10. Coming off sleeping tablets safely (z-drugs)

10. Coming off sleeping tablets safely (z-drugs)


It’s very important I always say to
them, it’s so important for you to have the conversation with the prescriber
because there’s some good evidence to show that if that if there’s almost a letter of permission in the same way that the prescription is,
that the prescriber writes out, you know, I recommend that you come of this
and we’re gonna do this gradually and go and see this
psychologists or this counsellor and they’re gonna help you as well and get
your family and friends on board too, because this is gonna be a process over time and you’ve got to be ready to do it and you’ve got to get some skills and a bit of training. Different medications have different requirements for how quickly you can come off of them and how many stages of titration that takes and
things like that. The z-drugs generally are easier than say the old
benzodiazepines to titrate off of but nonetheless you want to do it with some
professional recommendations and then I think what you need to do is essentially
replace the drugs with other behavioral strategies that will help you sleep well
because what we don’t like to see happen is somebody says, “I don’t want to use
meds anymore”, they go off the meds but nothing else has changed and the sleep
problems come right back because then they’re much more likely to feel like, well I just can’t do this without the medications. So it’s important to then put more formal behavioural strategies in place. People who start their CBT-I with me and they’re already on medication they do quite well because we don’t sort of take away that crutch without, before we give them their
skills, so it’s okay, people can you know stay on their medication while
they’re accessing help and then gradually can come off. The evidence
shows that the people who by the end of their CBT-I, if they’re off the
medication, they do better than people who didn’t have any CBT-I ever or
people who just stayed on medication alone. And it’s such, it is a difficult process
it’s like anyone if you are saying, you know, have 30, 40, 50 kilograms overweight, anyone would know that that’s going to be a process, it’s not going to be a
quick fix, it’s not going to be overnight, it’s going to be multi-factorial,
multi-layered and sometimes some processes of, you know, sort of, or
quitting smoking, for instance, is the same, that you try with great gusto
but it’s a sort of a ‘fail’ but it’s not a fail. It’s just sometimes it takes three or four or more times to actually get the right combination of things
where you can actually make the changes for good.

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