- Their or their doctors’ concerns about over-dependence on medications.
- Side effects.
- Declining effectiveness.
- Individual health considerations such as pregnancy, upcoming surgery, or drug interactions.
- Relief in the certainty of a good night’s sleep and doubt about their ability to sleep without medication.
- High anxiety about poor sleep.
- Failed tapering attempts during which they experienced difficulty sleeping, anxiety or other withdrawal symptoms.
Ways to prepare to reduce or stop sleeping pills
- Work closely with your doctor to determine a safe rate and method.
- Pharmacists can help, by dividing pills or assisting with liquid or compound formulations to create fractional doses.
- Go slowly. The biggest mistake my patients make is going too fast. They end up returning to their full fix, chastised and disheartened by the experience.
- Going slowly minimizes withdrawal, or insomnia, anxiety, and other symptoms that can result from dosage reductions. If you’re cutting small amounts very gradually, your system will barely register the change. You are taking one small step at a time down the ramp.
- The slow approach is a form of graded exposure therapy. Each new step down the ramp, each new dose reduction allows you to minimize and perhaps even overcome your anxiety before proceeding to a more difficult step, which may not seem more difficult because you have mastered the previous step. It also feels relatively non-threatening to take baby steps.
- Slow taper provides time to develop sleep skills to replace the medication. I have written about some of these skills. You may not have needed it because you were on medication. Going slowly, you master swimming skills at each new depth. When you progress to the end, you will be an excellent swimmer.
Steps to stop using or cut down on sleeping pills
- Establish step sizes and milestones. Decide whether you want to cut down by an eighth of a pill at a time or a quarter or some other fraction. Let’s say it’s an eighth. Your first milestone is seven-eighths of a pill. You work towards that milestone and only that milestone at the start.
- Gradually increase the number of nights per week you take the milestone dose (for example, seven eighths) versus the full dose (one pill). You might start with once a week at the lowest dose and gradually work your way up to seven times a week, always taking the highest dose on the nights you don’t take the lowest. You don’t have to hit all of your travel numbers from zero to seven nights a week at the lowest dose.
- Distribute the lowest doses for example, every four nights if you take the smaller dose twice a week.
- You can repeat weeks. For example, if you take the lower dose every other night and the higher dose the other nights, you can repeat the pattern for another week or two.
- Once you reach the first milestone (e.g., seven-eighths of a pill each night), that dose becomes your new high dose, and one more drop (e.g., three-quarters of a pill) becomes your new low dose. You have finished taking a complete pill. Flexibly repeat the pattern that led you to the first milestone to reach the second and subsequent milestones.
- Slow down the cone towards the end. Reducing by an eighth of a pill is only a 12.5% reduction to start with, but it’s a 50% reduction once you’re down to a quarter of a pill.
- Try not to go up the rampbut if necessary, go back to the rung where you were last sleeping well and stabilize there before resuming the tapering more slowly.
- Map out what you’re going to to take each night on an editable calendar to track where you are and to keep your resolve.
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