How to Stop Taking Sleeping Pills: A Guide For Insomnia Sufferers
Many individuals seeking Cognitive Behavioral Therapy for Insomnia (CBT-I) have a history with sleeping pills. Some have tried multiple medications, and many are currently taking them, longing to discontinue their use but feeling apprehensive about doing so.
There is a wide array of prescription and OTC pills that help with sleep. Many people eventually want to sleep without them. CBT for Insomnia with a sleep therapist in Austin can be the path forward.
A common question that arises in therapy is, "How and when should I stop taking my sleep aid?" As a member of the Society for Behavioral Sleep Medicine, I consulted with experienced colleagues early in my career to gather insights on this crucial topic. This post synthesizes their valuable advice.
Important Note: Any reduction or cessation of prescribed sleep medications must be done in consultation with your prescribing physician.
Finding Your Confidence: The Key to Discontinuing Sleep Medication
There isn't a single "optimal" time to stop taking your sleep medication. The best time is when you feel willing and confident to do so. I've observed that individuals who attempt to stop before they feel ready often experience a quick return of their sleep problems.
It's important to know that you don't need to be off sleeping pills to begin CBT-I. The therapy can still be effective. I've supported clients in coming off sleep medications at various stages of our work together.
As we discuss discontinuing sleep aids, it's helpful to consider your sleep self-efficacy.
The best time to come off your sleeping pills? When you feel ready and confident in your sleep ability. CBT-I with a sleep therapist in Austin can get you there.
What is Sleep Self-Efficacy?
Sleep self-efficacy refers to your level of confidence in your ability to:
Lie in bed and feel physically relaxed.
Lie in bed and feel mentally relaxed.
Lie in bed with your thoughts "turned off."
Fall asleep at night in under 30 minutes.
Wake up at night fewer than 3 times.
Go back to sleep within 15 minutes of waking during the night.
Feel refreshed upon waking in the morning.
Wake after a poor night’s sleep without feeling upset about it.
Prevent a poor night’s sleep from interfering with your daily activities.
CBT-I is specifically designed to help you achieve all of these. Typically, around the halfway point of our treatment, you'll start noticing improvements in these areas, and that's often a good time to begin thinking about coming off your sleep aid.
When Might Be a Good Time to Start a Taper?
It’s good to have a strategy for coming off your sleeping pills. A sleep therapist trained in CBT-I is a great partner to have.
These are some factors to consider, in no particular order, when contemplating a medication taper:
After You've Seen Progress in Treatment: When your sleep efficiency is high (ideally 85-90%) and you feel confident in the strategies learned through CBT-I.
Understanding Sleep Efficiency: Sleep efficiency is calculated as (Total Time Asleep / Total Time in Bed) x 100%. An optimal range of 85-90% generally indicates feeling rested. Many people with insomnia have a sleep efficiency below this.
As You Begin Sleep Restriction Therapy: This CBT-I technique involves limiting your time in bed to increase sleep drive and efficiency. Despite its name, it's about restricting time in bed, not restricting sleep itself. For example, if you average 6 hours of sleep, your initial time in bed might be set at 6.5 hours. Go here to learn more about how less time in bed can improve your sleep.
Prior to Expanding the Time-in-Bed Window: As sleep restriction therapy becomes effective and your sleep efficiency improves (often exceeding 90%), we gradually add back time in bed. This is a natural point to consider reducing medication.
When You Are Willing to Commit to One Full Week at a Reduced Dose: Are you ready to try a smaller dose consistently for at least a week? Again, always discuss this with your prescribing doctor, as some medications cannot be stopped abruptly due to potential health risks.
As an Austin sleep therapist trained in CBT-I, I can help you make a plan to eventually sleep without medication.
How to Manage the Tapering Process
Keep Medication Consistent Initially: Continue taking your sleep medication as prescribed until you and your doctor decide it's time to start tapering. It's generally better to take it daily rather than trying to skip doses early on.
The Pitfalls of "As Needed": Trying to take medication only when you feel you need it can backfire. It often leads to increased anxiety and hypervigilance around sleep, with constant self-monitoring ("Am I falling asleep yet? Should I take it now?").
Allow Time for CBT-I to Work: Experience the benefits of CBT-I, which will build your confidence in your natural ability to sleep.
Learn to Cope with Poor Sleep Nights: Bad nights happen to everyone, even those without insomnia. The key is not to panic or engage in behaviors that can worsen sleep in the long run, such as staying in bed longer, napping excessively, or going to bed earlier the next night.
Implement the Taper Gradually: Some prescribers might say you can simply stop your medication, meaning it's medically safe to do so. However, you may still experience discomfort or rebound insomnia. Don't hesitate to ask your doctor for a gradual tapering plan to make the transition smoother.
Ready to Sleep Without Medications?
CBT-I offers a path towards better sleep without relying on medication. Go here to learn more about how I work with insomnia, and go here to contact me about scheduling a free 15-minute phone consultation.
By implementing these strategies and, most importantly, working closely with your healthcare provider, you can navigate the process of how to stop taking sleeping pills safely and effectively, ultimately achieving more restful and natural sleep.