Eszopiclone: Long-Term Use vs Short-Term Use for Insomnia

Good sleep is essential for overall well-being. In fact, it’s considered one of the three pillars of health, alongside movement and nutrition.[1] Unfortunately, as important as sleep is, achieving it can be difficult for some. Currently, one in three adults fails to get a good night’s sleep, and 12% of Americans have trouble falling or staying asleep.[2] This is called insomnia.[3]

Insomnia causes individuals to experience various physical and mental health challenges and can deteriorate their quality of life without treatment. One such treatment is eszopiclone, also known as Lunesta.

In this blog post, you will learn about Lunesta, its short-term and long-term effects, and whether or not using it leads to addiction.

What Is Insomnia?

Insomnia is a sleep disorder that makes falling or staying asleep difficult. It is usually an ongoing problem that affects sleep and how you function when awake.[4] There are two forms of insomnia: acute and chronic.[4]

• Acute Insomnia lasts anywhere from a few days to a few weeks and is usually triggered by trauma or stress.
• Chronic insomnia lasts more than three months and normally disturbs sleep for three or more nights per week. It is typically, but not always, a symptom of a physical or mental health issue.

Insomnia has many causes that range from poor lifestyle choices to chronic health conditions.

Other causes include, but are not limited to:[4]

• Using caffeine close to bedtime.
• Overindulging in alcohol.
• Breathing disorders, such as sleep apnea or asthma.
• Chronic pain resulting from migraines, arthritis, or fibromyalgia.
• Gastrointestinal disorders, including gastroesophageal reflux disease (GERD)
• Hormone imbalances, such as thyroid conditions or perimenopause.
• Mental health conditions like anxiety or depression.
• Neurological disorders, including Alzheimer’s and Parkinson’s disease.

Insomnia risk factors encompass older age, lack of physical activity, mental distress, stressful jobs, and African-American ethnicity.

You might have insomnia if you have experienced:[4]

• Difficulty falling asleep
• Waking up frequently
• Difficulty falling back asleep after waking up
• Feeling exhausted during the daytime

Untreated insomnia can lead to health conditions like high blood pressure, heart disease, and diabetes. It can also affect your mental health, energy, and cognitive function.

What Is the Sleep Medication Eszopiclone?

Traditionally, benzodiazepines were used to treat sleep disorders like insomnia.[5] However, medications in this class of drugs carry a high potential for abuse and dependence. Eszopiclone (Lunesta), on the other hand, is a nonbenzodiazepine that carries the same hypnotic properties, making it a safer alternative for those who wish to avoid more addictive treatments.[6]

Who Does It Treat?

Lunesta gained FDA approval in 2004 for the treatment of insomnia. However, a number of potential off-label uses have been observed in clinical practice.

They include:

• Restless leg syndrome (RLS): Lunesta’s sedative properties help treat sleep disturbances experienced by people with RLS.[7]
• Anxiety disorders: Some evidence supports the use of Lunesta by individuals dealing with troubling anxiety symptoms, particularly insomnia.[8]
• Pain management: Although Lunesta is not a painkiller, it may serve as a helpful adjunct treatment for individuals with moderate pain to aid in falling asleep.[9]
• Irregular sleep patterns: Individuals with shift work sleep disorder suffer from disturbances in their sleep-wake schedule.[10] Lunesta may help regulate their sleep patterns.

Even with a low risk for dependency, taking Lunesta for a reason other than prescribed can significantly enhance this risk.

How Does Eszopiclone Work in People With Insomnia?

Eszopiclone works by interacting with GABA receptors in the brain.[11] This slows brain activity and promotes restful sleep. Its effects begin rapidly after taking an initial 3 mg dose.[12] The medication is quickly absorbed in tissues throughout the body, including the brain, with peak plasma concentration within 1-1.6 hours.[12]

Common Side Effects of Lunesta

Due to the way Lunesta interacts with GABA A receptors in the brain, using it can cause side effects like:[13]

• Fatigue
• Fever
• Chills
• Cough
• Hoarseness
• Painful, difficult urination
• Lower back or side flank pain
• Sleepiness and unusual drowsiness

Some Lunesta users may experience serious side effects, including:[13]

• Worsening depression
• Confusion
• Hallucinations
• Suicidal thoughts
• Unusual excitement
• Irritability
• Nervousness

If you develop any of the above-listed symptoms, discuss them with your doctor. Do not stop taking Lunesta without first checking with your doctor. Stopping it suddenly can lead to withdrawal symptoms.[13]

Black Box Warning

A black box warning is the most serious warning the U.S. Food and Drug Administration issues for medications. According to StatPearls, these warnings are intended to draw the consumer’s attention to the medication’s major risks.[14]

Lunesta received a black box warning from the FDA on April 30, 2019, for complex sleep behaviors resulting in serious injuries or death.[15] They can occur even at the lowest recommended dose or after just one dose.

According to the FDA, healthcare professionals should not prescribe Lunesta to patients who have previously experienced complex sleep behaviors after taking a sleep aid.[15] Although occurrences of complex sleep behaviors are rare, patients should stop taking this medication if they experience one, including:[15]

• Sleepwalking
• Sleep driving
• Accidental overdoses

What Are the Long-Term Effects of Using Eszopiclone?

Based on clinical evidence, Lunesta is generally well tolerated.[16] However, this doesn’t mean there aren’t long-term effects of using the medication. This drug is habit-forming, and long-term use has been associated with a higher risk of developing a physical dependence.[17] For this reason, some physicians are reluctant to prescribe it as a long-term solution for chronic insomnia and opt instead for a non-habit-forming alternative.

Other long-term effects associated with eszopiclone use include:

• Next-day impairment: Some users experience extreme drowsiness or fatigue the day after taking Lunesta, which may last until their next dose.[18][19]
• Withdrawal: Dose reduction or discontinuation may trigger symptoms of withdrawal, such as upset stomach, abnormal dreams, anxiety, nausea, and rebound insomnia.[20]
• Dependence:[21] This medication may cause physical and psychological dependence, especially in individuals taking high doses over an extended duration or those concurrently using other psychoactive drugs.[20] The risk of dependence is also greater in users who have a history of drug abuse or substance use disorders.[20]

It’s important to note that clinical trials revealed no evidence of serious withdrawal syndrome in Lunesta users. However, adverse events were reported within the first 48 hours.[20]

Eszopiclone Withdrawal Symptoms

According to the U.S. Food and Drug Administration, symptoms of Lunesta withdrawal are similar to those of other CNS depressants.[20]

They include, but are not limited to:[22]

• Nausea
• Anxiety
• Headache
• Irritability
• Agitation
• Sleep disturbances
• Depression
• Dysphoria

To prevent these symptoms, the prescribing physician will gradually decrease the dose until reaching the minimal effective dosage.[23] A common tapering schedule involves reducing the dose by 25% each week. This tapering dose may be adjusted based on the patient’s withdrawal symptoms.[23]

What Are the Short-Term Effects of Using Eszopiclone?

Short-term effects linked to Lunasa typically subside once the medication is fully eliminated from the system. Since it has a mean elimination half-life of six hours, it would take approximately 30 to 36 hours for most of these effects to dissipate.[24]

Common short-term effects include:[24]

• Drowsiness
• Lightheadedness
• Dry mouth.
• Unpleasant taste
• Upset stomach
• Impaired motor functioning (loss of coordination)

Abnormal thinking behaviors have been observed in individuals who take Lunesta, no matter the dosage or duration used.[25] If you experience an increase in agitation, depression, or anxiety, or you have new or worsening suicidal thoughts, contact your prescriber immediately.

Is Eszopiclone a Controlled Substance?

Yes, Lunesta has been given a controlled substance designation by the United States Drug Enforcement Agency.[26] It is listed as a Schedule IV Controlled Substance due to its risk for misuse and abuse.[26] While this risk remains relatively low for individuals who use the medication short-term and as prescribed, studies indicate a potential for dependency due to misuse or concurrent drug use.

Does Using Eszopiclone Long-Term Increase the Risk of Dependence?

Yes. Although Lunesta is FDA-approved for both short-term and long-term treatment of insomnia, long-term use has been linked to a higher prevalence of physical dependency and abuse. However, AccessFDA states that the risk of dependency is relatively low for Lunesta when compared to sleep aids with benzodiazepine properties, such as Ambien.[20]

What Are the Signs of Eszopiclone Dependence?

People who become dependent on hypnotic drugs like Lunesta do so as a result of drug tolerance. This means over time, their bodies adjust to the medication in a way that requires higher doses to achieve the original effect. Although the risk of dependence is relatively low with Lunesta, taking it in a way other than prescribed can significantly increase this risk. Combining Lunesta with alcohol or other CNS depressant drugs can also lead to dependence and addiction.[20]

Signs of Lunesta dependence include:

• Craving Lunesta when not using it
• Unsuccessful attempts to reduce use
• Experiencing physical withdrawal symptoms when trying to stop
• A continued need for Lunesta despite adverse consequences

As noted by Harvard Health, no specific dosage or daily pill count definitively indicates dependence on a hypnotic medication.[27]

Does Eszopiclone Dependence Lead to Addiction?

Addiction is defined as a relapsing disorder characterized by compulsive drug seeking and drug use. When taken as prescribed, Lunesta rarely leads to addiction. However, using more than prescribed, for longer than prescribed, or in any way other than prescribed is considered misuse and can lead to addiction.[28]

According to the Diagnostic and Statistical Manual V (DSM-5), a person must acknowledge two or more of the following 11 criteria to have an addiction:[29]

• Taking more Lunesta than prescribed or an amount larger than prescribed
• Wanting to cut back on use, but not managing to
• Spending a lot of time using, obtaining, or recovering from Lunesta use
• Having cravings or urges to use Lunesta
• Failing to complete obligations at work, home, or school because of Lunesta use
• Continuing to use Lunesta despite the problems it causes with loved ones
• Forfeiting important activities because of Lunesta use
• Using Lunesta repeatedly, even if it puts you at risk of physical or psychological injury
• Continuing to use Lunesta despite having a physical or psychological issue that could have been caused by or made worse by using Lunesta
• Needing more Lunesta to get the original effect
• Experiencing withdrawal symptoms that are only relieved when you use more Lunesta

What Are the Treatment Options for Eszopiclone Addiction?

Although addiction is not curable, it is a treatable disorder. According to the National Institute on Drug Abuse, the principles of an effective addiction treatment plan include detoxing with or without medication combined with behavioral therapy or counseling.[30]

Behavioral therapy helps patients identify, avoid, and cope with situations that trigger drug abuse.[30] It is an action-based therapy, which requires the participant to make attainable incremental changes to reach their goal of full recovery. Some forms of behavior therapy engage in contingency management. This form of therapy uses positive reinforcement, such as rewards or other incentives for remaining substance free, attending counseling sessions, or participating in group activities.

Overcoming Lunesta Addiction

If you feel you have a dependence on Lunesta, bring this up to your healthcare provider. The sooner you begin a recovery plan, the sooner you regain control over your life.

Are you or someone you know struggling with Lunesta addiction? We’re here to help! Contact Engage Wellness today for a confidential consultation to find out how we can help you reach full recovery.

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