Compresse per dormire

Are sleeping tablets bad for you?

In particular, the concern is that you could become dependent on sleeping aids or addicted to them. Possible problems when taking sleeping tablets include the following:

Drowsiness the next day

You may not be safe to drive a vehicle or to operate machinery due to the sedating effect. Evidence shows people who take sleeping tablets are more likely to be involved in road traffic accidents.

Clumsiness, drowsiness, and confusion in the night (if you get up)

These can occur - for example, if you have to get up in the middle of the night to go to the toilet. You may fall over and injure yourself if you feel sleepy. Some people have fallen down stairs due to the drowsiness caused by sleeping tablets. (Older people who take sleeping tablets have an increased risk of breaking their hip, as the result of a fall.)

Rischi

One study suggests that people who use sleeping tablets for a long time are more likely to develop dementia. (This has not been proven yet.)

Tolleranza

If you take sleeping medicine such as benzodiazepines and Z drug sleeping tablets to treat insomnia each night, your body becomes used to them. This means that, in time, the usual dose has no effect. You then need a higher dose for it to work. In time, the higher dose does not work and you need an even higher dose, and so on. It can take as little time as just a few days for tolerance to develop.

Dipendenza

Some people become dependent on benzodiazepines or Z drugs. This means that withdrawal symptoms occur if the tablets are stopped suddenly. Withdrawal symptoms include mental health problems such as anxiety, shaking, or just feeling awful. If you have taken a benzodiazepine or Z drug regularly for more than two to four weeks, you will need to come off it gradually, to avoid withdrawal symptoms.

Dipendenza

Some people who are dependent on benzodiazepines or Z drugs may become addicted to them. If you are addicted to a medication, you have uncontrollable cravings for it and feel a need to take it. This can happen even after you have slowly withdrawn from it so that you are no longer dependent. Tolerance, dependence and addiction are different things. Some types of people seem more likely than others to become addicted to substances.

In some cases, however, sleeping tablets may be very helpful. In short courses for time-limited problems, they are safe to use. For example, if you have had a sudden shock or bereavement, sleeping can be a problem. A short course of sleeping tablets (for a week or two) may help you cope better in the daytime. Or if you have jet lag and are struggling with re-setting your internal time clock. Doctors advise that you take no more than two weeks of sleeping tablets at a time. If you just take the tablets for a week or two, you will not become dependent on them.

Sleeping tablets work either by a general affect on the brain to promote drowsiness or by directly binding with receptors in the brain to cause sleepiness or relaxation. There are different types of sleeping pills that work in different ways, but all generally affect the brain in some way to promote sleep. It is also thought that there is an additional placebo affect, which means that just by taking the tablets, you may feel more relaxed and positive about getting to sleep, and therefore more likely to get a better night's sleep.

Benzodiazepine e farmaci Z

Benzodiazepines and Z drugs are sometimes used as sleeping tablets. Benzodiazepines include temazepam, loprazolam, lormetazepam, e nitrazepam. They are only available on prescription. Other related drugs called zaleplon (no longer available in the UK), zolpidem e zopiclone are also sleeping tablets. Strictly speaking, they are not benzodiazepines. They are known as the Z drugs. However, they act in a similar way (they have a similar effect to benzodiazepines on the brain cells).

Antistaminici

These medicines are commonly used to treat allergic reactions such as hay fever. However, drowsiness is a side-effect of some antihistamines - per esempio, prometazina. This 'side-effect' is useful in some people who have difficulty sleeping because of their allergy. An antihistamine is the active ingredient of some sleeping tablets that you can buy from pharmacies, without a prescription. Antihistamines are not as powerful as benzodiazepines or Z drugs at causing sleep. Also, they may cause a 'hangover' effect and some drowsiness in the morning. They may also cause rebound insomnia if you take them for a long time. For these reasons, current UK guidelines do not advise the use of antihistamines to be used solely as a sleeping tablet.

Melatonina

Melatonina is, strictly speaking, not a 'sleeping tablet'. Melatonin is a naturally occurring hormone made by the body. The level of melatonin in the body varies throughout the day. It is involved in helping to regulate the daily cycles (circadian rhythms) of various functions in the body. A melatonin supplement is sometimes advised in older people (more than 55 years of age) with sleep disorders such as long-term insomnia. The recommended duration of treatment is for three weeks to start with. If helpful, it can be used for a maximum of ten weeks in total.

In some countries melatonin is used to help with sleep problems related to jet lag. In the UK it is not currently licensed for this.

Altri farmaci

Chlormethiazole, chloral, and barbiturates are old-fashioned sleeping tablets. They are not commonly used these days, as benzodiazepines and Z drugs are usually preferred. Certain antidepressants are sometimes used to help with sleep, particularly if depression or anxiety is thought to be causing the problem.

Try to work out the reason for your sleeping difficulties and identify any specific factors that counter sleep. Where possible, correct any or all of these factors.

Your doctor or nurse may give you advice on how to tackle poor sleep naturally. They may also refer you for a type of talking therapy called cognitive behavioural therapy (CBT). CBT is a type of brain-training, which aims to teach your brain how to fall and stay asleep.

Vedi anche il foglio separato intitolato Insonnia (Sonno Scarso).

If your doctor or pharmacist prescribes a benzodiazepine or Z drug as a sleeping tablet for you, it will usually be only short-term (a week or so). This is to help you get over a particularly bad patch and get a good night's sleep. Sometimes a doctor will advise sleeping tablets to be taken on only two or three nights per week, rather than on every night. This prevents either tolerance to or dependence on the tablet from developing.

For various reasons, some people have become used to taking a benzodiazepine or Z drug sleeping tablet every night. As a rule, if you are taking one of these sleeping tablets each night, you should consider reducing or stopping them. However, in some people, problems of tolerance or dependence (see above) mean that it can be difficult to stop the tablet suddenly.

If you want to reduce or stop benzodiazepine or Z drug sleeping tablets, it is best to consult a doctor or nurse for advice. The sort of advice may include the following:

• Do it gradually and cut the dose down a little at a time. A switch to a different benzodiazepine (diazepam) may be advised. This is because it is easier to reduce the dose of diazepam gradually than it is with other benzodiazepines or Z drugs.

• It is best to wait until any life crisis has passed and your level of stress is as low as can be.

• Consider stopping the tablets whilst on holiday, when you have less pressure from work, family, etc.

• You are likely to have a period of worse sleep when you stop the tablets. Try to anticipate and accept this.

• Advice on coping strategies, and tips on how to improve your sleep pattern naturally.

See the separate leaflet called Stopping Benzodiazepines and Z Drugs. However, stopping benzodiazepine or Z drug sleeping tablets is not practical in every case.

How many sleeping tablets are harmful?

The National Institute for Health and Care Excellence (NICE) has published guidance on safe prescribing and stopping medicines that can lead to addiction or withdrawal symptoms in adults. They have concentrated on benzodiazepine e farmaci Z which are often used for sleep issues, as well as some medication used for pain relief (oppioidi, gabapentin e pregabalin). They have also discussed antidepressants which are not addictive but can cause withdrawal symptoms.

Prima di prescrivere, il tuo medico prenderà in considerazione:

• Se sono stati provati altri metodi o farmaci che non creano dipendenza.

• Issues that could lead you to becoming addicted to the medication

• Che tu abbia tutte le informazioni necessarie per prendere una decisione.

Cosa dovresti sapere quando inizi un farmaco:

• Il tipo di farmaco e il motivo per cui ti è stato prescritto.

• La dose iniziale e quando le dosi verranno modificate se necessario.

• Gli effetti collaterali e quanto tempo possono durare.

• Chi contattare in caso di domande o preoccupazioni.

• Quanto tempo impiegherà il farmaco a fare effetto e per quanto tempo lo assumerai.

• How long the prescription given is for - eg, one week, two weeks

• I rischi di dipendenza e overdose.

• Quando avrai una recensione.

Il tuo medico potrebbe interrompere il farmaco se:

• Non c'è alcun beneficio o non ti sta più aiutando.

• Ci sono sintomi o segni di dipendenza.

• La tua malattia è migliorata.

• Ci sono più danni che benefici nell'assumere il farmaco.

• Tu, come paziente, vuoi interrompere il farmaco.

The doctor will stop the medication slowly. They will discuss with you how to do this taking into account issues that may make stopping the medication difficult.

A note on withdrawing from benzodiazepines: if you are on medications such as lorazepam or nitrazepam, you may be switched to diazepam. This medication has a longer half life, meaning it will stay in your body longer reducing any withdrawal effects. Terapia cognitivo comportamentale La terapia cognitivo-comportamentale (CBT) insieme alla sospensione di una benzodiazepina può anche aiutare a gestire i sintomi. Il tuo medico potrebbe indirizzarti alla CBT mentre interrompi questo tipo di farmaco.

For Further Reading, see below.