Do sleeping pills work long term?

The evidence that sleeping pills keep working over months and years is thin, and the major guidelines recommend cognitive behavioral therapy for insomnia (CBT-I) first. The US labels say short-term, but in a national survey, 85% of the Z-drugs people used for sleep had been taken for six months or more.

In trials, most of which last a few weeks, the pills do modestly better than a placebo, and the gains tend to fade once people stop.

By sleeping pills we mean the two older kinds. Those are benzodiazepines, like temazepam (Restoril) and triazolam, and the Z-drugs, which are zolpidem (Ambien), eszopiclone (Lunesta) and zaleplon (Sonata). Other benzodiazepines, like lorazepam (Ativan), clonazepam (Klonopin) and alprazolam (Xanax), are mostly prescribed for anxiety and some people take them for sleep. What's here on dependence and stopping applies to them too. Newer kinds work differently and aren't covered here.

Don't stop or cut down a sleeping pill on your own. Stopping some of them suddenly, benzodiazepines above all, can bring on seizures and severe withdrawal. To come off one, ask whoever prescribes it about a slow taper, and about CBT-I while you do it. The FDA makes one exception. If zolpidem, eszopiclone or zaleplon has made you sleepwalk, drive or do things you can't remember, stop taking it and call your prescriber right away. If you take something for sleep, take it only as prescribed and talk to your doctor before changing it.

How long are sleeping pills meant to be taken?

The US labels for temazepam and zolpidem say not long. Temazepam's is for short-term treatment, "generally 7 to 10 days." Zolpidem's says long-term use isn't recommended and treatment should be as short as possible, because the risk of dependence grows the longer it goes on. The trials behind those labels ran two weeks for temazepam and four to five for zolpidem.

People take them for far longer than that. A US national health survey had interviewers look at people's medicine bottles. Of the 94 Z-drugs it recorded in 2013 and 2014 that people used for sleep, 85% had been taken for six months or more. Benzodiazepines used for sleep were about the same. From 1999 to 2014, Z-drug use went up fourfold, and almost all of the rise came from people on them for more than six months.

What do the guidelines recommend first?

The three main insomnia guidelines, from the American College of Physicians (2016), the American Academy of Sleep Medicine (2017) and Europe (2023), all put CBT-I first for chronic insomnia, meaning trouble sleeping three or more nights a week for three months or more.

The ACP calls CBT-I first a strong recommendation. Its advice on pills is weak and rests on low-quality evidence. For someone CBT-I alone hasn't helped, it suggests deciding with a doctor whether to add one for a short time. The AASM rates every one of its recommendations for a specific drug as weak, because the evidence is so uncertain, and says a weak rating doesn't mean a drug doesn't work. The European guideline allows benzodiazepines and Z-drugs for up to four weeks when CBT-I isn't enough, and longer only in some cases.

How much do sleeping pills help?

Across 13 trials with 4,378 adults submitted to the FDA, Z-drugs got people to sleep 22 minutes sooner than a placebo did in the sleep lab. Compared with before treatment they fell asleep 42 minutes sooner, so about half of the improvement also happened on the placebo. By their own reports, they fell asleep only 7 minutes sooner than on the placebo. The researchers called the drug's effect small and of questionable clinical importance.

For benzodiazepines, a review pooled 45 trials, most lasting a week or two. By their own reports, people on the pills slept about 48 minutes longer than on a placebo and fell asleep about 14 minutes sooner. Sleep recordings were scarcer. In 4 trials with 159 people they didn't fall asleep significantly sooner, and in 2 small trials with 35 people they slept about an hour longer. Daytime drowsiness and dizziness were more common than on a placebo, and several trials reported memory problems.

Do they keep working?

Whether sleeping pills keep working past a few weeks is hard to say, because so few trials run that long. Most of those in the AASM's review lasted between a day and five weeks, and every trial in the benzodiazepine review ran 14 days or less. The AASM notes that some longer studies of the Z-drugs found them safe and effective under properly controlled conditions. It allows long-term use for people who can't get CBT-I or didn't benefit, as long as the pill is still working and a doctor checks on them regularly.

Tolerance means a pill does less over time. Rebound insomnia means sleeping worse than before once you stop. Both vary by drug. In a review of 75 sleep-lab studies, which included 804 people with insomnia, triazolam showed clear tolerance and intense rebound on the first night off, and zolpidem only marginal tolerance and mild rebound.

Can you get dependent on sleeping pills?

Yes, you can become dependent on a sleeping pill even taking it as prescribed. The FDA says physical dependence on benzodiazepines can develop after taking them steadily for several days to weeks. Stopping suddenly or cutting down too fast can cause withdrawal, including seizures that can be life-threatening, and some people have had withdrawal symptoms for many months. Combined with opioid painkillers or alcohol, benzodiazepines raise the risk of overdose and death.

Since 2020 every benzodiazepine has carried the FDA's most prominent warning, a boxed warning, on addiction, dependence and withdrawal. Withdrawal has also been reported after people stopped zolpidem suddenly or cut the dose quickly, according to its label.

What are the FDA's warnings on sleepwalking and sleep driving?

In 2019 the FDA put a boxed warning on all three Z-drugs about sleepwalking, sleep driving and doing other things while not fully awake. Some people were seriously hurt or died. The FDA calls these injuries rare. It can happen after the first dose or any later one, according to zolpidem's label.

When that happens on one of the three, the FDA's advice is to stop taking it and call your prescriber right away, and it tells doctors not to prescribe any of the three to you again. It's the one case on this page where stopping comes before the call. Tell them how long and how much you've been taking, since stopping suddenly after long nightly use can bring on withdrawal. Benzodiazepines can cause sleep driving too, and temazepam's label says to tell your doctor immediately. On a benzodiazepine, call the same day, before your next dose, and don't stop it on your own.

Zolpidem can also impair driving the next morning, more so after less than 7 to 8 hours of sleep, and its label says not to drive until you know how it affects you. If you're drowsy, don't drive.

Are sleeping pills safe for older adults?

The Beers Criteria, the American Geriatrics Society's list of medicines that may be inappropriate for people 65 and older, says to avoid both benzodiazepines and Z-drugs, and rates that advice strong, meaning the harms clearly outweigh the benefits. For benzodiazepines it lists a higher risk of memory and thinking problems, delirium, falls, fractures and car crashes. Z-drugs carry similar risks, it says, while doing little for sleep. For someone already taking one, Beers says coming off takes a plan, often a slow taper with an eye on withdrawal, and the 2025 tapering guideline says doctors should generally taper benzodiazepines in older adults. Don't stop one on your own.

For people 60 and over, sleeping pills added about 25 minutes of sleep a night by their own reports, with slightly fewer wakings, across 24 short-term trials with 2,417 people. Side effects on thinking were nearly five times as common as on a placebo, and daytime tiredness nearly four times. The authors concluded that over 60, the benefits may not justify the risk.

Older adults have often stayed on them for months anyway. US pharmacy records from 2008 show 8.7% of people aged 65 to 80 filled a benzodiazepine prescription, for any reason, and 31% of them were on it for 120 days or more.

How does CBT-I compare?

In the long run CBT-I did better than pills across the five trials in a 2012 review that compared them head to head, on low to moderate quality evidence. Benzodiazepines may have the edge in the short term, though that evidence is very low quality.

A trial in older adults followed 78 people with chronic insomnia, average age 65, through eight weeks of CBT-I, temazepam, the two together or a placebo. All three treatments beat the placebo by the end. Over the next two years, people who'd had CBT-I on its own kept their gains and those on the pill alone didn't. Results for the two together were more mixed.

You can do CBT-I on your own with free programs and apps, and that guide lists who should check with a doctor first.

How do you come off a sleeping pill?

Coming off a sleeping pill means a slow taper, planned with whoever prescribes it. A 2025 guideline on tapering benzodiazepines, from the American Society of Addiction Medicine and nine other medical groups, says not to stop them abruptly in anyone likely to be dependent. The goal can be stopping, or a lower dose where the risks no longer outweigh the benefits. It recommends offering CBT-I during a taper, and says Z-drugs, which it doesn't cover, may carry similar risks.

CBT-I seems to help people get off and stay off. In a trial of 65 adults with chronic insomnia, average age 67, who had taken a benzodiazepine every night for more than three months, 77% of those who had CBT-I with a supervised taper were off it at the end, against 38% with the taper alone. A year later it was 70% against 24%, checked with blood tests.

If you have bipolar disorder or epilepsy, or you're in the middle of a taper, check with your prescriber before starting a program that limits your time in bed. During a taper, a sleep diary shows you and your doctor how your nights are changing week to week.

Call 911 or go to an emergency room for a seizure, trouble breathing, or sudden confusion or seeing things that aren't there after stopping. If you're having thoughts of suicide or harming yourself, call or text 988 in the US, or your local emergency number.

Goodmorrow and sleeping pills

Goodmorrow doesn't recommend medicines and won't ask you to change one. A taper you've planned with your prescriber comes first. We coach one sleep habit for two weeks, then the next, each from CBT-I or sleep basics, with a check-in every morning. None of the habits is sleep restriction.