Coming Off Sleeping Pills: How to Taper Zolpidem, Zopiclone and Benzodiazepines Safely and Get Your Sleep Back
🌙 Most people on a nightly sleeping pill started it for a reason that made sense at the time — a bereavement, a hospital stay, a run of terrible nights. Months or years later the tablet is still there, it no longer does much, and stopping it feels impossible because the first night without it is awful. That awful night is predictable, temporary and manageable. This page is about getting through it.
📌 This is about the tablets taken specifically to get to sleep: the z-drugs (zolpidem, zopiclone, eszopiclone, zaleplon) and the benzodiazepine hypnotics (temazepam, nitrazepam, lorazepam, loprazolam and others). The general approach to insomnia without tablets is in what actually works for insomnia, and benzodiazepines taken for anxiety are compared in anxiety medication and which ones are non-addictive.
🤔 Why sleeping pills stop working
🧠 Both groups work on the same brain switch, the GABA-A receptor, which turns down activity in the brain. Within a few weeks of nightly use the brain adapts by turning that switch down itself. The tablet then mostly cancels out the adaptation instead of adding sleep, which is why the licence for most of them is two to four weeks.
🔎 What people experience after that is not that the tablet works, but that sleep without it is worse than it was before they ever started. That feels like proof the tablet is needed. In fact it is the adaptation showing itself — and it fades once the brain readjusts.
💊 Which tablet you are on changes the plan
📋 How quickly a drug leaves the body decides how sharp the rebound is and how much it carries into the next day. Short-acting drugs give a harsher rebound but less hangover; long-acting ones the reverse.
| 💊 Tablet | 📝 What matters when coming off it |
|---|---|
| 🌙 Zolpidem | Short-acting. Rebound is quick and short. Women clear it more slowly, which is why the recommended dose for women was halved. Linked to sleepwalking, sleep-eating and sleep-driving, which is a reason to stop on its own |
| 🌙 Zopiclone and eszopiclone | Short to medium. A bitter metallic taste the next morning is common. Next-day driving impairment is real, especially at higher doses |
| 🌙 Zaleplon | Very short-acting. Rebound is mild but anxiety in the evening can be noticeable |
| 💤 Temazepam, loprazolam, lormetazepam | Benzodiazepines with a medium action. Withdrawal is more pronounced than with z-drugs after long use, so the taper is slower |
| 💤 Nitrazepam, flurazepam, diazepam at night | Long-acting. Little rebound but a lot of next-day hangover, and it builds up in older people. Sometimes used as the drug to taper from when coming off a short-acting benzodiazepine |
| 💊 Lorazepam, alprazolam taken for sleep | Short-acting benzodiazepines meant for anxiety. Often the hardest to stop, because withdrawal shows between doses as well as at night |
⚠️ Reasons to come off sooner rather than later
🧓 For many people the trigger is not insomnia at all but a fall, a near-miss in the car, or a worried relative. The risks grow with age and with every other sedating medicine added.
🦴 Falls and hip fractures
Night-time trips to the bathroom on a sedative, especially over 65. Most geriatric guidance lists these drugs as ones to avoid in older people.
🚗 Next-morning driving
Impairment can last into the morning even when you feel fine. It is worse with higher doses, middle-of-the-night doses and in women on zolpidem.
🚶 Complex sleep behaviours
Walking, cooking, driving or calling people with no memory of it. Carries a boxed warning for z-drugs, and any episode means stopping.
🧠 Memory and concentration
Gaps for the hours after a dose, and daytime fogginess people blame on age.
🫁 Breathing
Combined with opioid painkillers, alcohol or untreated sleep apnoea, sedatives can slow breathing dangerously.
🚨 Never stop suddenly after long or high-dose use.
🔹 Stopping a benzodiazepine abruptly after months of regular use can cause seizures, as well as severe anxiety, confusion and, rarely, hallucinations. The risk is lower with z-drugs but not zero.
🔹 The safe route is a gradual taper agreed with your prescriber, which is also the route that works best.
🔹 If you have only taken a short course — a couple of weeks — stopping usually means a few rough nights and nothing more. Still ask first.
📉 How a taper actually works
📋 The principle is small steps, enough time between them for the brain to adjust, and slower steps near the end, where each cut is a bigger share of what is left. A common pattern is to reduce by about a quarter of the starting dose every two weeks, then by smaller amounts at the end.
📉 What each step down feels like
💭 Knowing the shape of it in advance is what stops people giving up on the second night. The pattern after each cut is the same: worse for a few nights, then back to where you were.
| 📅 When | 📝 What is typical |
|---|---|
| 🌙 Nights 1 to 3 after a cut | Rebound insomnia. Longer to fall asleep, more waking, vivid dreams. Often worse than before you ever took the tablet. This is the expected part, not a sign it is failing |
| ☀️ The days after | Some edginess, irritability, sensitivity to noise or light, a mild tremor. More noticeable with benzodiazepines than with z-drugs |
| 📆 Days 4 to 14 | Settling back towards how you were sleeping on the higher dose |
| 🏁 Weeks after the final dose | Sleep usually ends up no worse, and often better quality, than on the tablet. Dreams can be vivid for a while as deep sleep stages return |
| ⚠️ Longer-lasting symptoms | A minority of long-term benzodiazepine users have anxiety, poor sleep or odd sensations for months. A slower taper reduces this, and it does fade |
🛏️ The one thing that doubles your chances
📊 Tapering on its own works for about half of people. Tapering combined with cognitive behavioural therapy for insomnia (CBT-I) works for about three in four, and the gains hold up a year later because you have something to replace the tablet with.
💡 The core of CBT-I, in four rules
🔹 Fixed getting-up time, seven days a week, however the night went. This anchors the body clock.
🔹 Bed only when sleepy, not when it is “time for bed”.
🔹 Not asleep in about 20 minutes? Get up, sit somewhere dim and quiet, and go back only when sleepy.
🔹 Time in bed matched to time actually asleep, then widened as sleep consolidates. This is sleep restriction, and it is the most powerful part. It works through apps, books and online programmes as well as in person.
📨 Information alone gets people started
📄 In one trial, older people on long-term benzodiazepines were simply sent a booklet explaining the risks and a self-taper plan. Six months later, a quarter of them had stopped, against almost nobody in the comparison group.
💊 What can help sleep during and after the taper
🔎 Swapping one habit-forming sedative for another defeats the point. The options below do not cause the same dependence, and each fits a different kind of sleep problem.
| 💊 Option | 📝 Who it suits, and the catch |
|---|---|
| 💤 Low-dose doxepin | For waking in the night and early morning. At very low doses Sinequan (Doxepin) acts mainly as a gentle antihistamine, not as an antidepressant, and has not shown dependence or rebound. The sleep dose is far below the antidepressant dose, and your prescriber sets it |
| 🌙 Melatonin | Prolonged-release melatonin has a licence for insomnia over 55, and helps most where the body clock is involved. Restfine (Melatonin) and Altonil (Melatonin). Timing matters more than dose, as set out in melatonin dose and timing |
| 💤 Trazodone | Widely prescribed off-label for sleep, especially with anxiety or depression. The evidence for sleep alone is modest, and next-day drowsiness and dizziness on standing are common. Desyrel (Trazodone) |
| 😔 Mirtazapine | When poor sleep comes with depression and poor appetite, it treats all three. Weight gain is the usual trade-off. Remeron (Mirtazapine) |
| 🧪 Orexin receptor blockers | Newer prescription sleeping tablets that block the brain’s wake signal instead of sedating. Much lower dependence risk, though not available everywhere and costly |
| 🚫 Over-the-counter sleep aids | Diphenhydramine and similar sedating antihistamines. Tolerance develops within days, and in older people they cause confusion, constipation and urinary retention. Not a substitute |
| 🚫 Alcohol | Gets you to sleep and then wrecks the second half of the night. Particularly dangerous during a benzodiazepine taper |
😰 When the real problem is anxiety
💭 For many people the sleeping pill is really treating evening anxiety and a racing mind. If that is the case, the anxiety needs treating in its own right, or the insomnia comes back as soon as the tablet goes. Worry that keeps coming back at bedtime is explained in generalized anxiety disorder and the worry loop.
💊 Options that do not cause dependence include an SSRI antidepressant, Buspar (Buspirone), and psychological therapy. Starting one of these a few weeks before the taper makes the taper itself easier, because the background anxiety is already lower. What to expect in the first weeks of an antidepressant is in antidepressant side effects in the first weeks.
🔎 Rule out what the tablet was hiding
🩺 Sometimes a sleeping pill has been papering over a treatable cause for years. Coming off is a good moment to look for it.
Snoring, gasping, morning headaches. Sedatives make it worse. See obstructive sleep apnoea
An urge to move the legs in the evening, eased by moving them
Prostate, diabetes, evening fluids or a diuretic taken too late
Arthritis or back pain that wakes you needs its own treatment
Early waking with low mood is a classic sign
Afternoon coffee, steroids, some decongestants and inhalers
🧓 Older people, pregnancy and other special situations
| 👥 Situation | 📝 What changes |
|---|---|
| 🧓 Over 65 | The strongest case for stopping. Falls, confusion and next-day sedation are all more likely, and long-acting drugs accumulate. Tapering is usually slower and gentler |
| 🤰 Pregnancy or planning one | Regular use late in pregnancy can cause withdrawal and floppiness in the newborn. Discuss a plan before conception, rather than stopping abruptly when the test is positive |
| 💊 Also taking opioid painkillers | The combination slows breathing. Reducing the sedative is a priority, and an overdose-reversal plan is worth asking about |
| 🍷 Drinking regularly | Alcohol and sedatives add together. Cutting alcohol makes the taper easier and safer |
| 💢 Taking high or escalating doses | Taking more than prescribed, or from several sources, means the taper should be specialist-led, sometimes with a switch to a long-acting drug first |
🗿 Six beliefs that keep people on sleeping pills
| 💭 The belief | ✔️ What is actually the case |
|---|---|
| “I cannot sleep without it, so I must need it.” | That is rebound from the adaptation, not proof of need. It fades after the taper |
| “It still works, I sleep fine on it.” | On average it adds about 25 minutes. Much of the benefit people feel is avoiding the rebound |
| “I have been on it too long to stop.” | People stop successfully after ten or twenty years. Long use means a slower taper, not an impossible one |
| “Z-drugs are not addictive like benzodiazepines.” | They act on the same receptor. Tolerance, rebound and dependence happen with both |
| “The first bad night shows it is not working.” | One to three bad nights after each step is the expected pattern |
| “A herbal or over-the-counter pill will replace it.” | Sedating antihistamines lose effect within days. CBT-I is what actually replaces the tablet |
🚨 When to get help, and how fast
🚨 Urgently
A seizure · confusion, hallucinations or severe agitation after stopping · thoughts of harming yourself · slow or shallow breathing in someone taking sedatives with opioids or alcohol · driving, cooking or leaving the house during sleep with no memory of it
🟡 Within days
Withdrawal symptoms that are not settling two weeks after a step · anxiety or low mood getting steadily worse · a fall · next-morning drowsiness that affects driving or work
🟢 At your next appointment
Ask for a taper plan if you have been on a sleeping pill for more than a month · ask about CBT-I, including online programmes · mention snoring, restless legs or night-time urination · bring a list of every sedating medicine you take
❓ Frequently asked questions
Can I just stop taking zopiclone or zolpidem?
After a short course, usually yes, with a few rough nights. After months of nightly use, taper gradually with your prescriber. Abrupt stopping can bring severe rebound and, rarely, seizures.
How long does rebound insomnia last?
Typically one to three nights after each dose reduction, then sleep settles back. After the final dose it usually settles within two weeks.
How long does a sleeping pill taper take?
For most z-drug users, about two months. Long-term benzodiazepine users often need several months with smaller steps. Slower is better than faster.
Are z-drugs less addictive than benzodiazepines?
Slightly, but they act on the same brain receptor. Tolerance, rebound insomnia and dependence happen with both after regular use.
What can I take for sleep that is not habit-forming?
Low-dose doxepin for night waking, prolonged-release melatonin over 55, and orexin blockers where available. CBT-I is the most effective option of all.
Does CBT-I really work for people on sleeping pills?
Yes. Combined with a taper, about three in four long-term users came off, against about half with tapering alone, and their sleep improved.
Can I drink alcohol while tapering?
Best avoided. Alcohol adds to sedation, worsens sleep in the second half of the night and makes withdrawal symptoms harder to judge.
Is it safe to drive while coming off sleeping pills?
Coming off usually improves next-day alertness. Avoid driving after a night of very little sleep, and check how a new sleep medicine affects you first.
Why are sleeping pills risky for older people?
They raise the risk of falls, hip fractures, confusion and road accidents. In over-60s, harm is about twice as likely as a meaningful benefit.
What if the taper is not working?
Stay longer at the current step rather than going back up, add CBT-I if not already, and check for anxiety, depression, sleep apnoea or pain that needs its own treatment.
📑 Sources and editorial
- 📘 Clinical guidelines on the pharmacological and behavioural treatment of chronic insomnia in adults, including the recommended short-term use of benzodiazepine receptor agonists
- ⚖️ Meta-analysis of sedative hypnotics in older people with insomnia, comparing number needed to treat for improved sleep with number needed to harm for cognitive and psychomotor adverse events
- 🧪 Pharmacology of benzodiazepines and z-drugs at the GABA-A receptor, tolerance and rebound insomnia
- 💊 Regulatory safety communications on zolpidem dosing in women, next-morning impairment, and the boxed warning on complex sleep behaviours with z-drugs
- 🧓 Geriatric prescribing criteria listing benzodiazepines and z-drugs as potentially inappropriate in older adults, and studies of falls and hip fracture risk
- 🚨 Guidance on benzodiazepine withdrawal, including seizure risk with abrupt discontinuation, gradual dose reduction schedules and protracted withdrawal symptoms
- 📉 Randomised trial of supervised tapering, cognitive behavioural therapy for insomnia and the combination in long-term hypnotic users
- 📄 The EMPOWER cluster randomised trial of direct-to-patient education for benzodiazepine discontinuation in older adults
- 🛏️ Evidence for cognitive behavioural therapy for insomnia, including sleep restriction, stimulus control and digital delivery
- 💤 Trials of low-dose doxepin for sleep maintenance insomnia, prolonged-release melatonin in adults over 55, and orexin receptor antagonists
- 💊 Reviews of off-label sedating antidepressants for insomnia, including trazodone and mirtazapine, and of over-the-counter sedating antihistamines
- 🫁 Regulatory warnings on concomitant use of benzodiazepines with opioids and the risk of respiratory depression
- 🤰 Guidance on hypnotic use in pregnancy and neonatal withdrawal
- 📖 Related reading: what actually works for insomnia, melatonin dose and timing, anxiety medication and which ones are non-addictive, generalized anxiety disorder, obstructive sleep apnoea
- 🛒 Related products: Sinequan (Doxepin), Restfine (Melatonin), Altonil (Melatonin), Desyrel (Trazodone), Remeron (Mirtazapine), Buspar (Buspirone), sleep aid range
- 🩺 RXshop Editorial Team — reviewed by James Carter, MD — Neurologist and Sleep Specialist
Medical Disclaimer: The information in this article is for educational and informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek guidance from a qualified healthcare provider with any questions you may have regarding a medical condition, and before starting, stopping or changing any medication.