Prescription medication can get you through a few sleepless nights and back on track, but experts agree: They're not the best choice for the long-term.
But if you're getting the best sleep you've had in months while using a nightly prescription, why (and when, and how) should you stop? The answer to these questions is different for everyone—and something you should decide with the help of your doctor.
Short-term vs. long-term
Short-term insomnia is a sudden, brief inability to sleep well, often brought on by troublesome events such as an impending divorce or a sudden medical ailment. In these cases, a short regimen of sleeping pills can help you get some good, quality rest—and work on better sleep habits—to avoid the process by which acute insomnia can become chronic.
"Pills can work wonders during a short period of stress," says Michael J. Sateia, MD, chief of sleep medicine at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. "Doctors need to manage for the short-term, to prevent patients from falling into the cycle. It's an ounce of prevention versus a pound of cure."
If you're still taking pills after a month and having trouble falling asleep without them, it's time to talk to your doctor again. (You'll have to anyway, to get a new prescription, so that's the time to consider other options.)
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Safety and efficacy
There don't seem to be any serious safety concerns in terms of taking sleep medication long-term: While most hypnotics are approved for short-term use only, many doctors prescribe them for longer. Among medications approved for long-term use (Ambien CR, Rozerem, and Lunesta), some have been studied for up to two years, with very little risk of abuse or tolerance.
Occasional side effects, such as daytime sleepiness, headache, and strange nocturnal behaviors, can occur at any time while taking these drugs, so it's important to weigh the benefits against the risks over any period of time.
For some patients, sleep meds will work indefinitely. For others—like Jo Dickison, 38, an executive assistant in Washington, D.C., who cycles regularly between Lunesta and Ambien—the drugs can start to lose effectiveness in as little as three weeks.
Studies show that cognitive-behavioral therapy and simple lifestyle changes are generally better than prescription medications at curing long-term insomnia. Spending a few sessions with a therapist can usually teach you techniques that you can refer back to—free of charge, without a prescription—for years to come.
"With drugs it can become a constant reliance," says Ralph Downey III, PhD, director of the Loma Linda University Sleep Disorders Center in California. "We don't want people in the middle of the desert without pills, having nothing to fall back on."
There will always be patients, however, who don't want to devote the time to therapy or change their habits; for those people, continuous sleep medication may be their treatment of choice. Ultimately the choice should be yours, with the help of your doctor.
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Transitioning off sleep medication
Laura, 36, had been taking prescription sleeping pills every night for about a year and a half when she decided to end her dependence on medication. "It wasn't easy to get the same prescription month after month, but I went to a few different doctors and always managed," says the marketing executive from Atlanta. "It was incomprehensible to think that I could get to sleep without medication, and that worried me."
"I'm in a new relationship and popping pills every night was just an unattractive quality," she says. "Plus I know that I'm going to want to get pregnant one day, and not have to worry about drugs in my system."
Laura visited a sleep specialist, who started her on a series of cognitive-behavioral therapy modifications aimed at weaning her off medication. Her first step was to switch to a weaker sedative.
"It stopped my mind from racing and I fell asleep easily enough, but it only stayed in my system for two or three hours," she says. "So now I'm up in the middle of the night, aggravated, not able to fall back asleep." That's where her learned behavioral techniques—not watching the clock; getting out of bed if she can't sleep—comes into play.
The last few months without medication have been rough for Laura; she's gotten sick a lot because, she believes, her immunity is down. But she's slowly training her body to adjust and hopes that a year from now she'll be sleeping soundly through the night.
"I think you have to be in the state of mind that you really want to make a change," she says. "For a long time I was very happy just taking a pill and being put into a very deep sleep. But now I have different motivations, and that's what is going to make it work."
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