Ashwin Lewis
Sleeping pills are used to treat insomnia by making the user feel drowsy and relaxed. The strongest sleeping pills are generally available only via prescription and include benzodiazepines, Z-drugs, and antidepressants. Prescription sleeping pills are stronger than over-the-counter options, but they are not a cure for insomnia and carry a risk of dependence and addiction. Over-the-counter sleeping pills often contain antihistamines, which can also cause drowsiness. Natural sleeping pills with melatonin, chamomile, and vitamin B6 can also help improve sleep quality. Sleeping pills should be used only occasionally or over a short period as part of a broader strategy to improve sleep.
| Characteristics | Values |
|---|---|
| Strongest sleeping pills | Benzodiazepines, Z-drugs, antidepressants |
| Availability | Prescription-only |
| Over-the-counter options | Antihistamines like promethazine, doxylamine, diphenhydramine (Benadryl), natural supplements |
| Side effects | Sleepwalking, sleep-driving, hallucinations, dependence, addiction, drowsiness during the day |
| Treatment duration | Short-term, occasional |
| Alternative treatments | Cognitive behavioural therapy, natural sleep aids (melatonin, chamomile, valerian root), lifestyle changes, sleep supplements |
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What You'll Learn
Prescription vs. over-the-counter sleeping pills
Sleeping pills are categorised as either prescription or over-the-counter (OTC). Prescription sleeping pills are generally stronger than OTC pills and are recommended for short-term use only. They include benzodiazepines, "Z-drugs", and antidepressants. Benzodiazepines, such as Ativan (lorazepam) and Restoril (temazepam), are Schedule IV controlled substances due to their potential for abuse, addiction, and dependence. They work by stimulating the production of gamma-aminobutyric acid (GABA) in the brain, which results in sedation, muscle relaxation, and reduced anxiety. Z-drugs, such as zolpidem (Ambien) and eszopiclone (Lunesta), function similarly to benzodiazepines but are non-benzodiazepines. Antidepressants, such as doxepin (Silenor), are another option for treating insomnia, but they are rarely prescribed due to the potential side effects of these medications.
OTC sleeping pills are widely available and can be purchased without a prescription. They are typically recommended for occasional use and include natural remedies and antihistamines. Melatonin supplements, for example, can be used to regulate the sleep-wake cycle and are particularly useful for jet lag. Diphenhydramine (Benadryl) and doxylamine succinate (Unisom SleepTabs, Robitussin Nighttime Cough DM, and Vicks Nyquil D Cold and Flu Nighttime Relief) are also effective OTC sleep aids. It is important to note that while OTC sleeping pills are more easily accessible, they should still be used with caution and in consultation with a healthcare provider to ensure safe and effective use.
Prescription sleeping pills are typically recommended for short-term relief and are often used to treat severe or chronic insomnia. They are stronger than OTC pills and carry a higher risk of dependence and addiction. As such, they require careful consideration and monitoring by a healthcare provider. On the other hand, OTC sleeping pills are generally milder and are not intended for long-term use. They can be useful for occasional sleep difficulties, such as jet lag or adjusting to shift work schedules. However, it is important to consult a healthcare provider before taking any sleep medication to determine the underlying cause of sleep issues and make an informed treatment decision based on individual needs and medical history.
The choice between prescription and OTC sleeping pills depends on various factors, including the severity and chronicity of insomnia, the presence of any underlying medical conditions, and individual preferences. While prescription pills may be necessary for more severe or persistent cases of insomnia, OTC options can be a good starting point for milder or occasional sleep difficulties. Combining sleep medication with lifestyle changes, psychological treatments, and natural remedies can also enhance their effectiveness and promote better sleep hygiene overall. It is always advisable to consult a healthcare professional before starting any sleep aid to ensure a comprehensive and tailored approach to treating sleep issues.
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Natural sleeping pills
The strongest sleeping pills, such as benzodiazepines, "Z-drugs", and antidepressants, are generally only available on prescription. However, natural sleeping pills can also help you get a better night's sleep. These can be used in conjunction with medical treatment or on their own.
Other natural sleep aids include magnesium and valerian root. You can also increase your glycine intake by eating foods rich in the nutrient, such as bone broth, meat, eggs, poultry, and fish, or by taking it in pill or powder form. Cannabidiol (CBD) is another natural sleep aid that has been shown to relieve anxiety and help with insomnia.
While these natural remedies may help, it's important to remember that they should not replace good sleeping habits. Getting a good night's sleep is crucial for your health, and there are many potential negative consequences of insufficient sleep.
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Side effects of sleeping pills
Sleeping pills are generally considered a short-term solution for sleeplessness, as they can cause dependence and other side effects. While natural sleeping pills, which contain vitamins and herbal extracts, are available, prescription sleeping pills are stronger and tend to have more potent side effects.
Prescription sleeping pills such as Ambien, Halcion, Lunesta, Rozerem, and Sonata have been known to cause a burning or tingling sensation in the hands, arms, feet, or legs. Other common side effects of prescription and over-the-counter sleeping pills include constipation, muscle weakness, digestive problems, and a dry mouth.
Sleeping pills can also cause a hangover effect, with approximately 8 out of 10 people feeling drowsy, experiencing muddled thinking, and dizziness or balance problems the day after taking them. This can negatively impact your ability to perform daily tasks, such as driving, working, or going to school.
Sleeping pills can be especially dangerous for older adults, as the drugs can stay in their system for longer, increasing the risk of falls and hip fractures. They can also cause confusion and memory issues, which can be problematic for older adults.
It is important to note that sleeping pills can interfere with normal breathing and be harmful to people with certain chronic lung problems, such as asthma, emphysema, or chronic obstructive pulmonary disease (COPD). Additionally, mixing sleeping pills with alcohol or other medications can lead to overdose, and in some cases, death.
Before taking any sleeping pills, it is recommended to consult a healthcare provider to ensure they are safe for you and to discuss potential side effects.
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Sleeping pills for elderly patients
Sleeping pills are generally available over the counter or with a prescription. The choice of medication depends on individual circumstances, and older adults are advised to opt for lower doses or non-benzodiazepine options, such as melatonin or newer drugs. This is because elderly patients are more susceptible to sedative effects and side effects.
Chronic insomnia affects 57% of the elderly in the United States, impairing their quality of life, functionality, and health. Sleep disorders are underdiagnosed in the geriatric population, and various factors can contribute to sleep disturbances, including retirement, health issues, loss of loved ones, and changes in circadian rhythm.
For elderly patients with insomnia, non-benzodiazepine gamma aminobutyric acid receptor agonists, also known as "Z-drugs," are an option. These include eszopiclone (Lunesta), zolpidem (Ambien), and zaleplon (Sonata). Similar to benzodiazepines, these drugs are classified as Schedule IV controlled substances due to their potential for abuse and addiction. Eszopiclone is approved for long-term treatment, while zolpidem and zaleplon are recommended for short-term use. Another Z-drug, zopiclone, is typically taken as a 7.5mg tablet before bed and should not be combined with alcohol due to the risk of breathing problems.
Other FDA-approved drugs for treating insomnia in the elderly include suvorexant, low-dose doxepin, ramelteon, and benzodiazepines like triazolam and temazepam. Ramelteon is the only FDA-approved prescription melatonin receptor agonist for treating insomnia and is not a controlled substance due to its low potential for misuse and addiction. While trazodone, an off-label drug for insomnia, improves sleep quality, it carries significant risks. Non-FDA-approved options include melatonin, diphenhydramine, tryptophan, and valerian, although data on their benefits and harms is limited.
It is important to note that sleeping pills are most effective when used occasionally or over a short period and should be combined with cognitive behavioural therapy whenever possible. Natural sleeping pills containing ingredients like tart cherry, chamomile, and Vitamin B6 can also aid in improving sleep quality.
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Sleeping pills for shift workers and travellers
Sleeping pills are categorised as either benzodiazepines or nonbenzodiazepines ("Z-drugs"). The strongest sleeping pills tend to be available only on prescription. However, over-the-counter antihistamines such as promethazine can also be used to help with insomnia.
Sleeping Pills for Shift Workers
Shift work disorder is a condition marked by excessive sleepiness when awake or an inability to sleep when needed. It affects those who work at night or rotate shifts frequently. To adapt to shift work, one must coach their body to sleep at times that may feel unnatural. While medication can help minimise the symptoms of shift work disorder, it is recommended that shift workers also use bright light therapy and make lifestyle modifications. Light is one of the most powerful drivers of the circadian rhythm, and exposure to light at targeted times may help shift workers adjust their sleep cycle.
Melatonin is a sleep-promoting hormone that the body usually produces in the evening. Taking melatonin supplements may help shift workers sleep during the day. Prescription sleep aids, such as benzodiazepines, can also be used to facilitate sleep for shift workers. However, it is important to be wary of taking sleep medications too close to the start of a shift, as they may raise the risk of accidents if drowsiness does not wear off in time.
Sleeping Pills for Travellers
Sleeping pills can be helpful for travellers who need to sleep on planes, especially during long-haul flights. It is recommended that travellers have at least six or seven hours to sleep to allow the drug to metabolise. Zolpidem (Ambien), Lunesta, Sonata, and Rozerem are prescription-only sleep aids that can help with jet lag. Rozerem, a melatonin receptor stimulant, may be a more attractive option for travellers as it reaches peak levels quickly and has a very short half-life. Melatonin supplements can also be started a few days before a trip to help prevent jet lag.
Over-the-counter sleep aids, such as Benadryl, Aleve PM, Tylenol PM, and Unisom Sleep Tablets, can also be used to help travellers sleep on planes. Valerian root, known as "nature's Xanax" or "nature's Valium", can also be used to induce sleepiness and relaxation within about 30 minutes. CBD sleep aids, which are often mixed with melatonin, are another option for sleeping while travelling.
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Frequently asked questions
Sleeping pills are typically available over the counter or by prescription. The strongest sleeping pills tend to be available only on prescription. These include:
- Benzodiazepines
- Z-drugs
- Antidepressants
- Zolpidem (Ambien)
- Eszopiclone (Lunesta)
- Zaleplon (Sonata)
- Ramelteon (Rozerem)
Over-the-counter sleeping pills include antihistamines such as doxylamine and diphenhydramine (Benadryl). Natural sleeping pills with ingredients like tart cherry, chamomile, and Vitamin B6 can also help improve sleep.
Sleeping pills can cause side effects such as drowsiness during the day, confusion, and parasomnia (sleepwalking, sleep-eating, etc.). Sleeping pills can also cause dependence and addiction, especially when used long-term.
Alternatives to sleeping pills include cognitive behavioural therapy, natural sleep supplements, and lifestyle changes.
Elderly patients are more sensitive to sedatives and their side effects. Lower-dose medications or non-benzodiazepine options, such as melatonin or newer drugs, may be safer for this demographic.
