The Centers for Disease Control and Prevention (CDC) reports that between 50 and 70 million adults in the United States suffer from a wakefulness or sleep disorder. The CDC considers sleep issues to be a public health concern. Benzodiazepine medications have traditionally been prescribed to treat insomnia and other sleep disorders, although these drugs are habit-forming and carry a large risk of being abused and individuals becoming dependent on and addicted to them. Enter non-benzodiazepine sleep aids, such as eszopiclone, known by the brand name Lunesta, which according to the National Institute on Drug Abuse (NIDA), are said to act much in the same way as benzodiazepine drugs, but they are thought to have fewer side effects and less potential for dependency.
Sedative-hypnotic drugs like Lunesta work by depressing some of the nerve firings in the brain that are related to the stress response and can keep people awake. Lunesta acts as a central nervous system depressant, slowing down heart rate and lowering blood pressure, respiration levels, and body temperature. Eszopiclone may also enhance pleasure when taken in larger amounts or outside of a prescription, and individuals may abuse this drug for its sedative, mellowing, or pleasant effects. The FDA publishes that in 2013, there were about 3 million Lunesta prescriptions that were licitly dispensed for the treatment of insomnia. The FDA also reports that more than 21 million people in the United States have abused a prescription tranquilizer, such as Lunesta, at least once in their lifetimes.
Chronic abuse of a prescription drug may lead to a person being unable to control use of the substance, and compulsive drug-seeking and using behaviors are the main features of addiction. The National Survey on Drug Use and Health (NSDUH) estimated that more than 8 percent of American adults (people aged 12 and older) battled a substance use disorder in 2014.
Lunesta may lead to significant withdrawal symptoms when an individual who has been using it regularly for a length of time stops taking it suddenly, and these may be best managed through a medical detox program. Detox should be followed with a drug abuse treatment program to address the psychological components of substance abuse and addiction, and to teach methods for promoting healthy sleep. Recovery is enhanced by therapeutic and pharmacological tools as well as support groups, complementary therapies, and 12-Step programs.
Non-benzodiazepine sedative-hypnotic drugs are commonly referred to as z-drugs and include the drugs zolpidem (Ambien), zaleplon (Sonata), and zopiclone. Eszopiclone (Lunesta) has essentially the same method of action as zopiclone and differs only slightly in chemical structure, the journal Neuropsychiatric Disease and Treatment reports. When abused, these drugs may produce a euphoric effect, or “high” that is similar to benzodiazepine drugs, leaving individuals feeling relaxed, mellow, and generally good. A study published by the British Journal of Psychiatry (BJP) that interviewed individuals who reported misusing at least one benzodiazepine or z-drug found that diazepam (Valium) was the most commonly abused, with slightly over half of the respondents abusing it, while zopiclone was the second-most abused, with close to a quarter of the respondents abusing it.
Prescription tranquilizers, according to the 2014 NSDUH, are most commonly abused by individuals between the ages of 18 and 25 followed by those aged 26 and older. Women may be more prone to abusing sleeping pills than men as two-thirds of the emergency department visits for the non-medical use of zolpidem were for women in 2010, according to Women’s Health. Z-drugs may also commonly be abused with other drugs or alcohol in an attempt to heighten the effects of both substances, which can greatly increase the potential risk factors and odds for a life-threatening overdose.
The BJP study showed that of the people surveyed who were abusing benzodiazepines or z-drugs did so for the following reasons at these rates:
Lunesta alters the chemistry of the brain to help promote sleep. It is not recommended to be taken long-term, however, as Consumer Reports publishes that Lunesta can lead to drug dependence. A dependence on a drug is formed when the brain needs it to keep functioning how it now perceives as “normally.” Since drugs like Lunesta change brain chemistry with regular use, levels of some of the naturally occurring brain chemicals, or neurotransmitters, may be negatively impacted. The brain may no longer produce or move them around the central nervous system in the same manner as before and may instead expect Lunesta to help with this. When Lunesta then wears off, or a person stops taking it, withdrawal side effects may occur. Insomnia may actually worsen, and it may be difficult for an individual to feel “normal” without the drug.
Along this vein, when an individual develops a dependence on Lunesta, the person may wish to keep taking it even after the prescription runs out. Any use of Lunesta that is not considered medically necessary is considered drug abuse. Individuals may exaggerate insomnia symptoms in order to get more Lunesta prescribed to them; according to the BJP study, a prescription from a health provider was the most common source for prescription z-drugs or benzodiazepines that were used non-medically. Individuals may also “doctor shop” or go to multiple doctors to try and get multiple prescriptions for Lunesta. The 2013 NSDUH reported that when prescription drugs are abused, they are obtained for free from a relative or friend more than half the time, and that person likely got them through a legitimate prescription from a medical provider. Using a prescription drug like Lunesta when it is not medically necessary may increase the odds of developing an addiction to the drug.
Anytime a person is using Lunesta recreationally, or without a legitimate medical need for it, can be cause for concern. Substance abuse can create a multitude of problems socially, economically, physically, emotionally, and behaviorally. When regular abuse turns to addiction, these problems may be exponentially compounded.
Addiction is considered a disease affecting the brain’s circuitry that is responsible for impulse control, decision-making, reward-processing, and emotional regulation. As mentioned, drugs such as Lunesta alter the normal ways that the brain’s chemical messengers flow throughout the central nervous system, and over time, changes to some of the brain’s wiring is made. A shortcut to feeling pleasure, lowering stress, and enhancing sleep functions is formed, and Lunesta may be needed to help with these functions after the dependency is formed from chronic use.
Addiction is a step beyond just physical or chemical dependency, however. Drug use, recovering from use, and determining where the next dose is coming from may become the center of a person’s life. Someone suffering from addiction is unable to control how much Lunesta is taken and may end up taking more than intended at once or take the drug for a longer period of time than intended. The person likely has attempted to stop taking the drug on more than one occasion and been unsuccessful.
When a person battles an addiction, several behavioral changes are noted, such as a lack of interest in things that do not involve the drug, or even dropping activities that may have been especially important before. Regular obligations may not be consistently met, and interpersonal relationships, grades at school, and production at work may suffer. Sleep patterns may become erratic as may eating habits or appetite levels. Weight fluctuation and a lack of concern for healthy hygiene practices may be potential signs of addiction. Mood swings and even a complete shift in personality or behaviors that are risky and out-of-character may become commonplace.
Someone suffering from addiction likely understands that continued use of the drug has numerous consequences; however, the person continues to use anyway. Accidents, lapses in memory, legal problems, questionable sexual encounters, and the use of Lunesta in situations that may be dangerous or hazardous, such as driving while impaired, may become regular occurrences.
Behavioral therapies like Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT) teach healthy coping mechanisms for stress and help individuals to uncover the root cause of why they may be abusing drugs, thus working to avoid or manage potential triggers. MI is a non-confrontational approach that aids individuals in finding the internal motivation to change while learning to accept themselves for who they are. CBT works to turn negative thoughts into positive ones, thus influencing self-esteem and modifying behaviors in turn.
Group and individual therapy and counseling sessions as well as homework between sessions may be typical aspects of a substance abuse treatment program. Relapse prevention tools and communication skills are taught during these sessions, and support groups are formed that may help individuals to build a network of peers with a common interest and goal in remaining drug-free.
Since Lunesta is a sleep aid, and individuals who are addicted to the drug may suffer from difficulties sleeping, holistic and complementary methods may be useful during substance abuse treatment and recovery. Yoga, meditation, mindfulness techniques, chiropractic care, massage therapy, nutritional meal planning, and fitness programs may all be beneficial in promoting healthy sleep habits. Methods of reducing stress and anxiety, which may include the use of antidepressant or anti-anxiety medications, may also be helpful.
When someone is well-rested, that person is better able to handle stressors and think clearly. As a result, improving sleep quality can enhance overall quality of life.
Lunesta, and other central nervous system depressants like benzodiazepines or alcohol, slow down some of the necessary functions for sustaining life and increase the presence of the inhibitory neurotransmitter gamma-aminobutyric acid, or GABA. GABA is a natural tranquilizer produced by the brain that works to lower stress and anxiety, and help people relax and get restful sleep.
People who suffer from insomnia may have an imbalance of the levels of GABA in the brain, and Lunesta can help correct this. When it is used in large amounts or for a long period of time, and a dependency forms, the imbalance of the levels of GABA that are naturally occurring the brain may actually worsen. If a drug like Lunesta is then stopped suddenly, this may cause a kind of ricochet effect wherein the brain tries to quickly regain a natural balance, potentially causing a range of unpleasant withdrawal symptoms. Withdrawal from Lunesta may include symptoms like a return of insomnia, or rebound insomnia, fatigue, a drop in energy levels, anxiety, depression, headaches, stomach cramps or pain, nausea and or vomiting, sweating, tremors, short-term memory impairment, mental “fogginess” and difficulties concentrating, dizziness, vivid and strange dreams, and mood swings. One of the major benefits of medical detox is that withdrawal symptoms and drug cravings can be safely managed with the main goal to help a person reach a level of stabilization before moving on with treatment.
The longer a person took Lunesta, and the more that was taken with each dose, may influence the intensity and duration of withdrawal. Lunesta has a half-life of about 6 hours, the journal Neuropsychiatric Disease and Treatment reports, so withdrawal symptoms are likely to start with 12 hours or so of the last dose.
Since the withdrawal symptoms can be both physically and emotionally uncomfortable, medical professionals will likely recommend a slow and safe removal of the drug through detox or a tapering schedule instead of just stopping it “cold turkey.” While everyone may have different requirements and circumstances regarding how the drug is slowly removed from the body, a common tapering schedule, as published by the journal BMC Pharmacology & Toxicology, may slowly reduce the dosage by 25 percent over a period of four weeks. This means that the first week the person will take 75 percent of the original dose for a week, then drop it to 50 percent the following week, 25 percent the third week, and stop taking it altogether after four weeks. A detox or tapering schedule should be set up and monitored closely by medical professionals.
Medical detox often uses medications to manage withdrawal. Lunesta may be replaced with another similar drug, like diazepam, during detox, and other drugs like anti-seizure medications (carbamazepine and valproate), antidepressants (trazodone and paroxetine), and the anti-anxiety drug buspirone may also be helpful in managing withdrawal symptoms.
Lunesta has the potential to increase suicidal thoughts, depression, anxiety, agitation, and abnormal thoughts, the drug safety information published by the FDA warns. When someone suffers from a co-occurring mental health disorder, such as depression or anxiety, a drug like Lunesta may be particularly hazardous to the person’s emotional health.
Substance abuse and mental health disorders commonly occur simultaneously in the same person, and when this happens the disorders are said to be co-occurring. The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that close to 8 million adults in the United States who are at least 18 years old suffered from co-occurring mental and substance use disorders in 2014.
When this is the case, treatment should be tailored to address both disorders, as each disorder can impact care for the other. Potential health complications and risk factors are heightened with co-occurring disorders, even though abusing a drug like Lunesta may seem to offer temporary relief from emotional symptoms of depression or anxiety. Lunesta addiction can actually exacerbate these symptoms, leading to a more significant withdrawal syndrome when the drug wears off or is stopped. Treatment providers across the medical, substance abuse, and mental health fields should all work together to help plan and carry out an integrated care model for co-occurring disorders, thus minimizing the risks and helping to manage withdrawal, while working toward recovery from both disorders.
The Journal of Medical Toxicology reports that z-drugs have the potential for abuse, and many reports of abuse are noted. In 2014, the NSDUH reported that over 2 million Americans (aged 12 and older) abused a prescription psychotherapeutic drug that was not a painkiller in the month leading up to the survey. Lunesta may be abused most regularly by adult women and may be combined with alcohol or other drugs with potentially disastrous consequences. Lunesta may cause dependency when taken regularly over a period of time ,which may manifest into a loss of control over its use, or addiction.
Improving overall quality of sleep may help to avoid a return to drug abuse. Many therapeutic, holistic, and complementary methods may be taught during a complete substance abuse program. By learning how to naturally lower heart rate and blood pressure, and increase levels of GABA in the brain, individuals may no longer feel the need for assistance from a sleep aid or other drugs. Recovery from a Lunesta addiction is also aided by learning new methods to manage stress, and the ability to recognize and handle potential triggers as they arise in everyday life. Family support and educational tools are helpful for addiction recovery as well.