Are sleeping pills harmful in the long term?
Long-term use of classic sleeping pills increases the risk of dependence, cognitive decline, and impaired driving ability. Therefore, do not use them for longer than two to four weeks, and discuss alternatives with your doctor if you are already a long-term user.
Classic sleeping pills (benzodiazepines) have been shown to be safe for up to two to four weeks. After that, the balance no longer holds. Yet short-term use often grows into long-term use: in a Japanese cohort study of nearly 4,000 new users, 1 in 10 people were still taking the pills after twelve months. Older age, a high starting dose, and concurrent use of antidepressants were the strongest predictors of that pattern1.
Physical dependence with long-term use is well established. There are two forms: dependence that arises from the treatment itself at low doses, and abuse at high doses. Both problems have been present for fifty years, yet are still underestimated by many prescribers2.
Long-term use also impairs your cognitive functioning. Attention, reaction speed, and the ability to plan and make decisions decline measurably, even in people who have been using these medications for years. On public roads, users drove less stably, with more lane deviations. Notably, with use lasting longer than three years, on-road driving performance appeared to improve slightly, probably due to habituation, but the cognitive deficits remained fully present3. A driving simulator study found no demonstrable difference, but the groups were small, so that evidence carries little weight4.
Whether long-term use causes lasting changes in the brain has not yet been adequately studied. It is taken seriously as a question, but an answer is not yet available.
Newer sleeping pills, the so-called z-drugs such as eszopiclone, perform somewhat better than classic benzodiazepines. Eszopiclone helps you fall asleep an average of 12 minutes faster, results in 17 minutes less time lying awake, and provides 28 minutes more sleep per night, based on moderate-quality evidence5. Side effects do occur: an unpleasant aftertaste (18% more often than with placebo), dry mouth, daytime drowsiness, and dizziness. Extra caution is warranted in older adults. Z-drugs appear on the whole to produce tolerance and withdrawal symptoms less readily than classic benzodiazepines, but this has been described in a narrative review and has not been demonstrated in direct comparisons6.
All claims are based on PMID 21714826 (review of benzodiazepines, dependence and cognition), PMID 31837049 (on-road driving test and cognition in long-term users), PMID 38996033 (driving simulator study, small groups), PMID 31786448 (Japanese cohort study of risk factors for long-term use), PMID 30303519 (meta-analysis of eszopiclone), and PMID 11716908 (narrative review of z-drugs). No randomised long-term safety studies are available; most findings on harm are observational or review-based.
Chronic sleep deprivation: how harmful is it for weight and hormones?
Chronic sleep deprivation disrupts your hormones and metabolism after just a few nights. Structurally sleeping too little increases the risk of weight gain, muscle loss and diabetes.
Does poor sleep really shorten your life?
Consistently sleeping too little is associated with a measurably higher risk of earlier death and serious illness; the evidence is strongly associative, so aiming for seven to eight hours of sleep per night is sensible, especially if you also get little exercise.
How dangerous is sleep apnoea?
Untreated sleep apnoea demonstrably increases the risk of stroke, heart problems, and accidents. If you have symptoms that may point to it, get checked by your general practitioner.
Is it safe to take melatonin every night?
For healthy adults, melatonin is relatively safe with short-term use, but as a sleep aid for chronic insomnia it works considerably less well than standard sleep medicines. Pregnant women, breastfeeding women, and children outside a medical indication are better off avoiding it.
What does alcohol do to your sleep?
Alcohol helps you fall asleep faster, but measurably disrupts the rest of your night, even with just two drinks. If you want to sleep better, drinking less or no alcohol before bed is the most effective step.
How bad is screen light in the evening for my sleep?
Screen light in the evening disrupts your sleep hormone and keeps you less sleepy at the wrong moment. Dim your screens after dinner, or wear amber-tinted glasses if you still need to work.