Sedative Addiction

Americans are no strangers to the problem of a sleepless night. According to the U.S. Centers for Disease Control and Prevention, there are between roughly 50 to 70 million people aged 18 and older with sleep-related disorders in the United States.

In previous years before the rise of widespread prescription drug misuse, benzodiazepines such as Xanax, Klonopin, and Valium, which were primarily used as a means to treat the symptoms of anxiety. They were hailed as the go-to medications for treating sleep disorders like insomnia. They quickly took the place of barbiturates, which were seen as more addictive and dangerous.

Unfortunately, it soon became clear the benzos also had a very high potential for both abuse and addiction. Prescribing benzodiazepines to treat sleep-related issues has fallen off in favor of non-benzodiazepine sedatives known as “z drugs,” such as Lunesta, Ambien, and Sonata.

Much like benzos before them, sedatives seemed like the perfect alternative for ensuring a good night’s sleep without the danger of abuse and dependence. According to the U.S. Food and Drug Administration, Ambien was ranked among the top 20 most prescribed drugs in the country, in 2016

The popular opinion of non-benzo sedatives is that they are “safe” drugs when it comes to treating insomnia. That makes them almost too easy to misuse to the point of physical and psychological dependence. People will make the incorrect assumption that there are no real consequences of sedative misuse and instead suffer potentially serious health problems as a result of sedative abuse.

Even someone taking a sedative as prescribed can start building up a tolerance to z drugs within mere days of consistent use. As someone grows more tolerant and requires a higher dosage of a sedative to achieve the same effects as before, they are more likely to readily abuse them due to the perceived lack of danger.

It takes a brief amount of regular abuse for someone to develop a full-blown sedative addiction. An individual abusing Lunesta, for example, can transition from sedative abuse to addiction in as little as two weeks. Sedative addiction is not to be taken lightly, and the consequences of long-term, chronic abuse can be severe.

What Are Sedatives?

Sedatives are a fairly broad term that is used to describe drugs with so-called “hypnotic” effects, meaning that they induce feelings of relaxation, sedation, and sleep. Both benzodiazepines and barbiturates depress the central nervous system to produce hypnotic effects. As we previously mentioned, they have largely fallen out of use due to their addictive natures.

Z drugs are the name of the alternative group of sedative medications used to treat insomnia and other sleep disorders without the same danger of abuse and addiction. However, not only do they, too, have addictive potential, they also come with a whole host of unwanted side effects, including memory loss, sleepwalking, sleep-eating, and even sleep-driving, and depression.

Perhaps the most dangerous side effect of z drugs is that they can stop working and have the opposite effect. Those who take them can experience worsening insomnia and require them to take a heavier dose each time in order to experience any sedative effects.

Common sedatives include:

• Ambien: The brand name for the drug zolpidem, Ambien was approved to treat the symptoms of sleep disorders by the U.S. Food and Drug Administration (FDA) in 1992. It is among the most powerful of the z drugs, with a long half-life to ensure that users stay asleep longer.
• Sonata: Sonata is the brand name of the drug zaleplon. It has a very short half-life, which means that it is primarily used to induce sleep as opposed to helping people stay asleep. Despite this, many of its side effects involve dangerous unconscious behavior.
• Lunesta: The brand name for the drug eszopiclone is Lunesta. It comes with a variety of unwanted side effects. It has been proven through several sleep studies to be only slightly more effective than placebos at alleviating insomnia symptoms and promoting sleep.

How Do Sedatives Work?

Non-benzo sedatives work in a very similar way as their benzodiazepine counterparts, meaning that they enter the brain and bind themselves to a neurotransmitter called gamma-aminobutyric acid (GABA). GABA is responsible for regulating how the body responds to feelings of stress, anxiety, or fear, sending nerve signals to the brain and body in response to stressful situations.

Benzos activate the brain’s GABA receptors to increase production and flood the brain with GABA to create a substantially stronger feeling of sedation than the brain could produce on its own. This is how medications like Xanax counteract anxiety, and also how they can be abused to get someone high.

Z drugs also affect the GABA levels in the brain, but they do so on a significantly more selective basis. Instead of binding with every GABA receptor to increase production, sedatives like Ambien and Lunesta specifically target GABA receptors explicitly related to initiating sleep and activate those. Because of this selective activation, the effects of z drug sedatives are generally much less intense, with less of a “sleep hangover” the next morning in comparison to benzo use.

However, even though this process makes them less dangerous than benzos because they do not alter as much GABA, regular abuse of non-benzo sedatives can still be enough to make the brain produce less and less of its own GABA and become dependent on the sedative of abuse to provide it.

What Are the Effects of Sedative Abuse?

The effects of regular, chronic sedative abuse carry far from the ones that they were intended to produce, and can, in large enough doses, prove to be deadly.

Some of these effects include:

• Drowsiness
• Difficulty concentrating
• Slurred speech
• Impaired coordination
• Memory loss
• Loss of appetite
• Dangerously slow or shallow breathing
• Coma

What Are the Signs of Sedative Addiction?

It can sometimes be difficult to spot a growing sedative addiction before it is too late. However, there are a good number of signs and symptoms that point to sedative abuse that is escalating into addiction. These signs can manifest in both physical and psychological ways, including:

• Mood swings
• Loss of appetite
• Noticeably altered sleep pattern
• Constant headaches
• Memory problems
• Chest pains

As sedative use becomes the driving force behind the majority of someone’s decisions, they will also begin to exhibit certain behaviors that act as clear signs of a growing sedative addiction, as well as a general substance use disorder. Some of these behaviors include:

• A substantial decline in school or work performance
• Difficulty performing everyday tasks
• Prioritizing drugs over responsibilities or relationships
• Attempting to justify or rationalize sedative abuse
• Legal problems caused by sedative abuse
• Missing money or valuable to pay for sedatives
• Lying or being secretive about sedative use
• Significant lack of concern for personal hygiene and appearance

If you have experienced these signs and behaviors of yourself or observed them in someone you know, they are a clear indication of sedative addiction and that you need to seek professional addiction help and treatment as soon as you are able. Doing so will avoid further abuse and mitigate the psychological and physical damage it may have already caused.

What Is Involved in Sedative Addiction Treatment?

Sedative addiction treatment must begin with detox in order to flush out the z drugs in someone’s system, along with any harmful toxins and substances associated with them. Detox must come first to ensure that someone is sober and fit both physically and psychologically to start their addiction recovery program.

Whether it is done on an outpatient or residential basis, generally the determination is by the severity of someone’s sedative addiction.

If they need medical monitoring or not, detoxing should always be done with at least some level of intervention and supervision from a professional medical detox center. This both ensures your safety and gives you the highest chance of a successful detox without relapsing.

Sedative detox withdrawal means a doctor can put you on a tapering schedule and slowly wean you off of the z drug you’ve become dependent on until it is safe to stop using it, without the risk of triggering a seizure or other health complications.

Once detox has been completed and the withdrawal period is over, the next step should always be entering into a recovery treatment program. Again, this can be done either as an inpatient or outpatient, but it must be done to make any kind of progress toward successfully managing your sedative addiction in the long-term.

While it’s true that your body will have flushed out all of the sedatives, this doesn’t do anything to curb the addictive behaviors that led to dependency in the first place. It will only act as a band-aid until the actual underlying issues at the root of your addiction are addressed and understood. An addiction rehabilitation treatment program is crucial to the recovery process being able to maintain long-term sobriety.

Typically, a client will work with their counselor and the facility staff to customize a treatment plan that will work best for them. They can choose from a variety of treatment programs, including support groups, counseling, and different types of therapies.

Sedative Withdrawal

Sedative withdrawal symptoms are caused by your brain’s reliance on the sedative chemicals that you have been taking. Sedatives can work in the brain by a variety of methods, but they all work to suppress the nervous system. Most of them affect GABA, so they suppress excitability and promote sleep and relaxation.

However, over time, your body will start to get used to the drug, and it may even try to counteract it to balance brain chemistry. It may do this by decreasing its natural inhibitory and increasing excitatory chemicals. As your brain adapts to the drug in your system, you may begin to need it to feel normal. If you stop taking it, you’ll feel uncomfortable withdrawal symptoms.

Like other central nervous system depressants, sedatives can cause potentially life-threatening withdrawal symptoms. As you become chemically dependent, your body will try to counteract the drug with exciting chemicals.

If you stop taking the drug abruptly, it can cause your nervous system to become overactive, causing you to feel jittery and nervous.

Other symptoms can include the following:

• Restlessness
• Tremors
• Muscle twitching
• Nausea
• Sweating
• Insomnia
• Irritability
• Depression
• Anxiety
• Seizures
• Confusion

Non-benzodiazepine sedative sleep-aids are less likely to cause severe symptoms than benzos, barbiturates, or alcohol. But high doses can lead to dangerous withdrawal symptoms, especially if you used a high dose for a long time and then quit suddenly.

You are also more likely to experience severe symptoms if you’ve been through depressant withdrawal before. Depressant withdrawal symptoms can cause what is called kindling. Kindling is a neurological phenomenon where sedative withdrawal leaves changes in the brain that can make subsequent withdrawal periods more intense.

Dangerous symptoms include seizures and delirium tremens. Seizures aren’t typically deadly on their own, but they can come on suddenly, causing serious injuries. In some cases, they can cause dangerous complications on their own.

Delirium tremens is a condition marked by sudden and severe confusion, terror, tremors, chest pains, catatonia, and sometimes death. Medical treatment significantly improves your odds of getting through withdrawal without encountering intense symptoms.

How Dangerous are Sedatives?

As mentioned previously, even just regularly prescribed sedative use can still have dangerous side effects, including:

• Blackouts
• Memory loss
• Unconscious behavior (sleepwalking, sleep-eating, etc.)
• Suicidal thoughts and behavior

These side effects also can become magnified when sedatives are abused in excess, especially in unintended ways, such as crushing up tablets and snorting them. For Ambien, in particular, there have been studies that have shown how addiction can lead to many different unpleasant and potentially dangerous unconscious behavior. People misusing Ambien were reported to have bouts of not only sleepwalking but also engaging in sexual activity, cooking, and even driving.

Another danger of sedative addiction is what is known as “rebound insomnia,” which is when someone attempts to stop using sedatives and experiences their old symptoms of insomnia, except now significantly worse and much stronger than the symptoms they might have experienced before abusing z drugs.

Rebound insomnia can easily leave someone trapped in a destructive cycle of addiction and withdrawal as they unsuccessfully attempt to quit using sedatives. This only serves to highlight the importance of undergoing sedative detox in the care of a medical detox professional to avoid relapse.

It is also not only possible to overdose on non-benzo sedatives but extremely likely due to the fact that many of the symptoms of a sedative overdose are similar to the effects these drugs are meant to elicit, including:

• Drowsiness
• Slowed reflexes
• Heaviness in limbs

But also, there are symptoms of z drug overdoses that should definitely stand out, including:

• Difficulty breathing
• Anxiety
• Trembling
• Hallucinations
• Nausea due to lack of oxygen in the bloodstream

If you experience these symptoms or observe them in someone else then it is imperative that emergency medical assistance be sought as soon as possible. The consequences could be fatal, especially in the case of breathing problems, which could lead to someone becoming comatose or even experiencing organ failure due to a lack of oxygen.

Start Your Journey to Recovery Today

If you or someone you care about is suffering from a dependence on sedatives and ready to take first steps towards recovery and a better, sober tomorrow, The Palm Beach Institute can help. We offer medical detox treatment with a seamless transition into ongoing care through to our post-treatment alumni program.

Sources

Modesto-Lowe, V., Huard, J., & Conrad, C. (2005, May). Alcohol withdrawal kindling: Is there a role for anticonvulsants? from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000183/

Inagaki, T., Miyaoka, T., Tsuji, S., Inami, Y., Nishida, A., & Horiguchi, J. (2010). from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3067983/

Sleep and Sleep Disorders. (2017, May 02). from https://www.cdc.gov/sleep/data_statistics.html

Substance Abuse and Mental Health Services Administration, & Center for Behavioral Health Statistics. (2015). Prescription Drug Use and Misuse in the United States: Results from the 2015 National Survey on Drug Use and Health. from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR2-2015/NSDUH-FFR2-2015.htm

U.S. National Library of Medicine. (2019, July 10). Delirium tremens: MedlinePlus Medical Encyclopedia. from https://medlineplus.gov/ency/article/000766.htm