Sleeping Pill Safety: 10 Dos and Don'ts

Follow these guidelines if you take an over-the-counter or prescription sleep medicine.

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7. Don't drive a car or operate machinery after taking any kind of sleep product.

You won't be alert, so these activities can become dangerous.

8. Don't increase the dosage that your doctor prescribed.

With the older benzodiazepines, doctors worried about patients increasing dosages on their own as they became more tolerant, which could lead to physical addiction.

"There is no question that if one takes substantial quantities of benzodiazepines over periods of time and escalates dosage and stops those medications, there's a real possibility of serious withdrawal," Sateia says. "Those individuals are addicted and benzodiazepine withdrawal can be quite serious; it can be life-threatening."

That's much less of a problem with the newer GABA prescription drugs. "They've demonstrated a reduced abuse potential," Tomecki says.

Sateia agrees. "Individuals with chronic primary insomnia are able to take these medications in apparently quite safe fashion with continued effectiveness, without dosage escalation or evidence of significant withdrawal symptoms when stopped," he says.

But taking a higher dose than prescribed boosts the risk of complex sleep-related behavior, Sateia says.

9. Don't hide it from your doctor if you're taking other sleep products, including over-the-counter ones.

Sateia frequently sees patients combining prescription and over-the-counter sleep products. "The biggest problem is that really, their doctors don't know what they're taking, which introduces further potential for various 'drug-drug' interactions," he says.

Using more than one sleep product is also a red flag, Sateia says. "It usually represents a desperate attempt to find the right medication or combination of medications that are going to solve the problem. It's almost always a counter-productive strategy."

Instead, "People need to work closely with their doctors to identify an appropriate medication," Sateia says. For example, people may be losing sleep because they're struggling with pain or depression. They may need to treat these issues before they can sleep better.

10. Don't stop taking a sleep medication unless you consult your doctor first.

If you've been taking prescription sleep drugs for an extended period, don't stop abruptly, in order to avoid withdrawal symptoms such as anxiety, nausea, and muscle cramps.

Not everyone experiences withdrawal symptoms -- it depends, in part, on what type of drug you've been taking, how often, and for how long. But instead of taking matters into your own hands, ask your doctor whether you need to taper off the drug and how to do so.

That can be done in two ways, Sateia says. First, you can gradually reduce the frequency. If you take the drug nightly, you can pick one night of the week to skip it. When you've acclimated, then you can skip two nights and eventually wean off.

Or you can still take the drug nightly, but gradually reduce the dosage, Sateia says. But again, check with your doctor first.

WebMD Feature Reviewed by Louise Chang, MD on January 12, 2010



Michael J. Sateia, MD, professor of psychiatry and chief of the section of sleep medicine, Dartmouth Medical School.

Margaret H. Tomecki, PharmD FAPhA, senior manager of practice development and research, American Pharmacists Association.

National Sleep Foundation: "Sleep in American Poll Summary of Findings."

FDA: "Side Effects of Sleep Drugs." "Prescription sleeping pills: What's right for you?" "OTC sleep aids and supplements: What's best and safe?"

Mayo Clinic: "Insomnia treatment: cognitive-behavioral therapy instead of sleeping pills"

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