Herbie Murray
Sleeping pills are medications designed to facilitate or maintain sleep. They are typically used to treat insomnia and other sleep disorders. The science behind how they work varies depending on the type of pill. Some sleeping pills cause drowsiness by blocking histamines, the substances in your body that cause alertness. Others work on the GABA receptors in the brain, which help control our level of alertness or relaxation. Prescription sleeping pills are stronger than over-the-counter ones and are typically only recommended for short-term relief due to the risk of dependence and addiction.
| Characteristics | Values |
|---|---|
| How they work | Sleeping pills work on the GABA receptors in the brain, which help control our level of alertness or relaxation. |
| Types | Sleeping pills can be over-the-counter, prescription, or natural supplements. |
| Prescription types | Benzodiazepines, Non-benzodiazepine (Non-BZD) or Z-drugs, Tricyclic antidepressants (TCAs), Selective GABA medications, Melatonin |
| Over-the-counter types | Antihistamines, Diphenhydramine, Doxylamine |
| Natural supplements | Melatonin, Valerian supplements |
| Effects | Sleeping pills can make you feel drowsy, relaxed, and calm anxiety. |
| Side effects | Dependency, addiction, withdrawal symptoms, sleepiness during the day, confusion, parasomnia, constipation, difficulty urinating, dry mouth or throat, decreased sexual drive, weight gain |
| Precautions | Not recommended for long-term use, not to be given to children without consulting a doctor, not to be shared with others |
| Sleep hygiene | Maintaining a consistent sleep schedule, limiting caffeine and alcohol intake, controlling factors like noise and temperature, avoiding stimulating activities before bed, doing relaxing activities before bed |
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What You'll Learn
How do sleeping pills work?
Sleeping pills are medications designed to help people fall asleep or stay asleep. They are typically used to treat insomnia and other sleep disorders. While they can provide short-term relief, they are not a cure for insomnia and are not recommended for long-term use due to potential side effects and the risk of dependence and addiction.
There are various types of sleeping pills, including over-the-counter (OTC) and prescription medications. OTC sleep aids often contain antihistamines, which can cause drowsiness as a side effect. Prescription sleeping pills, on the other hand, are generally stronger and may include benzodiazepines, non-benzodiazepines (Non-BZD) or Z-drugs, and selective GABA medications. Benzodiazepines, such as temazepam, slow down brain and body functions, promoting relaxation and sleep. Non-BZD or Z-drugs like Zolpidem, Ambien, and Zopiclone are fast-acting and induce sleepiness without leaving you feeling groggy in the morning. Selective GABA medications target specific GABA receptors in the brain, promoting sleep with fewer side effects and less addictive potential compared to older drugs.
Sleeping pills can also include natural supplements like melatonin, which is a synthetic version of the hormone naturally produced by the pineal gland to stimulate sleep onset. Melatonin is often preferred for individuals with irregular work schedules or seniors with decreased melatonin secretion. Additionally, antidepressants may be prescribed to treat insomnia in individuals with depression or chronic pain. However, these medications can have more pronounced side effects, especially at higher doses.
While sleeping pills can be beneficial for short-term relief, they should not be the only solution for sleep problems. Non-drug therapies, such as cognitive behavioural therapy (CBT), can often be more effective in improving sleep quality. Good sleep hygiene practices, including maintaining a consistent sleep schedule, limiting caffeine and alcohol intake, and creating a relaxing sleep environment, are crucial for promoting healthy sleep habits.
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Types of sleeping pills
Sleeping pills are of various types, each working differently and treating insomnia by making one feel drowsy and relaxed. While some sleeping pills are available over the counter, others require a prescription.
Over-the-Counter Sleeping Pills
Over-the-counter (OTC) sleeping pills often contain antihistamines, which are typically used to treat allergies. Antihistamines block histamines, the substances in the body that cause alertness, thereby making one feel drowsy. Common ingredients in antihistamines include diphenhydramine and doxylamine. While these can be helpful for occasional sleep problems, they are not meant for long-term use.
Natural sleep aids like melatonin and valerian are also available over the counter. Melatonin is a hormone that promotes sleep by influencing when one falls asleep and wakes up. Valerian has a natural calming effect on the nervous system, helping to promote a better night's sleep.
Prescription Sleeping Pills
Prescription sleeping pills are generally stronger than over-the-counter ones. They are not a cure for insomnia and are usually only prescribed for short-term relief due to the risk of dependence and addiction.
Benzodiazepines
Benzodiazepines (benzos) are prescription-only sleep aids. They work by stimulating a chemical in the brain called GABA, which leads to sedation, muscle relaxation, and reduced anxiety. They increase sleep time and quality and have the potential to be addictive, leading to substance use disorder. Hence, they are generally recommended for short-term use. Examples include estazolam (Prosom) and zolpidem (Ambien).
Benzodiazepine Receptor Agonists or Nonbenzodiazepines
Also called "Z-drugs," these prescription-only sleep aids include eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien). Similar to benzodiazepines, they are classified as Schedule IV controlled substances due to their potential for misuse and addiction. While eszopiclone can be used for long-term treatment of insomnia, zaleplon and zolpidem are approved for short-term use.
Antidepressants
Tricyclic antidepressants like doxepin (Silenor) are FDA-approved for treating insomnia characterised by difficulty staying asleep. They slow brain activity to promote sleep and are only available with a prescription. Other tricyclic antidepressants like amitriptyline and nortriptyline have been prescribed off-label for treating insomnia, but this is rare due to the medications' many potential side effects.
Antipsychotics
Antipsychotics are not FDA-approved for treating insomnia and are not recommended by the American Academy of Sleep Medicine for sleep problems. However, they may be prescribed off-label for patients being treated for psychiatric disorders due to their sedating effects. Examples include quetiapine (Seroquel), olanzapine (Zyprexa), and risperidone (Risperdal). These medications require a prescription but are not controlled substances.
Other Types
Some newer medications like daridorexant or lemborexant may offer sustained benefits for chronic insomnia with a potentially lower risk of dependence compared to older drugs. Ramelteon (Rozerem) is the only FDA-approved, prescription melatonin receptor agonist for treating insomnia. It is not a controlled substance as it has not been proven to have the potential for misuse and addiction.
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Safety and effectiveness
Sleeping pills are scientifically designed to treat insomnia by making individuals feel drowsy and relaxed. However, their safety and effectiveness are questionable due to associated side effects and risks of dependency.
Sleeping pills are available over the counter (OTC), as natural supplements, or by prescription. While OTC pills are more accessible, they are not without side effects. Common side effects of sleep medications include drowsiness, impaired focus, and difficulty with movement or balance, which can persist into the following day. More severe side effects include parasomnias, allergic reactions, and dependence on or abuse of the medication. Parasomnias involve behaviours such as sleepwalking, sleeptalking, sleep-eating, and even sleep driving, which can be extremely dangerous.
The risk of dependency is a significant concern with sleeping pills. They are not intended for long-term use, as they can become habit-forming, leading to psychological dependence. This means that individuals may find it challenging to fall asleep without the medication, creating a cycle of reliance. Additionally, sleeping pills can interact with other OTC or prescription drugs, particularly those affecting the central nervous system, and even certain foods like grapefruit. These interactions can have serious consequences, including depressed breathing and, in extreme cases, death.
Prescription sleeping pills are even stronger than OTC ones, and providers typically recommend them only for short-term relief due to the risk of dependence and addiction. It is crucial to consult a doctor before taking any sleep medication to ensure safety and understand potential side effects. Doctors will consider an individual's medical history and other medications they may be taking to determine if sleeping pills are appropriate.
While sleeping pills can provide temporary relief from insomnia, they are not a cure and may even worsen insomnia over time. Non-drug therapies, such as cognitive behavioural therapy (CBT), are often recommended as a safer and more effective alternative to improve sleep quality. These therapies focus on addressing the underlying factors contributing to insomnia and helping individuals develop healthy sleep habits and a better understanding of sleep physiology.
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Side effects
Sleeping pills are prescription medications that contain tranquilizers to treat insomnia, restless sleep, or difficulty falling asleep. They are designed to help people fall asleep or stay asleep. While they can be effective in the short term, sleeping pills can have several side effects and are not recommended for continuous long-term use.
One of the most common side effects of sleeping pills is excessive drowsiness or sleepiness during the day. This can impact activities that require concentration, such as driving, and increase the risk of injuries. Additionally, some people may experience allergic reactions to the medication, which can be serious and require immediate medical attention.
Sleeping pills can also cause digestive problems, including constipation, diarrhea, gas, heartburn, and nausea. They may worsen snoring and sleep apnea, and in some cases, lead to parasomnia, a disruptive sleep disorder. Parasomnia can result in dangerous behaviors such as sleepwalking, sleep talking, sleep eating, and even sleep driving. Approximately 8 out of 10 people experience a hangover effect the day after taking sleeping pills, and they may feel confused or groggy.
Sleeping pills can also cause muscle weakness and reduced coordination. They may negatively affect an individual's mental health, leading to confusion and worsening insomnia when trying to stop taking the medication. Furthermore, sleeping pills can be habit-forming, and long-term use can result in dependence or addiction. Rebound insomnia may occur when discontinuing the medication, with insomnia returning worse than before.
It is important to consult a healthcare provider before taking sleeping pills and to gradually reduce the dosage under supervision if discontinuing their use.
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Natural alternatives
Sleeping pills are scientifically designed to make you feel drowsy and relaxed, but they are not a cure for insomnia and can have side effects. Natural alternatives to sleeping pills include:
- Melatonin supplements: Melatonin is a natural hormone that regulates the body's circadian rhythm, or sleep-wake cycle. It is triggered by reduced light exposure and is usually released around four hours before we feel sleepy. However, exposure to artificial light from phones, laptops, or TVs can prevent its release, making it difficult to fall asleep. Melatonin supplements are available over the counter and can help reduce the time it takes to fall asleep, increase feelings of sleepiness, and potentially extend sleep duration. It is important to note that melatonin supplements are unregulated, and their long-term effects are unknown.
- Valerian: Valerian is an herbal extract used to manage anxiety and insomnia. While there is limited evidence, some findings suggest that valerian may reduce the time needed to fall asleep and improve sleep quality. Unlike benzodiazepines, valerian does not appear to cause morning grogginess. However, other studies have shown that valerian may not be more effective than a placebo in treating insomnia.
- Kava: Kava, or kava-kava, is an herbal remedy used for stress, anxiety relief, and insomnia. It is said to induce relaxation without hindering memory or motor function. However, research findings are conflicting, and there have been reports of potential liver toxicity associated with its use.
- Cognitive Behavioral Therapy (CBT): Non-drug therapies like CBT, which can be accessed through apps, online resources, or a therapist, can be effective in improving sleep. Techniques may include reading or listening to calming music to promote relaxation and prepare the body for sleep.
- Lifestyle changes: Simple lifestyle changes can also improve sleep quality. Reducing caffeine intake, limiting screen time before bed, and creating a calm and quiet environment can all contribute to better sleep. Additionally, warm milk, chamomile tea, and tart cherry juice are natural drinks that may help with sleep, although there is limited scientific proof of their effectiveness.
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Frequently asked questions
Sleeping pills can be over-the-counter (OTC) or prescription medications. Prescription sleeping pills are stronger and often contain tranquilizers. Antidepressants, barbiturates, benzodiazepines, and Z-drugs like zolpidem (Ambien) and eszopiclone (Lunesta) are some common prescription sleeping pills. OTC sleep aids often contain antihistamines, which cause drowsiness.
Sleeping pills work by acting on the central nervous system to promote drowsiness and improve sleep quality. They target the GABA receptors in the brain, which control alertness and relaxation. When activated, GABA reduces neuronal excitability, inducing relaxation or sedation.
Sleeping pills can have various side effects, including daytime sleepiness, confusion, parasomnia (sleepwalking or eating), and withdrawal symptoms with long-term use. They can also lead to dependence and addiction if used continuously over an extended period.
Alternatives to sleeping pills include non-drug therapies such as cognitive behavioral therapy (CBT), stimulus control, sleep hygiene instructions, and relaxation training (meditation, breathing exercises, muscle relaxation). Natural sleep aids like melatonin and valerian supplements are also available but may cause side effects.
