overview: epidemiology, pathophysiology, diagnosis and monitoring, and nonpharmacologic therapy. The American Journal of Managed Care, 26(4 Suppl), S76–S84. https://doi.org/10.37765/ajmc.2020.42769
  2. Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., Denberg, T. D., & for the Clinical Guidelines Committee of the American College of Physicians. (2016). Management of chronic insomnia disorder in adults: A clinical practice guideline from the American college of physicians. Annals of Internal Medicine, 165(2), 125. https://doi.org/10.7326/m15-2175
  3. Longo, L. P., & Johnson, B. (2000). Addiction: Part I. Benzodiazepines–side effects, abuse risk and alternatives. American Family Physician, 61(7), 2121–2128. https://pubmed.ncbi.nlm.nih.gov/10779253/
  4. Inagaki, T., Miyaoka, T., Tsuji, S., Inami, Y., Nishida, A., & Horiguchi, J. (1291852800). Adverse reactions to zolpidem: case reports and a review of the literature. Primary Care Companion to the Journal of Clinical Psychiatry, 12(6), 26600. https://doi.org/10.4088/PCC.09r00849bro
  5. Safety Announcement. (2013). Risk of next‐morning impairment after use of insomnia drugs; FDA requires lower recommended doses for certain drugs containing zolpidem (Ambien, Ambien CR, Edluar, and Zolpimist). Fda.gov. Retrieved February 27, 2023, from https://www.fda.gov/files/drugs/published/Drug-Safety-Communication–Risk-of-next-morning-impairment-after-use-of-insomnia-drugs–FDA-requires-lower-recommended-doses-for-certain-drugs-containing-zolpidem-%28Ambien–Ambien-CR–Edluar–and-Zolpimist%29.pdf
  6. Bollu, P. C., Goyal, M. K., Thakkar, M. M., & Sahota, P. (2018). Sleep medicine: Parasomnias. Missouri Medicine, 115(2), 169–175. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139852/
  7. Rossman, J. (2019). Cognitive-behavioral therapy for insomnia: An effective and underutilized treatment for insomnia. American Journal of Lifestyle Medicine, 13(6), 544–547. https://doi.org/10.1177/1559827619867677
  8. Mitchell, M. D., Gehrman, P., Perlis, M., & Umscheid, C. A. (2012). Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Family Practice, 13(1), 40. https://doi.org/10.1186/1471-2296-13-40
  9. Alimoradi, Z., Jafari, E., Broström, A., Ohayon, M. M., Lin, C.-Y., Griffiths, M. D., Blom, K., Jernelöv, S., Kaldo, V., & Pakpour, A. H. (2022). Effects of cognitive behavioral therapy for insomnia (CBT-I) on quality of life: A systematic review and meta-analysis. Sleep Medicine Reviews, 64(101646), 101646. https://doi.org/10.1016/j.smrv.2022.101646