Gina Johnson
Sleep disturbances are common, with an estimated 50 to 70 million people in the United States experiencing chronic sleep issues. A range of medications can help people fall asleep, stay asleep, or both. Sleeping pills are typically divided into two categories: benzodiazepines and non-benzodiazepines or Z-drugs. Benzodiazepines, such as triazolam (Halcion) and clonazepam (Klonopin), are often prescribed for short-term use due to their potential for misuse and dependence. Z-drugs, including zolpidem (Ambien) and zopiclone, are also effective for inducing sleep but carry similar risks of addiction and withdrawal. Antidepressants like doxepin (Silenor) can be helpful for treating insomnia, particularly in cases of difficulty staying asleep. Melatonin receptor agonists like ramelteon (Rozerem) promote sleep and positively affect circadian rhythms, making them suitable for longer-term use. It's important to consult a healthcare provider to determine the most suitable treatment, considering potential side effects and interactions with other substances.
| Characteristics | Values |
|---|---|
| Prescription sleeping pills | Doxepin (Silenor), Ramelteon (Rozerem), Trazodone, Mirtazapine (Remeron), Zolpidem (Ambien), Eszopiclone (Lunesta), Lemborexant, Daridorexant, Triazolam (Halcion), Clonazepam (Klonopin), Suvorexant (Belsomra) |
| Over-the-counter sleeping pills | Melatonin, L-tryptophan, Valerian, Antihistamines (e.g. Diphenhydramine (ZzzQuil), Doxylamine (Unisom)) |
| Side effects | Confusion, sleepiness during the day, parasomnia, central nervous system (CNS) depression, withdrawal symptoms, dependence, addiction, misuse, allergic reactions |
| Other considerations | Sleeping pills are not recommended for long-term use, older adults are more sensitive to sedative effects, no convincing evidence that they improve long-term health, may interact with other medications, alcohol, or supplements |
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What You'll Learn
Prescription vs. over-the-counter
Sleeping pills are available both over the counter (OTC) and by prescription. OTC sleep aids often contain antihistamines, which can cause drowsiness as a side effect. Some common antihistamines used as sleep aids include diphenhydramine (ZzzQuil) and doxylamine (Unisom). Melatonin, L-tryptophan, and valerian are also available as OTC sleep aids. However, the American Academy of Sleep Medicine does not recommend OTC sleep aids for treating insomnia, as there is insufficient evidence supporting their effectiveness and safety. Additionally, it is not recommended to take OTC sleep aids for more than two weeks without consulting a healthcare provider, as insomnia could be a sign of an underlying medical condition.
Prescription sleeping pills, on the other hand, are generally stronger than OTC options. These include medications like doxepin (Silenor), Ramelteon (Rozerem), and suvorexant (Belsomra). While prescription sleeping pills can be effective for short-term relief, they are not recommended for long-term use due to the risk of dependence and addiction. Benzodiazepines, such as triazolam (Halcion) and clonazepam (Klonopin), are another option for treating insomnia, but they also carry a risk of misuse and are controlled substances. Similarly, Z-drugs like zolpidem (Ambien) and eszopiclone (Lunesta) are prescription sleep aids, but they are also classified as controlled substances due to their potential for abuse and addiction.
It is important to note that sleeping pills, regardless of whether they are OTC or prescription, can have side effects. These may include feeling confused or sleepy during the day, and in some cases, people may walk or eat in their sleep (parasomnia). As such, it is recommended to consult a healthcare provider before starting any sleep aid and to explore alternative treatments, such as cognitive-behavioral therapy (CBT), which may be more effective in improving sleep quality.
In conclusion, while both OTC and prescription sleeping pills are available, prescription sleeping pills tend to be stronger and are recommended for short-term relief only. OTC options may provide milder effects, but their effectiveness and safety for treating insomnia are not well-established. As sleeping pills can have side effects and the potential for dependence, it is crucial to use them cautiously and under the guidance of a healthcare professional.
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Antidepressants
Other antidepressants with sedating side effects may help manage insomnia in some people with depression. However, these should generally be avoided in people without a diagnosis of depression because the duration of sedative effects in these medications is shorter than other sleep aids, and the potential side effects may cause more harm than good. Additionally, health professionals and patients should be aware of the current paucity of evidence for antidepressants commonly used for insomnia management.
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Benzodiazepines
There are several types of benzodiazepines that are commonly prescribed for insomnia, including:
- Quazepam (Doral®): This benzodiazepine is specifically approved to treat insomnia and sleep problems.
- Temazepam (Restoril®): This medication is approved for treating insomnia and is known to have a sedative effect.
- Triazolam (Halcion®): This benzodiazepine is also approved for treating insomnia and inducing sleep.
It is important to note that while benzodiazepines can be effective in treating sleep disorders, they are typically not recommended for long-term use due to the risk of dependence and addiction. They are usually prescribed for short-term relief, and it is important to consult a healthcare provider before starting any sleep aid, including benzodiazepines.
Additionally, it is worth mentioning that there are nonbenzodiazepines that work similarly to benzodiazepines in treating insomnia and related sleep disorders. These include eszopiclone (Lunesta®), zaleplon (Sonata®), and zolpidem (Ambien®). These drugs activate the same receptors as benzodiazepines and cause GABA release, resulting in hypnotic effects.
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Natural sleep aids
While prescription and over-the-counter medications can help with sleep, they often carry risks of side effects, misuse, and dependency. Even natural sleep aids should not replace good sleeping habits. Here are some natural sleep aids that can help you get a good night's rest:
Melatonin
Melatonin is a hormone that is naturally produced by the body. Its production is influenced by the time of day, with levels rising in the evening and falling in the morning. Melatonin supplements have become a popular sleep aid, with studies showing their effectiveness in improving sleep quality, reducing the time needed to fall asleep, and combating jet lag. They are available over the counter at your local pharmacy, but it is recommended to consult a doctor before taking them.
Magnesium and Valerian Root
Magnesium and valerian root supplements are also natural sleep aids that can help promote better sleep.
Lavender
The scent of lavender is known for its calming and relaxing properties, which can aid in improving sleep quality.
Warm Milk, Chamomile Tea, and Tart Cherry Juice
Warm milk has long been associated with chemicals that simulate the effects of tryptophan on the brain, which can promote sleep. Chamomile tea and tart cherry juice are also recommended drinks for patients with sleep troubles, although there is limited scientific proof of their effectiveness.
CBD
Some studies have found that CBD can help relieve anxiety and improve sleep quality. However, more research is needed to confirm its effectiveness, and it is not recommended for pregnant or nursing individuals. The legality of CBD also varies depending on location.
In addition to these natural sleep aids, it is important to maintain good sleep habits and practices. This includes limiting exposure to unnatural light before bedtime, as light from smartphones and other electronic devices can interfere with sleep. If you need to get up at night, using a flashlight instead of turning on the lights can help minimize visual disruption. Sleeping in layers can also help you adjust your bedtime temperature for optimal comfort. Finally, avoid working out within two hours of bedtime, as it can raise your core body temperature and make it harder to fall asleep.
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Side effects
Sleeping pills are designed to treat insomnia and other sleep disorders by making people feel drowsy and relaxed. However, they often come with side effects, and long-term use is not recommended.
The most common side effects of sleeping pills include drowsiness, difficulty with movement, impaired focus, dizziness, and confusion. These side effects can be dangerous, especially if you need to drive or operate machinery the next day. In older adults, drowsiness and confusion can increase the risk of falls, broken hips, and car accidents.
Sleeping pills can also cause parasomnias, which are complex sleep behaviours that occur while the person is unaware. Parasomnias may include sleepwalking, sleeptalking, sleep eating, and even sleep driving. While rare, parasomnias are difficult to detect once the medication takes effect and can be life-threatening.
Sleeping pills can also lead to dependence, with many long-term users becoming unable to sleep without them. Abruptly quitting the medication can cause rebound insomnia, resulting in vivid dreams, nightmares, and increased anxiety. This can create a cycle where individuals feel they need to continue taking the medication, potentially leading to overdose or abuse.
Additionally, some people may experience allergic reactions or other side effects such as constipation, dry mouth, decreased sexual drive, and weight gain. It is important to consult a doctor if any side effects occur, as they may recommend adjusting the dosage or trying a different treatment approach.
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Frequently asked questions
Sleeping pills are of two types: over-the-counter and prescription. Over-the-counter pills include antihistamines such as diphenhydramine (ZzzQuil) and doxylamine (Unisom). Prescription pills include doxepin (Silenor), Ramelteon (Rozerem), and zolpidem (Ambien).
Some natural sleep aids include melatonin, L-tryptophan, and valerian.
Sleeping pills can have side effects like confusion or sleepiness during the day. Some people walk or eat in their sleep (parasomnia). Sleeping pills can also cause dependence and addiction.
Some alternatives to sleeping pills include cognitive-behavioral therapy (CBT) and natural sleep aids such as melatonin.
Lower-dose medications or non-benzodiazepine options such as melatonin or certain newer drugs may be safer for elderly patients.
