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Many people in cities in India have started relying on sleeping pills to help them solve the problem of insomnia and sleep-related problems. Recent studies have shown that almost 33 percent of adults in India suffer from chronic sleep problems [1] and need both over-the-counter and prescription sleep aids. Problem use and lack of awareness of possible risks by health professionals are a serious concern, particularly in young people, as the abuse has been noted.
The use of sleeping pills has been increasing rapidly in India over the past few years owing to the high levels of stress, urban lifestyles, and a higher incidence of sleep disorders.
To tackle this crisis, people often resort to over-the-counter (OTC) or prescription sleeping pills which in turn makes people to be exceedingly dependent on sleeping pills. These medications are becoming more popular in younger populations, particularly those with high-stress careers, who are unaware of the potential health consequences.
While sleeping pills are available easily all across India, their public perception is still mixed. Some see them as ‘the answer to their unanswered prayers’ to manage their transient sleep trouble, others see them with caution for possible side effects and the habit-forming potential of these medications.
Health authorities and healthcare providers in India may address the misuse of sleeping pills by being more cautious in regulating and prescribing them.
Sleeping pills in India can be broadly classified into two categories: OTC and prescription medications. OTC medications are generally used for transient or mild sleep problems, whereas prescription medications are more potent and, more importantly, require a doctor’s prescription for safe use. Different categories of sleep aids and medications work differently on the central nervous system to induce and maintain better sleep.
Indian OTC sleep aids usually contain antihistamines like doxylamine and diphenhydramine which, as a result of their side effect, cause drowsiness. These medications have easier access and tend to be the first choice for most people. However, OTC sleep aids are not as potent for more serious sleep problems. Moreover, they can eventually cause dependence and users might not be able to have adequate sleep without them.
More severe sleep disorders may require doctor-prescribed medications such as benzodiazepines (e.g. alprazolam and diazepam), as well as nonbenzodiazepine hypnotics (e.g. zolpidem and eszopiclone). Benzodiazepines are central nervous system depressants and non-benzodiazepines act on specific brain areas in the regulation of sleep. These drugs have a high risk for dependency, and although not meant for long-term use, they could cause cognitive impairments or withdrawal symptoms.
Prescription drugs typically enhance the action of gamma-aminobutyric acid (GABA), a neurotransmitter that dampens brain activity. The GABA-related activity is calming and leads users to fall asleep more easily. Frequent use can cause problems of impaired motor skills, grogginess, and problems with concentration and cognitive reasoning.
A wide variety of sleeping pills are used wrongfully in India. Alprazolam, diazepam, zolpidem, or clonazepam are some of the most commonly prescribed, and usually overused sleeping pills.
Benzodiazepines (alprazolam or diazepam) and non-benzodiazepine hypnotics (zolpidem) carry substantial risk. They are highly addictive and even when they are taken as prescribed, they can cause a dependency. Although less addictive than benzodiazepines, nonbenzodiazepine hypnotics can result in sleepwalking and memory problems. High doses of diphenhydramine in over-the-counter sleep aids are a risky venture too, as large amounts can cause confusion agitation, and even seizures.
The Indian government and the Central Drugs Standard Control Organization (CDSCO) have issued a barrage of warnings in recent years. Some sleeping pills have the potential for misuse and are an addiction risk, and the CDSCO has urged doctors to limit prescribing them. Like many of the more commonly abused drugs, health experts advise against unsupervised use, as misuse might result in drug overdose, which can be deadly. Moreover, mixing these medications with alcohol or other depressants can be life-threatening.
Sleeping pills are meant as a quick fix, and long-term use poses a myriad of health risks, some right away and others down the road.
Short-term effects include dizziness, confusion, impaired motor skills, neurological clouding, and drowsiness during the day. These symptoms can make it difficult to do everyday things, like driving or using machinery that requires concentration [2]. Many people who take sleeping pills suffer from a ‘hangover’ the next day, missing work and increasing the risk of accidents.
If sleeping pills are used for an extended amount of time, they could prove more damaging, resulting in dependency, and the user needing to take the pills to sleep. But it can be hard to give it up and withdrawal from dependency can bring symptoms of agitation, sweating, and tremors.
Sleeping pills also have been linked to a greater risk of dementia in older adults — research shows that frequent use may speed up the clouding of the brain. Research has also demonstrated that those who use sleeping pills on a long-term basis have an increased risk for respiratory problems, particularly for those with an existing condition such as asthma [2].
Sleeping pills are becoming a cause of worry with the rising dangers of death in India. There are scant figures but according to studies, it is a worrying trend.
The Lancet research found the use of sedatives and hypnotics has risen dramatically in South Asia, and overdose cases have increased. Misuse of sleeping pills isn’t the only reason, but dependency and misuse put people at risk for fatal outcomes.
Accidental overdoses and suicides due to sleeping pills increased, providing evidence of a link between these drugs and a risk of death when they are misused and abused.
The fact that India doesn’t release extensive data about the number of people who die from sleeping pill-related deaths every year does not mean that there is no light that global trends can provide. According to a 2022 World Health Organization (WHO) report, misuse of sleeping pills led to almost 20 percent of medication-related deaths worldwide.
Benzodiazepines and sedative-hypnotics cause accidental overdose deaths in India because of their potency and high dependency potential. Furthermore, an especially dangerous practice of taking these pills with alcohol to increase the sedative effect increases the risk of respiratory failure and death.
Most sleeping pills are misused because people don’t know about the potential dangers. While not everyone who tries it will become dependent, many people start with mild doses to address occasional sleeplessness, unaware just how quickly it can hook you.
Combining pills with alcohol, taking higher dosages without medical supervision, and taking sleep pills with other drugs all increase the risk of overdose.
Also, sleeping pills are used as a panacea by some people with other conditions, vulnerabilities, and medical problems, such as anxiety and depression, thereby further blowing their chances of overdose and death.
Sleeping pill use in suicide attempts has emerged as a major public health problem in India. With these medications being so easily accessible, they are a frequent choice of option for self-harm for people having difficulties with their mental health.
The National Mental Health Survey of India shows that suicide attempts involving sleeping pills have gone up manifold, particularly among the under-20s.
Sleeping pills are easy to get, and people in high-stress and high-anxiety situations are dying by suicide attempting to either commit suicide or merely fall asleep.
Sleeping pills can be an attractive route to self-harm for those with depression and other mental health conditions for whom it provides an accessible option that feels a bit ‘less violent’. However, as this growing trend shows, a lot of action has been taken asking for stricter rules and an improvement in mental health services to address the central causes of this problem.
Anxiety, depression, past trauma, and other mental health factors are important contributors to sleeping pill misuse. Many people use these as a form of self-medication for underlying psychological pain. Having documented mental health problems in India is still stigmatized and it further confines you into this isolation where there is you can’t access healthcare and support. As health experts know, recognizing this they’re pushing to spread awareness and increase access to mental health services so individuals can look for more holistic solutions.
In response to these trends, the government and many different health organizations in India acknowledge the need for intervention. Mental health programs and awareness campaigns are being developed to show people the dangers of inappropriate sleeping pill use, as well as point out mental health resources.
Despite mental health issues having a stigma attached to them public health experts say that support services need to become more accessible and de-stigmatized.
The safety of sleeping pills depends on proper dosage, timing, and duration of use. Sleeping pills should never be recommended by anyone other than a certified health professional and used on an occasional basis only to gain temporary relief for severe sleep disturbance. In general, there is always a chance that combining these pills with alcohol or other sedatives can cause dangerous side effects and individuals are strongly advised to avoid this practice.
Usually, doctors prescribe the lowest dose needed to maintain sleep, to minimize the chance of side effects and dependency. Patients are told to keep strictly to their prescription guidelines and to not increase the dose without checking with their doctor. Taking sleeping pills is recommended only if you are planning to a get night’s sleep of 7–8 hours since getting woken up in the middle of your sleep cycle for any reason can lead to dizziness and confusion owing to the effects of sleeping pills [3].
Several nonpharmacological alternatives are effective in the treatment of sleep disorders and are increasingly encouraged as first-line therapies. Although there are other techniques such as cognitive behavioral therapy for insomnia (CBT-I) that have shown success rates over 75% they are also not considered to be a long-term safe option [3].
With CBT-I you learn to identify and change those thoughts and behaviors that perpetuate sleeplessness. Together, mindfulness practices, relaxation techniques, and sleep hygiene improvements such as reducing screen time before bed have shown success.
If your sleep problems are mild or moderate, then lifestyle modifications such as regular exercise, cutting back on your caffeine intake, and sticking to a regular sleep schedule may be all that’s needed to manage your sleep problems. The best part—these natural approaches are incredibly effective, for these natural approaches can avoid the need for medication almost completely and substantially reduce the risk of dependency.
In India, sleeping pill-dependent people are facilitated with various treatment options. Both government-funded and private rehabilitation centers provide support for people with substance dependency including sleeping pills. Treatment Centers offer a structured way of recovering from dependency combining medical detoxification with counseling and behavioral therapy to treat the root causes.
Addiction rehab programs are tailored to individuals who have developed a dependence on sleeping pills. These include prominent organizations such as NIMHANS and regional mental health hospitals. They offer medically supervised detoxification as well as group therapy and one-on-one sessions designed to help those going through the process of recovery. Also, private rehabilitation centers specialize in taking care of all the dependencies of sleeping pills by providing personalized treatment plans that are based on physical as well as psychological aspects.
Effective counseling is the key to addressing the underlying psychological problems. Such support means we can find the reasons behind dependency and find ways to deal with anxiety, stress, and trauma without the use of medication. Also, support groups such as Alcoholics Anonymous and Narcotics Anonymous may be beneficial because they offer a sense of community – and accountability.
1. Journal Of Family Medicine And Primary Care. Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities. https://pmc.ncbi.nlm.nih.gov/articles/PMC5353813/
2. Cleveland Clinic. Sleeping Pills. https://my.clevelandclinic.org/health/treatments/15308-sleeping-pills
3. Health Direct. Safe use of sleeping pills. https://www.healthdirect.gov.au/safe-use-of-sleeping-pills
Natural and herbal sleeping aids are in popular use in India since people have started becoming fond of Ayurvedic and alternative therapies. The natural sleep aids include ashwagandha, valerian root, and chamomile. Generally safer for long-term use, these options may or may not work as fast as prescription sleeping pills.
While they aren’t suitable for people with severe sleep disorders, they may be recommended for people with mild sleep disturbances, and they are often used as complementary treatments.
When you are frequently traveling, sleeping pills might offer a temporary solution to help with sleeplessness from jet lag after a consultation with a doctor. Short-term, low-dose sleeping pills may help travelers adjust to new time zones or get over brief periods of traveling-induced insomnia, but over time or on repeated occasions, it isn’t advisable. Travelers should also not take sleeping pills during transit, such as on planes, unless it is allowed enough time for them to sleep afterward, as this can make them drowsy for the rest of their journey.
The sleeping pills used to treat insomnia due to anxiety or depression do not address the mental health issues that bring about insomnia. These pills may help with occasional sleep problems, but not the long-term solution itself as long-term management tends to involve treatment of the mental health condition. Typically, mental health professionals like to employ cognitive behavioral therapy (CBT) along with lifestyle changes to naturally improve sleep without having to be lined on medication.
Sleeping pills may not improve sleep quality because they simply help you to sleep. In particular, some medications suppress certain stages of the sleep cycle (deep REM sleep), and thus, even if total sleep duration increases, shorter, less restorative sleep results.
That is why you may be groggy or unrested even if you have slept for hours. Sleep hygiene and behavioral change are usually recommended, or used instead of medication for truly restful sleep.
The Balance RehabClinic is a leading provider of luxury addiction and mental health treatment for affluent individuals and their families, offering a blend of innovative science and holistic methods with unparalleled individualised care.
