Evie Summers
Sleep is an essential part of our lives, and for those who struggle with it, sleeping pills can be a solution. Sleeping pills are available over the counter or by prescription, and they work in different ways. Over-the-counter pills typically contain antihistamines, which block the substances that keep us alert. Prescription medications, on the other hand, include benzodiazepines, which stimulate the brain chemical GABA, leading to sedation and muscle relaxation. While these pills can help with sleep disturbances and insomnia, they also come with risks and side effects, including dependency, misuse, and potential overdose. It is important to consult a healthcare professional before taking any sleep medication, as they can advise on the best course of action for your individual circumstances.
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What You'll Learn
Prescription vs. over-the-counter sleeping pills
Effective sleeping pills can be obtained either over the counter or by prescription. While over-the-counter sleep aids are readily available, prescription sleeping pills are regulated and can only be obtained with a prescription from a healthcare provider. Prescription sleeping pills are also stronger than over-the-counter ones.
Over-the-counter sleep aids typically include melatonin supplements, antihistamines such as diphenhydramine (Benadryl) and doxylamine succinate (Unisom SleepTabs, Robitussin Nighttime Cough DM, and Vicks Nyquil D Cold and Flu Nighttime Relief), and natural remedies such as valerian. Melatonin is a hormone that promotes sleep by influencing when you fall asleep and wake up. Antihistamines work by blocking histamines, which are substances in your body that cause alertness. Valerian has a natural calming effect on the nervous system.
Prescription sleep aids include benzodiazepine sedative hypnotics like Ativan (lorazepam) or Restoril (temazepam), non-benzodiazepine hypnotic sedatives like Ambien (zolpidem) or Lunesta (eszopiclone), and melatonin receptor agonists such as Rozerem (ramelteon). Benzodiazepines work by stimulating a chemical in the brain called GABA, which leads to sedation, muscle relaxation, and reduced anxiety. However, they can be addictive and are generally not recommended for long-term use due to the risk of serious side effects and the potential for physical dependence, misuse, withdrawal, and addiction. Z-drugs, such as zolpidem and eszopiclone, are often preferred over benzodiazepines due to a lower risk of dependency. Rozerem is considered the first line of therapy for insomnia as it does not cause physical dependence or abuse and does not typically cause morning sedation (daytime drowsiness).
Sleeping pills, whether over-the-counter or prescription, can cause a range of side effects, including constipation, diarrhoea, and muscle weakness. Approximately 8 out of 10 people experience a hangover effect the day after taking sleep medicine, feeling drowsy and experiencing dizziness or balance problems. This can negatively impact your ability to perform daily tasks, and caution should be exercised when taking sleep medicine. Additionally, a sleeping pill overdose can be deadly, and combining sleeping pills with alcohol or other medications can increase the risk of overdose.
It is important to consult a healthcare provider before taking any sleep medication to determine the best treatment option based on your individual needs, medical history, and current medication. Nondrug treatments and behavioural changes, such as improving sleep hygiene and cognitive behavioural therapy (CBT), are often the first line of treatment recommended for improving sleep.
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Effectiveness of sleeping pills
The effectiveness of sleeping pills varies from person to person. While some people may find relief from insomnia through the use of sleep aids, others may experience only mild benefits, such as falling asleep 8 to 20 minutes faster and gaining an extra 35 minutes of sleep. Additionally, sleeping pills are generally recommended for short-term use only due to the risk of dependency and potential side effects.
Over-the-counter (OTC) sleeping pills typically contain antihistamines, which work by blocking histamines responsible for alertness. Common antihistamines include diphenhydramine and doxylamine. Natural sleep aids, such as melatonin and valerian, can also be effective in promoting sleep by influencing sleep and wake cycles and calming the nervous system. However, it's important to consult a healthcare provider before taking any OTC sleep aid, as they can interact with other medications or substances and cause side effects.
Prescription sleep medications work differently and carry a higher risk of side effects, misuse, and dependency. Benzodiazepines, for example, stimulate the GABA chemical in the brain, leading to sedation, muscle relaxation, and reduced anxiety. However, they are classified as Schedule IV controlled substances due to their potential for abuse, addiction, and dependence. Other prescription sleep aids, such as doxepin (Silenor) and Ramelteon (Rozerem), can help with falling and staying asleep but may also have side effects. It's crucial to consult a doctor before starting any prescription sleep medication to ensure safe and effective use.
For older adults, lower doses or non-benzodiazepine options, such as melatonin or newer drugs, may be safer due to their increased sensitivity to sedative effects and side effects. Similarly, for chronic insomnia, newer medications like daridorexant or lemborexant may offer sustained benefits with a potentially lower risk of dependence. Shift workers and travelers experiencing jet lag or requiring rapid sleep onset can benefit from fast-acting medications or natural aids like melatonin.
While sleeping pills can provide temporary relief from sleep issues, it's important to explore non-drug treatments first, especially for older adults and children. Cognitive behavioral therapy (CBT) is an effective tool for improving sleep and curing insomnia without the need for medication. Behavioral changes, such as avoiding large meals, alcohol, caffeine, and smoking before bed, can also significantly impact sleep quality.
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Safety and side effects
Sleeping pills are medications designed to help people fall asleep or stay asleep. They are sometimes used to treat insomnia. While they can be effective, they should not be used as a long-term solution as they can have serious side effects and safety considerations.
Firstly, it is important to note that sleeping pills are not suitable for children. Children should not be given antihistamines, which are a common ingredient in over-the-counter (OTC) sleeping pills, as they can cause serious harm. Instead, changing a child's sleep behaviours is recommended to improve their sleep. For older adults, nondrug treatments should be tried first due to safety concerns. Sleeping pills can have side effects such as confusion, memory issues, and balance problems, which can increase the risk of falls and hip fractures in older adults.
Additionally, sleeping pills can cause dependency, especially with long-term use. This means that users may need higher doses over time to fall asleep and may experience worsened insomnia and other withdrawal symptoms when trying to stop. The effectiveness of sleeping pills may also decrease over time as the body develops a tolerance.
Sleeping pills can also cause various short-term and long-term side effects. Short-term side effects may include constipation, muscle weakness, dizziness, nausea, fatigue, irritability, and a "hangover" effect the next day. Long-term side effects may include poor memory, brain degeneration, Alzheimer's disease, and an increased risk of depression, especially in patients with liver and kidney disease.
To take sleeping pills safely, it is important to follow the directions on the prescription or package insert and not exceed the recommended dosage. Alcohol should be avoided near the time of taking a sleeping pill, as combining the two can lead to excessive drowsiness and increase the risk of injuries and memory issues. It is also recommended to have at least seven to eight hours to devote to a full night's sleep when taking a sleeping pill. Driving or operating machinery should be avoided after taking a sleeping pill. It is always advisable to consult a healthcare provider before taking sleeping pills to ensure they are suitable for you and monitor any side effects.
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Dependency and misuse
Sleeping pills are not a long-term solution for a good night's sleep. They are associated with a risk of developing physical and/or psychological dependence, tolerance, and addiction. All sleeping aids, including over-the-counter (OTC) drugs, have been reported to cause at least some level of psychological dependency. Most prescription drugs, particularly benzodiazepines (BZDs) and barbiturates, are linked to physical dependence and addiction.
The risk of dependency and misuse is higher with certain medications. For example, triazolam (Halcion) is a benzodiazepine with the potential for dependency and misuse, so doctors do not recommend it as a long-term treatment for insomnia. Similarly, suvorexant (Belsomra) may help a person fall asleep and maintain sleep, but it has a risk of misuse and the development of dependency. It can cause central nervous system (CNS) impairments, leading to trouble with driving and other activities.
Sleeping pills can also cause parasomnias, which are sleep disorders consisting of unusual behaviors, emotions, and perceptions that occur while falling asleep, sleeping, or waking up. Parasomnias can sometimes manifest as sleepwalking, nightmares, night terrors, teeth grinding, and talking in one's sleep. In some cases, parasomnias can lead to more extreme and potentially dangerous behaviors, such as eating, driving, or engaging in sexual activity while asleep.
Withdrawal symptoms can occur when individuals suddenly stop using sleeping pills or sedatives. These symptoms can include trouble sleeping, restlessness, anxiety, shivering, dizziness, and faintness. To avoid a relapse, it is crucial to minimize withdrawal symptoms when discontinuing the medication. This can be achieved by gradually reducing the dose over several weeks before stopping the medication completely. Additionally, seeking psychological or therapeutic support can be beneficial during this process.
To mitigate the risks of dependency and misuse, it is essential to take sleeping pills as directed by a healthcare provider and only for a short period. If you are experiencing sleep issues, it is advisable to explore nondrug treatments and behavioral changes first. Cognitive-behavioral therapy (CBT) is an effective tool for improving sleep and curing insomnia without medication. Adopting healthy habits, such as exercising, limiting caffeine intake, avoiding electronic screens before bedtime, and maintaining a consistent sleep schedule, can also enhance sleep quality without the need for potentially addictive drugs.
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Natural alternatives
Sleeping pills can help treat insomnia by making you feel drowsy and relaxed. However, they can also have side effects and are not recommended for long-term use. Natural alternatives to sleeping pills include:
- Melatonin: A hormone that promotes sleep by influencing when you fall asleep and wake up. It is available as a supplement and is also found in some prescription sleep aids, such as Ramelteon (Rozerem).
- Magnesium: A mineral that can help relax the body and improve sleep.
- Valerian: A natural supplement that has a calming effect on the nervous system and promotes better sleep.
- Lavender: A scent that has been shown to have calming and relaxing properties.
- Glycine: An amino acid that can be taken as a supplement or consumed through foods such as bone broth, meat, eggs, poultry, and fish.
- Cannabidiol (CBD): A compound derived from hemp, which is often featured in oils and capsules. CBD contains low amounts of tetrahydrocannabinol (THC) and has been found to relieve anxiety and act as a natural sleep aid.
- Warm milk, chamomile tea, and tart cherry juice: These drinks are recommended by some experts for patients with sleep troubles, although there is limited scientific proof of their effectiveness.
While these natural alternatives may help improve your sleep, it is important to maintain good sleeping habits and practices. Additionally, always consult a doctor before starting any new sleep medication or supplement to ensure safety and avoid potential interactions with other substances.
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Frequently asked questions
Sleeping pills are medications that can help people fall asleep, stay asleep, or both. They can be over-the-counter (OTC) or prescription medications.
Some OTC sleeping pills that may be recommended by healthcare providers include Benadryl Allergy®, Advil PM® or Tylenol PM®. Natural sleep aids such as melatonin and valerian are also available without a prescription.
Prescription sleeping pills include benzodiazepines, Z-drugs (e.g. eszopiclone (Lunesta), zolpidem (Ambien), and zaleplon (Sonata)), doxepin (Silenor), and ramelteon (Rozerem). Benzodiazepines and Z-drugs are controlled substances due to their potential for abuse and addiction. Rozerem is not a controlled substance as it has a low likelihood of misuse or dependency, but it can still cause side effects.
