Herbie Murray
Sleep is essential for our health and well-being, but for those who struggle to get a good night's rest, sleeping pills can seem like an attractive solution. However, the potential for dependency and side effects is a significant concern. The good news is that there are non-habit-forming options available, both over-the-counter and prescription, that can help treat insomnia and improve sleep quality. These include natural supplements like melatonin, antihistamines such as doxylamine succinate and diphenhydramine, and prescription medications like ramelteon (Rozerem). While these alternatives may not cause physical dependence, it's important to remember that even non-habit-forming sleep aids should be used with caution and under the guidance of a healthcare professional to ensure safe and effective use.
| Characteristics | Values |
|---|---|
| Non-habit-forming sleep aids | Doxylamine succinate, diphenhydramine, hydroxyzine, melatonin, gabapentin enacarbil, pramipexole, ropinirole, rotigotine, mirtazepine, trazodone, quetiapine, orexin receptor antagonists, eszopiclone, zaleplon, zolpidem, ramelteon, carbamazepine, pregabalin, valproate, gabapentin, methylphenidate, modafinil, pitolisant, sodium oxybate |
| Side effects | Confusion, sleepiness during the day, parasomnia, dizziness, nausea, death (in rare cases) |
| Precautions | Should not be used long-term, should not be combined with alcohol or other medications, may not be safe for pregnant or breastfeeding individuals, may not be suitable for children or older adults |
| Alternatives | Cognitive behavioral therapy, non-drug treatments, changing sleep behaviors |
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What You'll Learn
Over-the-counter sleep-aids
Sleeping pills can have side effects and are not recommended for long-term use. Over-the-counter (OTC) sleep aids are available without a prescription and can be purchased by anyone over the age of 18 at a drugstore or other retail location. However, it is advised to consult a healthcare provider before taking any OTC sleep aids or supplements, especially for those who are pregnant or breastfeeding, as the medication can pass to the fetus or baby. Older adults are also advised to try nondrug treatments first.
OTC sleep aids often contain antihistamines, which can cause drowsiness. Common antihistamine medications used as sleep aids include Benadryl, which contains the active ingredient diphenhydramine. It is important to note that while antihistamines can aid sleep, they are not approved for this purpose and should be used with caution, especially when given to children.
Natural supplements, such as melatonin and valerian, are also available as OTC sleep aids. Melatonin is a hormone naturally produced by the body that promotes sleep, while valerian is an herb that is believed to aid relaxation and sleep. However, herbal supplements are not regulated by the FDA, so there is uncertainty about the amount of the substance in each sleep aid. Lavender essential oil and herbal teas containing passionflower, chamomile, or valerian are other natural remedies that may help promote relaxation and sleep.
While OTC sleep aids can provide temporary relief for occasional sleepless nights or short-term stress, they are not a cure for insomnia or other long-standing sleep problems. For ongoing sleep difficulties, it is recommended to consult a healthcare provider or a sleep specialist, who can prescribe a more appropriate sleep aid or refer the patient to a sleep psychologist for cognitive behavioral therapy (CBT) to treat insomnia.
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Non-benzodiazepines
Sleeping pills are typically prescribed for short-term use and are meant to be taken for no more than three weeks, and ideally for just one week. They are used to treat insomnia by making the user feel drowsy and relaxed, but they can also cause side effects such as confusion or sleepiness during the day, and in some cases, parasomnia. Sleeping pills can also be dangerous when mixed with other substances, and a sleeping pill overdose can be deadly.
Z drugs, including zolpidem and zopiclone, are a type of non-benzodiazepine. They are short-acting drugs that are less likely to have a 'hangover' effect than some other types of sleep medication. They should only be prescribed for severe insomnia after other non-medication treatments have been attempted.
Other non-benzodiazepine hypnotics include eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien), which are used to treat short-term insomnia. The melatonin receptor stimulator ramelteon (Rozerem) is also in this category and was approved in 2005.
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Antidepressants and antianxiety medications
Sleeping pills are not recommended for long-term use due to their potential side effects. Antidepressants and antianxiety medications are sometimes prescribed to address both anxiety and insomnia. These medications can help individuals who experience difficulty falling asleep and staying asleep due to anxiety.
Doxepin (Silenor) is a tricyclic antidepressant (TCA) that treats depression and anxiety while also being effective in treating insomnia. Unlike other sleep medicines, doxepin is not addictive and does not cause dependence. It works by blocking histamine receptors in the brain, helping individuals stay asleep. However, it may cause side effects such as increased sleepiness, confusion, and behavioural changes, especially in older adults.
Zolpidem (Ambien) is a non-benzodiazepine sedative-hypnotic that can help individuals fall asleep and stay asleep longer. It is a fast-acting medication that should be taken immediately before bed. Zolpidem is available in tablet, sublingual, and oral spray forms. As with other sleep medications, individuals should ensure they have at least 7-8 hours to remain in bed after taking zolpidem.
Eszopiclone (Lunesta) is another sedative-hypnotic medication that assists in falling asleep and reduces the number of night-time awakenings. It is considered a non-benzodiazepine "Z" drug, which has a lower potential for dependency and abuse compared to benzodiazepines.
While antidepressants and antianxiety medications can be beneficial for treating insomnia, it is important to consult a healthcare professional before starting any medication. They can provide guidance on the most suitable treatment options and help manage any potential side effects or risks associated with these medications.
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Orexin receptor antagonists
Sleeping pills can be habit-forming and have side effects, so they are not recommended for long-term use. For extreme cases of insomnia, a healthcare provider may prescribe a short-term sleep aid. Non-drug treatments such as cognitive behavioural therapy (CBT) are usually recommended as a first-line treatment for insomnia.
Three ORAs—suvorexant, lemborexant, and daridorexant—are approved by the FDA for the treatment of insomnia in adults. Suvorexant (Belsomra) was approved in 2014 for the treatment of both sleep-onset and sleep-maintenance insomnia. It is available in 5-, 10-, 15-, and 20-mg tablets, with a starting dosage of 10 mg taken within 30 minutes before bedtime. If the 10-mg dosage is not effective, it can be increased to a maximum of 20 mg once daily. However, dosing cannot be repeated if sleep induction or maintenance fails. Lemborexant and daridorexant are the other two FDA-approved ORAs that have been shown to improve sleep quality in people with insomnia.
ORAs differ from other types of sleep aids as they affect different systems in the body. Unlike over-the-counter sleep aids, which cause sedation or help regulate the body's circadian rhythm, ORAs target the body's orexin system. While prescription sleep aids may promote sleep by targeting GABA receptors in the brain, they may have undesirable side effects such as memory issues, behaviour changes, and hallucinations. In contrast, the most common side effect associated with ORAs is drowsiness.
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Non-drug treatments
While over-the-counter sleep aids are easily accessible and can be purchased from your local pharmacy, they are not meant for regular use due to their side effects and risks. If you are looking for non-drug treatments for insomnia, you can try the following:
Cognitive Behavioural Therapy (CBT-I)
Cognitive Behavioural Therapy for insomnia (CBT-I) is a non-pharmacological treatment approach that focuses on modifying and altering maladaptive behaviours and distorted beliefs about sleep and insomnia. CBT-I targets behavioural, cognitive, and physiological factors that perpetuate insomnia. During therapy, a therapist helps you focus on the stressors that keep you awake at night. Over the course of typically four to ten visits, you will work through how to calm your mind when those stressors occur. CBT-I can be delivered in different formats, such as face-to-face individual or group therapy, or guided or unguided digitally delivered self-help formats.
Sleep Hygiene
Forming habits that help you fall asleep is called sleep hygiene. Being consistent with these habits is important to get a good night's sleep. This includes picking a bedtime that you can reliably stick to, keeping your bedroom temperature below 70 degrees, avoiding falling asleep with the television or radio on, and avoiding screens for an hour before bedtime.
Melatonin Supplements
Melatonin is a natural sleep aid that works with your body to help maintain its natural sleep cycle. It is available as a drug-free supplement and can help you fall asleep gently and wake up feeling refreshed.
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Frequently asked questions
Yes, there are non-habit-forming sleep aids available. Over-the-counter (OTC) medicinal sleep aids and sleep supplements can help with occasional sleepless nights. Antihistamine sleep aids like doxylamine succinate and diphenhydramine are considered "non-habit-forming" as they do not cause physical dependence. Natural sleep aids like melatonin can also be effective but may cause side effects like daytime drowsiness.
Unisom offers non-habit-forming sleep aids and drug-free supplements. Their OTC medicinal sleep-aids include SleepTabs, which contain doxylamine succinate, and SleepMinis, which contain diphenhydramine HCI. Their Simple Slumbers line is a drug-free supplement that contains melatonin to help maintain the body's natural sleep cycle.
Non-drug therapies like cognitive behavioral therapy (CBT) can be effective in improving sleep. Changing sleep behaviours, such as avoiding screens before bed, establishing a bedtime routine, and creating a comfortable sleep environment, can also help.
Yes, there are prescription medications available for treating sleep problems that are non-habit forming. Ramelteon (Rozerem) is a prescription melatonin receptor agonist that has been shown to be effective in treating insomnia. Other prescription options include anti-Parkinsonian drugs, antidepressants, and antianxiety medications, which may be prescribed off-label for sleep due to their drowsy side effects.
