Gina Johnson
Sleeping pills are available over the counter, as natural supplements, or by prescription. While some sleeping pills are available over the counter, stronger medications are available only by prescription and are classified as Schedule IV controlled substances by the FDA due to their potential for misuse, addiction, and dependence. Examples of prescription sleeping pills include estazolam (Prosom), eszopiclone (Lunesta), and temazepam (Restoril). On the other hand, over-the-counter sleeping pills often contain antihistamines, which cause drowsiness as a side effect. Natural supplements such as melatonin and valerian are also available over the counter and are promoted to aid relaxation and sleep.
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What You'll Learn
Sleeping pills: prescription vs over-the-counter
Sleeping pills are available over the counter (OTC), as natural supplements, or by prescription. Anyone over the age of 18 can buy OTC sleep medications at drugstores or other retail outlets without a prescription. OTC sleep aids often contain antihistamines, which treat allergies but can also cause drowsiness. Melatonin supplements and valerian are also available as OTC sleep aids. Melatonin is a hormone that the body naturally produces to promote sleep, while valerian is an herb that aids relaxation and sleep.
Prescription sleeping pills are stronger than OTC ones and can only be obtained with a prescription from a healthcare provider. Benzodiazepines, Z-drugs, and melatonin receptor agonists are some of the prescription sleep medications available. Benzodiazepines, such as Restoril (temazepam) and Ativan (lorazepam), work by stimulating the GABA chemical in the brain, leading to sedation, muscle relaxation, and reduced anxiety. However, they can be addictive and are typically prescribed for short-term use only. Z-drugs, such as zolpidem (Ambien) and eszopiclone (Lunesta), slow down brain activity. While generally safe, they can cause complex sleep behaviours such as sleepwalking or driving while asleep. Melatonin receptor agonists like ramelteon (Rozerem) are considered the first line of therapy for insomnia as they do not cause physical dependence or abuse.
Both OTC and prescription sleeping pills can cause side effects such as constipation, diarrhoea, and muscle weakness. Approximately 8 out of 10 people experience a hangover effect the day after taking sleep medicine, feeling drowsy, dizzy, and having muddled thinking. It is important to use caution when taking any sleep medicine, as they can negatively impact your ability to perform daily tasks. Additionally, sleeping pills should not be used long-term due to the risk of dependence and addiction. If you have been taking sleep aids for a long time, consult your healthcare provider to determine a safe way to stop.
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Controlled substances: misuse, addiction, and dependence
Sleeping pills are available over the counter (OTC), as natural supplements, or by prescription. Prescription sleep medications such as benzodiazepines and Z-drugs can be addictive and carry a risk of misuse and dependency. Benzodiazepines, for instance, stimulate a chemical in the brain called GABA, leading to sedation, muscle relaxation, and reduced anxiety. Z-drugs work by slowing down brain activity and can cause parasomnia, a disruptive sleep disorder that can lead to dangerous behaviors such as sleepwalking, eating, or even driving while being mostly asleep. Due to these risks, healthcare providers typically prescribe these sleeping pills for short-term use.
Controlled substances are medications or drugs that are regulated by government authorities due to their potential for misuse, addiction, and dependence. These substances are often categorized into schedules based on their potential for abuse and medical use. For example, Schedule I drugs have the highest potential for misuse and no accepted medical use, while Schedule V drugs have the lowest potential for abuse. The misuse of controlled substances can lead to significant societal challenges and adverse health consequences, including morbidity and mortality.
Addiction is a chronic relapsing disorder characterized by compulsive drug-seeking and use, despite negative consequences. It is considered a brain disorder as it involves functional changes to brain circuits involved in reward, stress, and self-control. These changes can be observed through brain imaging studies and can last long after an individual has stopped taking drugs. Addiction shares similarities with other diseases, such as heart disease, as they both disrupt the normal functioning of organs and can have serious harmful effects.
Misuse of controlled substances can occur due to various factors, including biological and environmental influences. Biological factors include genes, stage of development, and ethnicity, while environmental factors encompass family, school, and neighborhood influences. Adolescence is a critical period where risk factors, such as peers who use drugs, can increase the likelihood of substance use and subsequent addiction. Protective factors, on the other hand, can reduce the risk of misuse and addiction.
To prevent the misuse of controlled substances, it is crucial for prescribers to follow safe prescribing practices and comprehensive patient evaluations. This includes considering the patient's medical history, mental health, social history, and potential side effects of the medication. Additionally, consulting with addiction experts and other specialists can help ensure the appropriate prescription of controlled substances while minimizing adverse consequences.
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Side effects and interactions with other substances
Sleeping pills can cause a range of side effects, from constipation to muscle weakness. Other possible side effects include digestive problems, such as gas, heartburn, and nausea. They can also worsen snoring and sleep apnea, a potentially life-threatening condition. It is important to note that approximately eight out of ten people experience a hangover effect the day after taking sleep medication. They may feel drowsy, have muddled thinking, and experience dizziness or balance problems. These daytime effects can negatively impact daily tasks such as driving, working, or operating machinery.
Sleeping pills can also cause parasomnias, which are disruptive sleep disorders characterized by dangerous behaviors while the person is still mostly asleep. People taking sleeping pills may sleepwalk, eat, talk, or even drive without being fully awake and unaware of their actions. These behaviors can be complex and may include making phone calls or having sex while in a sleep state. While rare, parasomnias are challenging to detect once the medication takes effect, and most people do not remember these actions after waking up.
The use of sleeping pills over a long period can lead to dependence and other problems. Sleeping pills should not be mixed with other sedatives or alcohol due to the risk of overdosing. Additionally, older adults are more susceptible to health problems caused by sleeping pills, including prolonged drowsiness, confusion, and memory issues, which can increase the risk of falls and accidents.
It is crucial to consult a healthcare provider before taking sleeping pills, especially when considering long-term use. They can advise on potential interactions with other medications and recommend alternative treatments, such as cognitive behavioral therapy (CBT), to improve sleep without the risks associated with sleeping pills.
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Natural sleep aids and supplements
Sleeping pills can cause side effects and should not be used long-term. They are available over the counter (OTC), as natural supplements, or by prescription. Natural sleep aids are classified as dietary supplements, and they are usually plant-based, vitamins or minerals. They are popular because they tend to have fewer side effects than prescription sleep medications. However, they are not regulated as strictly as medications, so it's important to consult a doctor before taking them.
Melatonin
Melatonin is a hormone that is naturally produced by the body and promotes sleep. It is influenced by the time of day, with levels rising in the evening and falling in the morning. Melatonin supplements have been found to improve sleep quality and reduce the time needed to fall asleep. They are available over the counter.
Valerian
Valerian is an herb that has a natural calming effect on the nervous system and helps promote sleep. It is available as a supplement.
Magnesium and Valerian Root
Magnesium and valerian root are natural sleep aids that can help improve sleep quality.
CBD
CBD has been found to relieve anxiety and act as a natural sleep aid, particularly when used with THC. However, more research is needed to confirm its effectiveness and long-term safety, and it is classified as a controlled substance in some states.
L-Theanine
L-Theanine is a supplement that does not cause daytime sleepiness and appears to be safe for most people, including children with ADHD. It can improve sleep and behaviour.
Glycine
Glycine is an amino acid and neurotransmitter that plays a role in metabolism, nutrient absorption, disease prevention, and sleep. Taking a small dose of supplemental glycine before bed may improve sleep quality and reduce daytime sleepiness in people with insomnia.
Lifestyle Changes
In addition to supplements, there are natural lifestyle changes that can improve sleep. These include avoiding screen time before bed, limiting light exposure at night, avoiding working out within two hours of bedtime, and drinking warm milk, chamomile tea, or tart cherry juice before bed.
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Non-pharmacological treatments for insomnia
While sleeping pills can be effective in helping people fall and stay asleep, they are typically a short-term solution due to the risk of side effects, misuse, and dependency. Some common side effects include constipation, muscle weakness, and a hangover effect the next day. Additionally, sleeping pills may interact with other substances, including medications and alcohol, leading to dangerous consequences such as overdose or parasomnia. Due to these risks, it is important to consult a doctor before taking any sleep medication.
For those seeking alternative approaches to address insomnia, there are several non-pharmacological treatments available. These therapies are particularly beneficial for older adults and individuals with chronic insomnia, as they provide longer-lasting benefits without the potential drawbacks of pharmacological interventions. Here are some non-pharmacological treatments for insomnia:
- Sleep hygiene education: This involves educating individuals about sleep practices that can improve sleep quality. Recommendations include maintaining a regular sleep schedule by going to bed and waking up at the same time each day. While this may be challenging for patients with illnesses that cause fatigue, sleep hygiene education has proven effective in treating insomnia.
- Cognitive-behavioural therapy (CBT): This psychological intervention aims to address misconceptions and negative beliefs about sleep and insomnia. It challenges faulty attitudes about the perceived consequences of insomnia and helps individuals manage their condition effectively. CBT has been shown to improve sleep quality, particularly in older adults and those with chronic pain.
- Relaxation therapy: Techniques such as yoga, tai chi, acupuncture, and acupressure can improve sleep quality, especially in older adults. Massage therapy has also been found to be beneficial for hospitalized older patients.
- Bright light therapy: This approach involves timed exposure to a bright light source to restore the normal circadian rhythm, helping to delay sleep. Research has shown that just two four-hour sessions of bright light therapy can improve early-morning awakenings for up to one month.
- Positive airway pressure ventilation: For individuals with obstructive sleep apnea, positive airway pressure ventilation, such as CPAP, can dramatically improve symptoms. While some patients find it challenging to adjust to sleeping with a CPAP mask, this therapy can significantly enhance their sleep quality.
It is important to note that the choice of therapy depends on various factors, including clinician experience, patient motivation, the severity of insomnia, and the presence of underlying medical conditions. A comprehensive approach to treating insomnia may involve a combination of non-pharmacological and pharmacological interventions tailored to the individual's needs.
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Frequently asked questions
No, not all sleeping pills are controlled substances. Sleeping pills are available over the counter (OTC), as natural supplements, or by prescription. While some prescription sleeping pills are controlled substances, it is not the case for all of them.
Controlled substances are drugs that are regulated by government authorities due to their potential for misuse, abuse, or dependence. They are classified into schedules based on their risk level and are subject to strict controls on their prescription, distribution, and use.
Sleeping pills that are classified as controlled substances include Eszopiclone (Lunesta), Zolpidem, and Extended-Release Zolpidem (Ambien). These drugs are part of the Z-drug family and are considered Schedule IV controlled substances. Benzodiazepines, such as alprazolam (Xanax), clonazepam (Klonopin), and temazepam (Restoril), are also controlled substances.
Yes, Ramelteon is a prescription sleep aid that is not classified as a controlled substance by the FDA. It works by regulating the sleep-wake cycle and is generally well-tolerated, with common side effects like headaches and dizziness.
Controlled substance sleeping pills carry risks of side effects, misuse, addiction, and dependence. They can also interact with other substances, including alcohol and medications, leading to serious side effects. It is important to consult a doctor before taking any sleeping pills and to follow their recommendations for safe use.
