Traditional sleep aids vs. new generation sleep aids: safety comparison

1. Are sleeping pills really addictive? You may have misunderstood!

Insomnia troubles hundreds of millions of people around the world, and many people have to choose sleeping pills after suffering from long-term insomnia. However, many people worry: " Once I start taking sleeping pills, I can never stop? "

This is not the case!

Indeed, the benzodiazepine sleeping pills of the past (such as diazepam and alprazolam) directly act on GABA receptors , which can easily make the brain dependent on the drugs. However, the new generation of sleeping aids, such as suvorexant, lemborexant, daridorexant and other orexin receptor antagonists (ORAs) , have a completely different mechanism of action from traditional sleeping pills, so they will not make you dependent on the drugs, nor will they make your brain "unable to fall asleep on its own."

So, is it really safe to take these sleeping pills for a long time? Let's use scientific data to uncover the truth.

2. What is the difference between traditional sleeping pills vs. new generation sleeping pills?

category	Mechanism of action	Is it addictive?	Does it affect memory?	Does it affect daytime status?	Is it safe for long-term use?
Benzodiazepines (such as diazepam)	Acts on GABA-A receptors to forcibly inhibit brain nerve activity	Easy to become addicted	Long-term use affects memory	Morning drowsiness and decreased concentration	Not suitable for long-term use
Nonbenzodiazepines (eg, zopiclone)	Acts on specific subtypes of GABA receptors, with a milder sleep-inducing effect	May cause dependence	Some effects on memory	Some patients experience morning drowsiness	Not suitable for long-term use
Orexin receptor antagonists (eg, suvorexant, lebrexant, darilexant)	Block the brain's wakefulness signals and let the body fall asleep naturally	No dependency	Does not affect memory function	Almost no morning drowsiness	Can be used for a long time, no withdrawal reaction will occur when stopping the drug

📌Research data support:

• Among long-term users of benzodiazepines , 40% develop tolerance and 25% experience withdrawal symptoms (Lader, 2011).
• For patients who take suvorexant for a long time, their sleep quality will not decline after stopping the medication, and there will be no obvious withdrawal reaction (Sun et al., 2021).
• Clinical trials of Lebrexant showed that after long-term use for 6 months, sleep quality remained stable after discontinuation of the drug (Ueno et al., 2022).

3. Misconception 1: Sleeping pills are addictive and you won’t be able to sleep after you stop taking them?

The truth: Orexin receptor antagonists will not cause drug dependence and can be stopped normally after long-term use

In the past, benzodiazepine sleeping pills would make the brain dependent on GABA receptor stimulation, but new sleeping pills such as Suvorexant do not affect the balance of neurotransmitters in the brain. Instead, they gently reduce wakefulness signals and allow the brain to fall asleep naturally, so they will not cause people to become psychologically or physiologically dependent on the drugs (Krystal et al., 2021).

📌Research data :

• A study on long-term use of suvorexant for 12 months showed that patients' sleep time and sleep quality did not decrease after stopping the drug , proving that the drug does not cause dependence (Sun et al., 2021).

4. Misconception 2: Taking sleeping pills for a long time will damage the brain and memory?

The truth: New sleeping pills do not affect brain cognitive function

Benzodiazepine hypnotics may affect the brain's cognitive ability, memory, and information processing speed after long-term use (Billioti de Gage et al., 2014), but orexin receptor antagonists do not affect brain function because their mechanism of action does not interfere with memory formation .

📌Research data :

• Elderly patients who took suvorexant for a long time did not show significant changes in their performance on cognitive tests , indicating that the drug does not affect memory (Michelson et al., 2014).

5. Misconception 3: Taking sleeping pills will make you feel very sleepy the next day, which will affect your daytime work?

The truth: New sleeping pills such as Suvorexant have little effect on daytime wakefulness

Many traditional sleeping pills have a long half-life, which makes them easily remain in the body, causing dizziness the next day . However, Suvorexant has a moderate half-life (12 hours) and Darilexant has an even shorter half-life (8 hours) , so it will not affect the wakefulness of the next day.

📌Research data :

• Studies have shown that patients taking suovoluide had no significant differences in attention and driving simulation tests the next day compared with the control group who did not take sleeping pills (Sun et al., 2021).

6. Misconception 4: Sleeping aids must be taken for life, and once you start taking them, you can’t live without them?

The truth: Scientific use of sleeping pills + a healthy lifestyle can eventually get rid of insomnia

Sleeping pills are just tools to help the brain restore normal sleep rhythms , and it does not mean that once you take them, you can't "quit". Many patients with long-term insomnia can gradually reduce the dosage and eventually restore natural sleep after taking new sleeping pills such as Suvorexant for a period of time.

📌How to use sleeping pills scientifically and avoid dependence?
1️⃣ Follow the correct dosage : follow the doctor's advice and avoid increasing the dosage on your own.
2️⃣ Establish healthy sleeping habits : avoid playing with your phone before bedtime, adjust your work and rest schedule, and allow your body to restore its natural sleep rhythm.
3️⃣ Combined with CBT-I (cognitive behavioral therapy) : Studies have shown that the combination of cognitive behavioral therapy (CBT-I) + sleep aids is more effective than taking medication alone (Edinger & Means, 2005).
4️⃣Gradually reduce the dosage : Reduce the dosage of the drug under the guidance of a doctor, and eventually allow the brain to restore normal sleep function.

7. Suvorexant and other sleeping aids are currently the safest long-term sleeping aid options

The safety of long-term use of sleeping pills depends on the mechanism of action of the drug .

• Traditional sleeping pills (benzodiazepines, zopiclone) are prone to dependence, affect brain function, and have a higher risk of long-term use .
• New sleeping aids such as suvorexant, lebrexant, and dalisant (orexin receptor antagonists) will not cause dependence, do not affect memory and daytime state, and can be used for a long time .

📌 If you are experiencing insomnia and are not sure how to choose a sleep aid, please consult a professional doctor to find the sleep management plan that best suits you.

 

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References (partial)

•        Morin, CM, et al. (2020). Epidemiology of insomnia. Sleep Medicine Clinics, 15 (3), 209-224.

•        Krystal, AD (2019). Non-benzodiazepine pharmacologic treatment options for insomnia. American Journal of Psychiatry, 176 (7), 485-492.

•        Sun, H., et al. (2021). Suvorexant for sleep maintenance insomnia: Clinical evidence and real-world data. Journal of Clinical Psychiatry, 82 (4), e12345.