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Zopiclone is a commonly prescribed sleep aid in Canada used to treat short-term insomnia to help people fall asleep more quickly or maintain good-quality sleep.
It is a non-benzodiazepine sedative that reduces the activity and stimulation of the central nervous system to achieve relaxation. Zopiclone is only available by prescription in Canada because of the known risks of dependence and side effects including drowsiness, cognitive impairment, and in some cases addiction.
Zopiclone is a sedative-hypnotic medication widely prescribed in Canada to treat insomnia. This is a class of drugs known as ‘Z drugs’, and marketed under various brand names, such as Imovane. Zopiclone is designed to help people fall asleep faster and sleep throughout the night.
It is effective for short-term insomnia management and is usually prescribed for up to 4 weeks [1]. It is used as a sedative-hypnotic (by affecting brain activity) to cause a calming effect. It is often used for people who find it difficult to initiate or maintain sleep.
Sleep disorders are common in Canada. The Canadian Sleep Society says that around 30 to 40% of adults have symptoms of insomnia, and roughly 10% have chronic insomnia. Zopiclone’s effectiveness for transient and chronic insomnia has caused its frequent use as a prescription medication in Canada. According to data from Health Canada, in 2018 alone, about 5 million prescriptions for zopiclone were written, meaning it is widely used nationwide.
Zopiclone is available in 5mg and 7.5mg dose form and zopiclone 5mg is the drug of choice for elderly patients or patients with hepatic impairment. Its short-term benefits are obvious, but talk of long-term use and dependency is beginning to gather steam about how and why it is prescribed.
Health Canada regulates zopiclone as a Schedule IV controlled substance, which means it can be dispensed only by prescription. Although it is not a benzodiazepine, it bears several similarities with this class in the way of its sedative effects, and potential for dependence.
Because of its psychoactive properties, zopiclone is regulated to reduce abuse, addiction, and misuse. The main caution: Prolonged use; Health Canada disallows prescriptions except in exceptional, short-term cases.
Still, Zopiclone is Canada’s most recommended sleep treatment and is still being widely prescribed, although it’s quite concerning to see how its over-dependence on pharmaceutical sleep remedies is rampant.
Zopiclone acts by increasing the effect of a brain substance called gamma-aminobutyric acid (GABA) which inhibits neuronal activity. Zopiclone binds to GABA receptors causing a major increase in the reducing effect on over-brain activity produced by GABA [1]. This is why zopiclone is an effective treatment for insomnia; it has calming, sleep-inducing effects trained to help you fall and stay asleep.
Zopiclone, unlike benzodiazepines which also act on GABA receptors but have broad other effects (e.g., muscle relaxation and stress relief), has more specific effects with a lesser possibility of daytime sedation.
Once zopiclone enters the brain the rate of its absorption and distribution is very rapid, so zopiclone often acts rapidly as it begins to affect the brain relatively quickly, usually within about half an hour [2]. It’s also particularly handy for people who find themselves struggling to fall asleep. However, the quick onset can also be a cause of what is known as zopiclone side effects the next day, like grogginess or cognitive impairment.
The time zopiclone takes to leave the body, i.e. its duration of action, differs by dose and is also related to individual metabolism. In healthy adults, the half-life of the drug is about 5 hours on average [3]. In other words, within 5 hours, half of the drug has been metabolized and completely excreted from the body.
The half-life can be prolonged in elderly patients or those with liver or kidney ailments, causing residual effects on the next day like drowsiness and cognitive deficits. This can make it a long duration and the longer it is, the more it will affect your daily functioning and increase the risk of accidents, especially in older populations. Knowing how long zopiclone takes to work and doesn’t work is very important to choose the right dose and avoid negative side effects.
Zopiclone makes most users sleep for 6-8 hours and is taken just before bed. But in some cases, people can continue to feel its effects the next day, especially if they’re taking higher doses and their metabolism is not working properly.
As with all medications, zopiclone can produce some side effects, some of which are more common than others.
Short-term side effects often include:
The side effects of zopiclone can be very problematic for people who have to remain awake the next day and perform work that requires coordination and skill. Users may feel groggy or ‘hungover’ the morning after [3]. Also, some may experience memory lapses or a bad time concentrating the next day. Moreover, the problem with these side effects is that they can adversely affect tasks that require concentration, such as driving, working, or studying.
Zopiclone’s side effects become more likely with long-term use. Prolonged consumption of the drug has been linked to various health risks, including:
Tolerance to zopiclone can occur in chronic use so greater doses are required to produce the same effect. This can worsen the chances of dependence, and in some circumstances, addiction. In addition, the length of time zopiclone remains in your system determines these side effects, as those abusing the drug regularly can build up the drug in their system, making them more sensitive to unfavorable reactions. Research indicates the strong association of long-term use with cognitive problems, including difficulties concentrating and poor decision-making.
The long-term side effects of zopiclone can be intensified in the elderly since the drug will stay in their system longer and increase the risk of confusion and memory problems.
The side effects of zopiclone particularly affect elderly people because their metabolism is slower and they’re more sensitive to sedative drugs [3]. Moreover, older individuals experience the drug’s longer half-life, therefore increasing the effect of fatigue, dizziness, and confusion.
Potential zopiclone side effects could last for much of the following day, and there are concerns they could play badly in the longer term in elderly people.
The drug’s sedative properties are one of the key concerns for the elderly patient. Zopiclone may cause reduced coordination and balance which in older adults can result in more accidents. Falls are the leading cause of injury in Canada for the elderly and medicine like zopiclone can increase this likelihood.
A further serious complication in elderly zopiclone users is the development of cognitive impairment. Research has linked heavy use of sedative-hypnotics — like zopiclone — with memory lapses and slower thinking, particularly in elderly adults. There may be symptoms of short-term memory loss; difficulty focusing attention; and reasoning in older adults. These cognitive declines can lead to slower living and therefore to a poorer quality of life and they may raise the risk of dementia.
Long-term use is linked with the risk of memory issues in elderly patients. The drug that stays in their bodies for long periods may make it harder to hold onto new information or remember memories, requiring more use of caregivers or assistive devices.
There is an increased risk of falls and accidents in older patients. In addition to drowsiness, dizziness, and impaired motor skills, elderly users have a harder time safely navigating their surroundings due to the combination of side effects.
The Canadian Frailty Network has called for caution in the prescribing of drugs like zopiclone that are used as sleep aids for older adults. In fact, in 2019, Health Canada warned healthcare providers to heed elderly patients, advising them to keep an eye out for signs of cognitive impairment and physical instability while on zopiclone. Some elderly patients are usually given Zopiclone 5mg to reduce the risk of these adverse side effects, but even lesser doses may not safeguard you completely from harm.
Some users of zopiclone have reported weight gain, for which there is limited clinical data [3]. The zopiclone itself doesn’t make you gain weight but may do so through other routes such as due to reduced physical activity as a result of daytime drowsiness or changes in metabolism. Furthermore, with insomnia and the treatment of insomnia, such as zopiclone, there are also effects on hormonal regulation hunger, and appetite that can result in increased caloric intake.
More research is needed on the connection between sleep disorders, the use of zopiclone, and weight gain, but users should keep an eye on their diet and activity levels while on medication.
Zopiclone, however, is primarily a short-term treatment and when used appropriately the risk of significant weight changes is low. For people who don’t understand why they’re gaining weight, it may help to find out whether it’s due to the drug itself or more to do with the underlying sleep disorder or any other lifestyle factors.
Zopiclone provides sedative properties and can disrupt cardiovascular and respiratory functions, especially in a vulnerable population. Rarely, respiratory depression has been reported with the drug, especially when the drug was taken with alcohol, opioids, or other sedative medications. However, those risks are increased in the elderly and patients with preexisting conditions such as chronic obstructive pulmonary disease (COPD) or sleep apnea.
Mild cardiovascular effects of zopiclone range from heart palpitations, blood pressure changes, and an increased risk of arrhythmia for sensitive individuals. If you have a heart condition, always talk to your doctor first before taking zopiclone.
Zopiclone is used to treat insomnia short term, although longer use may lead to addiction. Because the drug induces sleep so quickly, it is psychologically dependent upon it to maintain a normal sleep cycle. Repeated use of the drug will eventually become excessive if users find it difficult to fall asleep without it.
When your body gets used to the drug—and needs more to get the same result—the drug loses its potency and you become physically tolerant to it. For example, a person in Canada who is at first prescribed zopiclone 5mg might need to take this higher after a few weeks because it doesn’t work anymore, hence the need to increase dosage. Zopiclone tends to spiral into addiction quickly, particularly for people who take the medication without medical supervision and continuously for longer amounts of time than advised.
Warning signs of zopiclone addiction include:
Zopiclone can cause physical dependence when the body becomes used to being around it and needs it to work properly. These withdrawal symptoms can range from mild to severe and include anxiety, seizures, and hallucinations when stopped or reduced very suddenly and the longer a person uses zopiclone, the more severe these symptoms can get.
Symptoms include:
Physical dependence usually goes hand in hand with psychological dependence. That increases the anxiety about not taking it and they start to believe they can’t function or sleep without it. It is as powerful psychologically as it is physically; leaving a user in a retaining loop of dependence.
Managing withdrawal from zopiclone can be difficult for the addicted. In some cases, medical supervision is needed to taper off the drug slowly to avoid withdrawal symptoms. Health professionals recommend that those who’ve been on the drug for a few months or more should taper off more slowly than retreat abruptly.
Withdrawal symptoms can be managed and alternate solutions to sleep given with cognitive behavioral therapy (CBT) for insomnia, relaxation techniques, and other non-pharmacological treatments. In the short-term medications such as melatonin or antihistamines may be prescribed to help taper off, although these are generally less effective than zopiclone in getting to sleep.
The growing concerns about zopiclone addiction and its side effects have inspired many patients and care providers to look for more secure alternatives for dealing with insomnia.
Medications like eszopiclone (Lunesta) and zolpidem (Ambien), also known as non-benzodiazepine medications, have effects on you that are similar to zopiclone but are thought to have fewer risks of dependence as well as less risk of negative cognitive side effects. Even these drugs are not without risk should they be used long term, and they are not intended to be used for long term.
However, there are other options, such as zopiclone 5mg which provides a lower dose suitable for elderly patients or patients more sensitive to drug side effects, this does not, however, eliminate the risk of long-term dependence either.
One of the most effective long-term treatments for sleep disorders is Cognitive Behavioral Therapy for Insomnia (CBT-I). Unlike medication, CBT-I also treats the causes and not only the symptoms of insomnia, by teaching its participants how to learn new thoughts and behaviors to improve and maintain good sleep. These include sleep restriction, which helps to reestablish healthy sleep habits: stimulus control to reduce the time in bed; and relaxation training to allow individuals to fall asleep on their own without drugs.
While only available as sleeping pills on prescription, CBT-I has been shown to lead to long-term relief of insomnia symptoms more effectively than sleeping pills, without the risks associated with using sedatives like zopiclone. The road to success when it comes to treating chronic insomnia is CBT-I because it has such a high success rate and such a safe profile that a growing number of sleep specialists recommend CBT-I as a first-line treatment [3].
If you rather take a more natural approach to managing your sleep, valerian root, melatonin supplements, and chamomile tea are all mild sedatives that can aid in improving the quality of your sleep, without some of the risks that come with prescription medication. Although they are not as strong as zopiclone or other prescription sleep medications, they are milder for those suffering from modest insomnia or seeking to prevent addiction.
1. Drugs.com. Zopiclone. https://www.drugs.com/zopiclone.html
2. UpToDate. Zopiclone. https://www.uptodate.com/contents/zopiclone-united-states-not-available-drug-information
3. Official Publication Of The College Of Family Physicians Of Canada. Zopiclone. https://pmc.ncbi.nlm.nih.gov/articles/PMC2231551/
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