Gina Johnson
Sleeping pills are medications that help people with sleep difficulties or insomnia. They are available over the counter (OTC) or by prescription. OTC sleep aids often contain antihistamines, which can make you drowsy, while prescription sleeping pills are stronger and may contain antidepressants, barbiturates, or benzodiazepines. Melatonin and valerian are natural supplements that promote sleep but are not regulated by the Food and Drug Administration (FDA). Prescription sleeping pills are generally not recommended for long-term use due to the risk of dependence and addiction, and they may have side effects such as drowsiness, hallucinations, and sleepwalking. It is important to consult a healthcare provider before taking any sleeping pills, especially during pregnancy or breastfeeding, as there may be alternative treatments available, and mixing sleeping pills with certain substances can be hazardous.
| Characteristics | Values |
|---|---|
| Type | Over-the-counter (OTC) or prescription |
| Ingredients | Antihistamines, melatonin, valerian, antidepressants, barbiturates, benzodiazepines, Z-drugs (zolpidem, eszopiclone, zaleplon) |
| Usage | Short-term relief, not meant for long-term use |
| Side Effects | Dependence, addiction, withdrawal symptoms, overdose, amplified effects when mixed with alcohol |
| Precautions | Not recommended for pregnant or breastfeeding women, not suitable for children, may cause drowsiness or sleepwalking |
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What You'll Learn
Natural sleep remedies: melatonin and valerian root
Sleeping pills are available over the counter, as natural supplements, or by prescription. Natural sleep remedies such as melatonin and valerian root are preferred by some people. Melatonin is a hormone naturally produced by the body that promotes sleep. While melatonin does not induce sleep, it increases with the onset of darkness, putting the body in a state of quiet wakefulness that helps promote sleep. Melatonin supplements may help people with insomnia fall asleep faster, with larger benefits observed for those with delayed sleep phase syndrome. Melatonin is generally safe for nightly use for up to two months, but it is recommended to consult a healthcare provider if you have certain pre-existing conditions or are taking specific medications. To enhance melatonin production, it is advisable to get exposure to daylight during the morning and afternoon and reduce exposure to blue and green light from electronic devices before bedtime.
Valerian is an herb that has been traditionally used in Europe to treat sleeping disorders and is becoming increasingly popular in the United States. While there is limited evidence to support the efficacy of valerian, studies have shown that it can almost double the chance of improved sleep compared to a placebo. However, it is important to note that the studies on valerian have exhibited significant variation in terms of preparation, dosing, and length of treatment.
Natural sleep remedies like melatonin and valerian root provide alternatives to over-the-counter and prescription sleeping pills, which may have side effects and risks of dependence or addiction. However, it is always recommended to consult a healthcare professional before taking any sleep aids, including natural supplements, to ensure safety and effectiveness.
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Over-the-counter (OTC) antihistamines: diphenhydramine and doxylamine
Over-the-counter (OTC) sleeping pills are often antihistamines, which treat allergies but can also cause drowsiness. Antihistamines work by blocking histamines, the substances in your body that cause alertness. Diphenhydramine and doxylamine are common antihistamines found in OTC sleeping pills. They are available as brand-name medications, such as Benadryl (diphenhydramine) and Unisom (doxylamine), as well as lower-cost generics.
Diphenhydramine is the active ingredient in Benadryl, an OTC cold and flu remedy. It is also found in OTC sleep aids like Sominex and Nytol. Diphenhydramine is intended for short-term use and is recommended for adults and adolescents ages 12 and older. It should not be used by older people as it increases the risk of dementia and may cause excitation rather than sedation.
Doxylamine is the active ingredient in Unisom, an OTC sleep aid. It is also found in many popular OTC combination products, including certain NyQuil products. Doxylamine is typically given at a lower dose than diphenhydramine because its effects last longer in the body. It is important to note that doxylamine is not recommended for children under 12.
While diphenhydramine and doxylamine can be effective for occasional insomnia, they are not recommended by the American Academy of Sleep Medicine for the treatment of chronic sleep problems. There is limited evidence that they are effective or safe for long-term use. It is always advisable to consult with a healthcare provider before taking any OTC sleeping pills, especially when considering their long-term use.
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Prescription Z drugs: zolpidem and zopiclone
Z-drugs are a class of non-benzodiazepine psychoactive depressant, sedative, hypnotic, and anxiolytic drugs used to treat insomnia and anxiety. They are called Z-drugs because their generic names begin with the letter 'Z'. Z-drugs emerged in the late 1980s and early 1990s.
Zolpidem and zopiclone are two commonly prescribed Z-drugs. Zolpidem, also known by its trade name Ambien, is a prescription drug used to treat insomnia. It is a sedative hypnotic drug that causes moderate impairment the next day. It is also sometimes used non-medically, often in combination with alcohol or other drugs. Zaleplon, another Z-drug, has been recommended as a safer alternative to zolpidem as it has no association with increased motor vehicle accidents.
Zopiclone, also known by its trade name Imovane, is a sedative hypnotic drug that is frequently detected in cases of people suspected of driving under the influence of drugs. It is a controlled substance in several countries, including the United States, Japan, Brazil, New Zealand, and some European countries, and may be illegal to possess without a prescription. Zopiclone has the potential for non-medical use, dosage escalation, and drug dependence. It is recommended to be taken at the lowest effective dose for a short duration of 2-3 weeks for insomnia. It has been found to increase the risk of vehicle accidents, cause impairment of psychomotor function, and lead to withdrawal-related anxiety.
Zolpidem and zopiclone have similar mechanisms of action to benzodiazepines, causing similar effects on locomotor activity and dopamine and serotonin turnover. However, they have different chemical structures and are unrelated to benzodiazepines on a molecular level. A meta-analysis of randomised controlled trials found few clear and consistent differences between zopiclone and benzodiazepines in terms of sleep onset latency, total sleep duration, quality of sleep, adverse events, tolerance, rebound insomnia, and daytime alertness.
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Non-benzodiazepine sleeping pills: chloral hydrate and clomethiazole
Non-benzodiazepine sleeping pills are used to treat severe insomnia, or difficulty falling and staying asleep. They are short-acting drugs with effects that last for a short period and are less likely to have a "hangover" effect compared to other sleep medications. Doctors should only prescribe Z drugs if patients have attempted other non-medication treatments for their insomnia.
Chloral hydrate is a non-benzodiazepine sleeping pill that was first synthesized in 1832 and used clinically starting in 1869. It is available as a liquid or in tablet form (cloral betaine). Chloral hydrate is also known by the trade name Welldorm. While it is an older drug with many side effects, it is still used today, with approximately 220 toxic exposures reported per year in the United States. It has a high likelihood of death in cases of self-poisoning.
Clomethiazole is another non-benzodiazepine drug that has been widely used for over 25 years for sedation and as an anticonvulsant, tranquillizer, and hypnotic. It is commonly used intravenously for patients with acute alcohol withdrawal, status epilepticus, pre-eclampsia, and eclampsia. Clomethiazole acts similarly to benzodiazepines, and physicians favour it as a replacement for diazepam. However, concerns remain about its safety if administered without careful monitoring. Clomethiazole was the most popular medication for ethanol withdrawal in Great Britain during the mid-1980s, but its use was discontinued due to drug interactions.
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Addiction and abuse: tolerance, dependence, and withdrawal
Sleeping pills are medications that can help treat insomnia and other sleep disorders. They are typically recommended for short-term relief and can have side effects, so healthcare providers advise against their long-term use.
Sleeping pills can be addictive, and long-term use can lead to dependence and abuse. The body can become accustomed to receiving a constant supply of sedatives to fall asleep, leading to tolerance and, eventually, reliance on the pills. This reliance can result in addiction, with individuals feeling they need the medication to sleep regularly. The most commonly abused sleeping pills are Ambien, Lunesta, and Sonata, classified as nonbenzodiazepine Z-drugs.
Withdrawal from sleeping pills can be challenging and produce various unpleasant side effects. The most serious consequence of withdrawal is "relapse insomnia," where individuals may struggle to fall asleep without the aid of sedatives. This withdrawal process typically lasts several weeks and can be difficult to manage without proper guidance and support.
To overcome sleeping pill addiction and dependence, individuals can seek treatment options such as therapy and cognitive-behavioural therapy (CBT). CBT helps address underlying issues that led to substance use and provides healthier coping mechanisms. Inpatient care is also an option, typically lasting between 30 to 90 days, depending on individual needs. Additionally, non-addictive alternatives like melatonin are available to aid sleep without the risk of withdrawal or addiction.
It is important to consult a healthcare provider if you are concerned about your sleeping pill usage or are considering adjusting your dosage or discontinuing the medication. They can provide guidance and help determine the best path to recovery.
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Frequently asked questions
Sleeping pills can be over-the-counter (OTC) medications, natural supplements, or prescription drugs. OTC sleep aids often contain antihistamines, which can also be given to children, although they are not approved for this purpose. Natural supplements include melatonin and valerian. Prescription sleeping pills are stronger than OTC pills and include antidepressants, barbiturates, benzodiazepines (benzos), and Z-drugs like zolpidem (Ambien) and eszopiclone (Lunesta).
Sleeping pills contain a variety of active ingredients depending on the type. Common ingredients in antihistamines include diphenhydramine and doxylamine. Melatonin is a naturally occurring brain hormone. Z-drugs are non-benzodiazepine sleeping pills, meaning they act in a similar way to benzodiazepines but are not the same.
Sleeping pills work by inducing drowsiness or silencing the area of the brain that keeps you alert. They are meant to be taken for a short period, usually from one to three weeks, as their effectiveness wears off over time and can lead to dependence and addiction.
Sleeping pills can cause a drugged effect the morning after and may lead to dependence and addiction with long-term use. They can also cause hallucinatory effects and sleepwalking. Mixing sleeping pills with alcohol can be dangerous and lead to overdose, coma, or death.
