Insomnia is very common in the UK, affecting one in three people. Insomnia may only happen short-term, but for some people, it can affect them for months or years, severely affecting their quality of life. There were over 14 million prescriptions for anxiety and sleeping pills in 2014, with the highest number of prescriptions being written in the poorest and most deprived areas of the UK, where people tend to be more stressed.
When people go to the GP for help with their insomnia, they may be prescribed a drug to help them sleep. One of the most commonly prescribed drugs is zopiclone, which is also known as Zimovane.
What is zopiclone?
Zopiclone is part of a group of medications called Z drugs. They were introduced in the 1990s as an alternative to benzodiazepines and work similarly. Unlike benzodiazepines, zopiclone is only prescribed for insomnia, while benzodiazepines are also prescribed for anxiety. Like benzodiazepines, Zoplicone is only supposed to be prescribed for short-term use – just 2-4 weeks.
Zopiclone is a type of drug called cyclopyrrolone. Both benzodiazepines and cyclopyrrolones work by interacting with GABA, but they do not interact with it in the same way. Zopiclone and other Z-drugs are thought to be less addictive than benzodiazepines – but this doesn’t mean addiction isn’t possible.
How zopiclone works
Both Zoplicone and benzodiazepines work on the brain’s GABA system. Gamma-aminobutyric acid, or GABA, is a neurotransmitter that works by slowing down the activity of neurons in your brain, which causes a calming effect. Zopiclone works by binding to the brain’s GABA receptors, specifically GABA_A, and enhancing those receptors’ response to GABA.
Zopiclone affects your GABA receptors slightly differently than benzodiazepines by binding to different sites on the receptors. This difference might explain why tolerance doesn’t seem to rise as quickly with zopiclone.
Zopiclone also causes fewer effects the following day, such as sleepiness, memory problems and psychomotor impairment. These differences are why doctors may prefer it over benzodiazepines when prescribing it for sleep.
It’s usually prescribed as one-a-night 7.5mg tablets, although a lower dose may be prescribed if you are older or have kidney problems.
Side effects of zopiclone
Like most medications, zopiclone has side effects. A common one is a strange taste in your mouth, often described as metallic or bitter. Zopiclone can also cause you to feel sleepy the next day, but less so than benzodiazepines.
Zopiclone has some rarer side effects that can be quite serious – poor memory, falling over and depression.
Another Z drug, zolpidem, also known as Ambien, has been reported to cause strange states in the user, including hallucinations and sleepwalking. This may cause people to do things in their sleep that they don’t remember doing or hallucinate bizarre situations. Similar effects have been reported in the media for zopiclone, but people may have mixed it up with zolpidem, as Z drugs tend to be confused with each other due to their similar names. Nevertheless, the NHS lists hallucinations and delusions in its list of serious side effects, and it’s important to stop using the drug and to talk to your doctor if any serious side effects occur.
Can zopiclone cause addiction?
Zopiclone is only obtainable via prescription. It is thought to be less addictive than benzodiazepines, but zopiclone addiction is still possible. This can be exacerbated by the fact that zopiclone can be easier to obtain via prescription than benzodiazepines precisely because it is considered less addictive.
Illicit use of zopiclone does happen, usually by using someone else’s prescription or taking imported tablets. When misused, zopiclone addiction symptoms can occur. Side effects of zopiclone addiction include memory problems, emotional numbness and aggressive outbursts. Heavy users have also reported symptoms common among addictive drugs – cravings and withdrawal symptoms.
While zopiclone addiction is rarer than benzodiazepine addiction, it is still possible, and users need to be cautious not to take it for longer than is prescribed by their GP.
Zopiclone withdrawal
One of the most common complaints when withdrawing from zopiclone is insomnia – but it is difficult to say if this is just the original sleep problems coming back after the drug is discontinued. Zopiclone does not cure insomnia; it just relieves the symptoms temporarily.
When a person has become dependent on zopiclone, similar but less severe withdrawal symptoms have been reported to benzodiazepines – tremors, palpitations, anxiety, and rebound insomnia. This is why the NHS recommends tapering off zopiclone if you have been taking it for a long time.
Getting better sleep without zopiclone
When someone approaches their GP for help with their sleep, they can feel desperate for relief. Unfortunately, no drug can offer a long-term solution to insomnia, and it will usually come back when you stop taking the drug.
Sleep hygiene is the introduction of habits and behaviours that make getting a restful night’s sleep more likely. These habits need to be applied consistently, so getting into a good routine is important. Good sleep hygiene behaviours include:
- Consistent bedtimes. Going to bed and getting up at the same time every night
- Making sure your bedroom is comfortable by keeping it quiet, dark, relaxing and at the right temperature
- Not using electronic devices before bed, removing screens, TVs, computers and smartphones from your bedroom entirely.
- Avoiding large meals, alcohol and caffeine before bedtime
- Getting some exercise during the day
- Limiting your bedroom to certain activities helps your brain to associate your bedroom with just sleeping. For example, if you work from home, try to work in another room.
For serious long-term sleeping problems, more structured interventions like Cognitive Behavioural Therapy for Insomnia (CBTI) can help. CBT is more effective at treating insomnia than drugs, with longer-term benefits, because it treats the underlying causes rather than the symptoms. Relaxation training, such as mindfulness meditation and breathing exercises, can also help insomnia by relieving anxiety and tension and preparing your body for sleep.
Sleep clinics
Sometimes insomnia can be caused by a medical issue, such as sleep apnea. Sleep apnea can cause you to stop breathing for short periods, disrupting your sleep and making you feel tired and moody and have difficulty concentrating the next day.
Sleep apnea can be serious if it isn’t treated. You may not realise you have it, but if you have been told that you snore loudly, wake a lot in the night or make gasping or choking noises during your sleep, these can be signs that you have sleep apnea. If your GP suspects you have sleep apnoea, they may refer you to a specialist sleep clinic for tests. If you are diagnosed with sleep apnoea, your doctor may recommend lifestyle changes, such as stopping smoking and drinking and losing weight. They may also give you a CPAP machine to wear as you sleep to improve your breathing.
Summing up
While zopiclone is less risky than other sleeping medications, it isn’t risk-free – and unfortunately, it isn’t a long-term solution to insomnia. By implementing good sleep hygiene or asking your GP to check that an underlying medical issue doesn’t cause your insomnia, you can put your sleep problems to bed – permanently.