Understanding Dependence and Addiction: Should You Worry About Sleep Medication?

If your sleep problem has become serious enough that you've decided to see a doctor, a prescription sleeping pill is likely one option he or she will suggest. Medication can be a great help in getting you over a temporary sleep issue and back on track with your regular schedule, but you may still have some reservations about taking it.

Can you get hooked?
All drugs come with the possibility of side effects, and many people worry about sleep medication's potential for abuse and long-term consequences. You may worry about dependence—becoming physically reliant on the pills and not being able to sleep without them.

But the risks among those who take hypnotic medications for insomnia (as opposed to using them to appease anxiety or to come down off illegal drugs) are extremely low: In a 1996 University of Minnesota study, researchers followed 170 people with serious insomnia or other sleep disorders who took the benzodiazepine drug clonazepam (brand name Klonopin) for 12 years. Only four people were reported to have misused their medications.

"I've been doing this thirty-odd years," says Mark W. Mahowald, MD, a sleep specialist at the University of Minnesota, "and the number of patients I've seen who've gotten in trouble with these drugs is not even a handful."
The risks for nonbenzodiazepines, newer hypnotic medications on the market, are even lower. In a 2003 German review of global medical literature, there were only 36 reports of Ambien abuse, despite the fact that in 2001-2002 alone, more than a billion Ambien tablets were prescribed in Europe, Japan, and the United States.

And the newest sleep medication on the market, Rozerem (ramelteon), is reported to have the lowest risk of all: In clinical trials there was little evidence to suggest the potential for abuse or tolerance, which allows the drug to not be classified as a controlled substance as other sleep medications are.

Psychological dependence
There is the chance, however, that taking sleep medications long-term can mask the real cause of your insomnia—such as poor sleep habits or too much stress in your life. Patients often tell their doctors that they are dependent on their medications: They just can't imagine ever falling asleep without them because they haven't addressed the real issues.

Jo Dickison, 38, takes a constant stream of medications, alternating between Lunesta, Ambien, and over-the-counter sleep aids—and when she doesn't take anything, she can't sleep. "I'm not physically dependent," says the executive assistant in Washington, D.C., "I'm psychologically dependent. They put my mind more at rest. I'd rather have that than be a frazzled basket case."

In these cases, a gradual transition off of sleep medication may be your best option, while cognitive-behavioral therapy helps retrain your brain and body to fall asleep naturally.