Americans, by and large, are no strangers to being unable to get a good night’s sleep. According to the U.S. Centers for Disease Control and Prevention (CDC), there are an estimated 70 million adults in the United States currently suffering from a sleep-related disorder.
In the years before the rapid and widespread rise of prescription drug abuse and the deadly overdoses that often follow, benzodiazepines, drugs like Valium, Klonopin, and Xanax that are primarily used to treat anxiety, were the go-to medications for treating insomnia and other sleep disorders.
However, as the high risk of addiction and abuse these drugs carried with them became more and more apparent, prescriptions for benzos to treat sleep issues saw a sharp decline in favor of non-benzodiazepine sleep aids like Ambien, Lunesta, and Sonata, otherwise known as “z drugs.”
These sedatives seemed like the perfect answer to benzodiazepine medications, working in almost the same way as benzos do in how they alter the brain; but with a significantly lower risk of dependency and other adverse effects.
In fact, z drugs were so heavily embraced as the safe alternative to benzos that, according to the U.S. Food and Drug Administration (FDA), there were about three million people taking Lunesta in 2013. Ambien was ranked among the top 20 most prescribed drugs in the country in 2016.
Ironically, it’s the common association of non-benzodiazepine sedatives as the “safe” option when it comes to treating insomnia and other sleep disorders that make them dangerously easy to misuse to the point of physical and psychological dependence and significant potential harm.
More than 21 million Americans have reported as having abused non-benzo prescription sedatives at least once in their lives. They often overlook concerning side effects of many sedatives, such as depression, general disorientation, sleep-walking, sleep-eating, even sleep-driving in some cases, as well as significant memory loss.
Many people will abuse these sedatives recreationally, mixing them with alcohol and other substances. Some even use them to come down from amphetamine highs, or even just to force themselves to stay awake to achieve hallucinatory effects.
But even to people who are, initially at least, taking these sedatives for their intended purpose, they still pose a substantial risk because the majority of them are only meant to be used for a short time. Ambien is medically recommended to be taken as five pills a week for 12 weeks at the lowest effective dose, and Lunesta for only up to 10 days, at a strictly controlled dose.
The reason for these limitations is that people can find themselves building up a tolerance to z drugs within just days of regular and consistent use. As someone grows to tolerate these sedatives, requiring more to achieve the same effects, they are more likely to abuse them, taking larger doses for longer periods, since they are considered safe and not carrying any serious consequences.
It only takes a brief period of regular misuse for someone to quickly become dependent on them, especially if crushed and snorted or injected as opposed to taken in tablet form. An individual abusing Lunesta can develop a full-blown addiction in just two weeks.
How Sedatives Affect The Brain
As previously mentioned, non-benzodiazepine sedatives work in much the same way as their benzo counterparts, binding themselves to a neurotransmitter in the brain called gamma-aminobutyric acid, or GABA.
GABA is a chemical in the brain that is responsible for regulating how the body responds to fear, anxiety, and stress. What GABA does is block these nerve impulses from reaching the brain. Essentially, GABA’s job is to help keep you calm.
What benzos do is increase the amount of GABA in the brain, flooding it in order to create a significantly stronger feeling of sedation, which is how it counteracts anxiety and can be used to get high.
While z drugs also affect the levels of GABA in the brain, they are much more selective. Instead of binding with any GABA receptors and increasing them, non-benzo sedatives like Ambien target specific GABA receptors that are specifically related to initiating sleep and creating more of those.
Because of this, the user will generally feel less intense effects and not as much of a potentially dangerous “sleep hangover” the next morning that comes with using benzos to treat insomnia.
Even though these sedatives are less dangerous because they do not alter the amount of GABA in the brain as much as benzos do, regular abuse of z drugs beyond the recommended dosage is still enough to make the brain produce less GABA on its own and become dependent on the sedative to provide it.
One of the most serious and potentially deadly situations that can happen during sedative withdrawal is when someone tries to stop taking a medication like Ambien or Lunesta all at once. This may not seem particularly dangerous since they’re just sleep aids, but it should be avoided at all costs.
When heavy users abruptly stop taking sedatives altogether, the sudden cessation of GABA causes the levels in the brain to crash, throwing both brain and body into shock, potentially triggering life-threatening seizures.
In order to avoid this danger, it is highly recommended that someone attempting a sedative detox do so in the care of a professional medical detox center. A doctor can place them on a tapering schedule, which slowly reduces the dosage until it is safe to stop taking it.
Types of Sedatives
There are several types of sedative medications available to individuals. These can range from benzodiazepines, barbiturates, or newer substances known as Z-drugs. Prescription sedatives are central nervous system (CNS) depressants. Their sole intention is to calm an overactive nervous system. Benzodiazepines are some of the most commonly prescribed drugs in the world, and they treat insomnia, anxiety, and seizures. Xanax and Valium are the two most common benzos.
Barbiturates, another potent type of sedatives, are not prescribed as frequently as benzodiazepines. Benzos were created to replace barbiturates due to their high potential for misuse and addiction. They are still used in hospital and veterinary settings and can be prescribed in severe cases of anxiety, tension, or sleep disorders. Barbiturates are used in the controversial assisted-suicide, which highlights their strength. The most common barbiturate drugs are Phenobarbital and Mephobarbital.
The newest class of sedatives, which are known as Z-drugs, are designed for insomnia. Drugs like Ambien and Lunesta are designed to work on specific receptors in the brain that allow someone to fall asleep and stay asleep.
While these medications are effective in treating anxiety or sleep disorders, they are potent and can be addictive. If a person misuses them on a long-term basis, it can lead to dependency, addiction, and increased risk of mental issues. Unfortunately, those who try to abstain or cut back their dose may experience withdrawal symptoms. These can be especially dangerous due to how they interact with GABA.
Signs of Sedative Abuse
The misuse and abuse of prescription sedatives in the United States is dangerous. The trend continues to grow, and nearly half of all Americans over the age of 12 take prescription pain relievers, sedatives, tranquilizers, or stimulants. Sixteen percent of the time, the drugs are misused by about 19 million Americans.
While it may be common, it’s not always obvious when someone is using sedatives. Some physical signs of misuse can include:
- Slurred speech
- Increasingly aggressive behavior
- Depressed state
- Suicidal behavior
- Dilated pupils
What You Can Expect From Sedative Withdrawal
Because z drugs affect the brain in much the same way as benzos do, they share many of the same withdrawal symptoms of drugs like Ativan, Librium, or Klonopin. However, what is usually the most intense symptom of sedative withdrawal is unique to these z drugs: rebound insomnia.
Once the sedatives have left your system and the body struggles to handle the loss of GABA, those in withdrawal can expect bouts of rebound insomnia.
The difference between the insomnia someone might have been experiencing before taking sedatives and rebound insomnia is that rebound insomnia will be significantly worse and more intense than the sleep issues they were dealing with, prior to using and can have the effect of total sleeplessness for sometimes days on end.
Other common symptoms to expect over the course of sedative withdrawal include:
- Anxiety and panic attacks
- Mood swings
- Periods of uncontrollable crying
- Increased sweating
- Extreme fatigue
- General insomnia and rebound insomnia
- Abdominal pain
- Vivid and upsetting dreams and nightmares
- Elevated heart rate
Although not as common as the above symptoms, some people may also experience sedative withdrawal symptoms such as hallucinations, delirium tremens (DTs), and seizures.
Sedative Withdrawal Timeline
While there is an established sedative withdrawal timeline that will match up with most people’s detoxing experience, when it comes to determining the sedative withdrawal timeline for a given individual, there are a variety of factors to consider, including general ones like:
- How long someone has been abusing this sedative
- How much of it they were taking
- How they were taking it
- If they were abusing sedatives with other drugs or alcohol
- If they have a history of previous addictions
- If they have a co-occurring disorder or other mental health issues
- The overall state of their current health
- Whether they are detoxing on a tapering schedule
It also matters which sedative they were abusing. For example, extended-release Ambien is meant to release its effects over a long span of time, and so it has a much longer half-life, which means it could as long as several days before withdrawal symptoms appear, and a much longer withdrawal timeline in general.
On the other hand, Lunesta is only meant to induce sleep, not maintain it, so its half-life is only six hours, which means that someone could start experiencing symptoms in as little as 12 hours after their last dose.
Keeping these important factors in mind, someone’s sedative withdrawal timeline will usually resemble the following:
- 12 to 48 Hours: Z drugs with a shorter half-life will have withdrawal symptoms appearing within the first 12 to 24 hours of the last use, while other ones that take longer to leave the body might not appear until a couple of days later. These early symptoms will include mood swings, anxiety, and rebound insomnia.
- 7 to 10 Days: Depending on the sedative, over the course of the following days into the next week, both the psychological and physical symptoms will have appeared and eventually reach their peak, with worsened rebound insomnia. This period is when people are usually their most vulnerable to relapsing.
- Two to Three Weeks: Either by roughly the second or third week, the majority of the symptoms will either have disappeared or become much easier to manage. However, symptoms of anxiety, mild depression, and rebound insomnia will most likely still be present.
- One Month and Beyond: Somewhere between the third week and a month, the symptoms of sedative withdrawal will have passed, though in some cases, symptoms of insomnia and anxiety can persist several months after stopping the use of sedatives.
There is also the possibility of experiencing what is known as post-acute withdrawal syndrome, or PAWS. PAWS is a secondary withdrawal phase that can persist months after someone has detoxed from sedatives and include symptoms such as random bouts of drug cravings, unstable moods, suicidal thoughts, and issues with coordination and balance.
What are the Sedative Withdrawal Treatment Steps?
The best way to treat sedative withdrawal that both ensures your safety and gives you the highest chance of a successful detox without relapsing is by doing it at a professional medical detox center.
This way you can avoid the dangers of detoxing at home, as you will be monitored around the clock by experienced medical staff who can provide medication to help ease withdrawal symptoms and make the process as painless as possible.
“Getting sedative withdrawal treatment at a medical detox center also means that 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. ”
Once the withdrawal period is over, the next step should be entering into a recovery treatment program. While 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.
In order to avoid relapse and truly address the issues behind addiction, a rehabilitation treatment program is crucial to the recovery process and 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, choosing from a variety of treatment programs, including support groups, counseling, and different types of therapies.