In the evening, the same gesture returns: a glass of water, a tablet, the hope of finally sleeping. Then the prescription is renewed, once, twice, until it becomes almost invisible in everyday life. In France, however, Health Insurance points out an important rule: benzodiazepines used for sleeping and related medications, such as zolpidem or zopiclone, must not be prescribed beyond four weeks, including dose reduction.
This recall concerns a specific scope, not all insomnia treatments. But it affects many patients: according to Health Insurance data from Sniiram between July 2023 and June 2024, just over two thirds of adults treated by these medications exceed this maximum authorized prescription duration. The key point is not to feel guilty, but to prevent renewal from becoming automatic.
Which sleeping pills are we talking about exactly?
In this article, the word “sleeping pills” refers to benzodiazepines prescribed for sleep disorders and so-called related medications. Zolpidem and zopiclone fall into this category. These are therefore not all the solutions proposed for insomnia, nor all the treatments that can influence sleep.
These medications may be useful in certain situations, but their use should be short-lived. Health Insurance indicates that the duration must be as short as possible and that the need must be reassessed before each prescription. In other words, the order should not be renewed month after month without reviewing the situation.
The question is not only: “Does this tablet help me sleep?“. It also becomes: “Why am I sleeping poorly, and is this treatment still suitable today?” This re-evaluation makes it possible to place the drug in a broader treatment of insomnia.
Why does the four week limit matter?
The term limit is not a simple formality. It is due to the possible side effects of these medications. Health Insurance notably mentions a risk of physical and psychological dependencememory problems, confusion, reduced alertness or drowsiness.
In the elderly, these effects can have significant consequences, as they increase the risk of falls and fractures. This point of vigilance particularly concerns benzodiazepines in seniors, as also recalled in this True Medical article on benzodiazepines in the elderly.
Two precautions are also worth keeping in mind. First, avoid alcohol, which can increase the sedative effects. Then, check with the doctor or pharmacist about combinations with other medications, because certain combinations can accentuate drowsiness or reduced alertness. Driving should also be addressed clearly: sleepiness may persist the next day and make driving dangerous.
If treatment has been going on for months, what should I do?
Discovering this four-week limit can be worrying when you have been taking this treatment for a long time. The bad option, however, would be to stop alone and suddenly. After prolonged use, stopping too quickly can lead to withdrawal symptoms and rebound insomnia. The Haute Autorité de Santé reminds that stopping benzodiazepines and related drugs must be gradual, with a pace adapted to each person.
This reduction is therefore prepared with the doctor. It can take several weeks, sometimes longer in the case of chronic treatment, and be slowed down if symptoms appear. The objective is not to “hold on” at all costs, but to build a bearable reduction, while looking for possible causes of insomnia: anxiety, pain, odd schedules, sleep apnea, consumption of alcohol or stimulants, or other disorder to be taken care of.
At the next renewal, three simple questions can restart the discussion: why am I sleeping badly? Is this medicine still useful? How to prepare for what comes next without stopping abruptly? A sleeping pill may be necessary at some point, but it should not become a habit without medical reevaluation.