Gina Johnson
Sleeping pills are medications that can help treat insomnia and other sleep disturbances by making you feel drowsy and relaxed. While there are many different types of sleeping pills available, it's important to remember that they are intended for short-term use and carry certain risks and side effects. Before taking any sleep medication, it's crucial to consult a healthcare professional, especially if you have a history of substance abuse, depression, or other mood disorders. They can help determine the cause of your insomnia and suggest the best treatment plan, which may include nondrug treatments, behavioural changes, or a combination of therapy and medication.
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What You'll Learn
Prescription vs. over-the-counter
Sleep medications are intended for short-term use, as taking them for longer periods may lead to dependence in some cases. They also carry significant risks, including memory problems, falls, and even death.
Prescription sleep medications used for treating insomnia and sleep disturbances include:
- Benzodiazepines: These work by stimulating a chemical in the brain called GABA, which leads to sedation, muscle relaxation, and reduced anxiety. Examples include triazolam (Halcion) and clonazepam (Klonopin). Benzodiazepines are controlled substances with a risk of misuse, dependence, and addiction.
- Z-drugs: This class of drugs includes eszopiclone (Lunesta) and zolpidem (Ambien). They work by slowing down brain activity and are generally safer than benzodiazepines. However, they still carry a risk of misuse and dependence.
- Ramelteon (Rozerem): This medication is a melatonin receptor agonist, promoting sleep and positively affecting circadian rhythms. It is typically prescribed for longer-term use and has a low likelihood of misuse or dependency.
- Doxepin (Silenor): This tricyclic antidepressant is FDA-approved to treat insomnia and is available in 3 and 6 mg doses. While it is not habit-forming, it can cause side effects such as dry mouth, constipation, and dizziness.
- Estazolam (Prosom): Doctors may prescribe this medication for the short-term treatment of insomnia. However, it has a risk of misuse and dependency.
Over-the-counter (OTC) sleep aids are also available and can be effective for some individuals. These include:
- Melatonin supplements: Melatonin is a naturally occurring substance in the body that regulates sleep-wake cycles. OTC melatonin supplements may be helpful for conditions like jet lag.
- Diphenhydramine (Benadryl): This antihistamine blocks histamines in the body that cause alertness.
- Doxylamine succinate (Unisom SleepTabs, Robitussin Nighttime Cough DM, Vicks Nyquil D Cold and Flu Nighttime Relief): This antihistamine is available in multiple formulations.
It is important to consult a healthcare professional before taking any sleep medication to determine the best treatment option based on individual needs and medical history.
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Side effects
Sleeping pills are typically intended for short-term use and are not recommended for long-term use due to their potential side effects and health risks. Even over-the-counter sleep aids can cause side effects, and approximately 8 out of 10 people experience a hangover effect the day after taking sleep medicine.
Some common side effects of sleeping pills include:
- Dizziness and balance problems: Sleeping pills can cause dizziness, especially when standing up too quickly, and can also lead to balance issues, increasing the risk of falls and injuries, especially in older adults.
- Daytime sleepiness and drowsiness: Many people experience drowsiness and sleepiness during the day after taking sleeping pills, which can negatively impact their ability to drive, work, or perform daily tasks.
- Confusion and memory issues: Sleeping pills may cause confusion, muddled thinking, and short-term memory problems. In the long term, there is also a risk of brain degeneration and Alzheimer's disease.
- Constipation and dry mouth: Sleeping pills can cause constipation and a dry mouth, which are common side effects of certain medications.
- Allergic reactions: Some people may experience allergic reactions to sleeping pills, such as skin rashes or breathing difficulties.
- Dependency and withdrawal: Sleeping pills can be habit-forming, and long-term use can lead to physical and psychological dependency. Abruptly discontinuing sleeping pills can cause withdrawal symptoms such as vomiting, sweating, and anxiety.
Additionally, certain types of sleeping pills may have specific side effects. For example, doxepin (Silenor) can cause dry mouth, constipation, dizziness, increased heart rate, and raised blood pressure. Trazodone may also cause daytime sleepiness, dry mouth, dizziness, and a rare but serious risk of priapism in male patients. Benzodiazepines can cause sedation, muscle relaxation, reduced anxiety, and long-term side effects such as depression, especially in patients with liver and kidney disease.
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Safety concerns
Sleeping pills are intended for short-term use, usually a few weeks or less. They are not a cure for insomnia, and long-term use can lead to dependence and addiction. Some common side effects of sleeping pills include:
- Drowsiness
- Dry mouth
- Constipation
- Dizziness
- Difficulty with balance or motor coordination
- Impaired focus or memory
- Sleepwalking
- Allergic reactions
- Increased risk of falls, especially in older adults
- Increased thoughts of suicide
- Complex sleep behaviours, such as sleepwalking or driving while asleep
Some sleeping pills, such as Lunesta, are part of a drug family known as Z-drugs, which carry a higher risk of misuse and dependency. Benzodiazepines, such as triazolam (Halcion) and clonazepam (Klonopin), are also associated with a high risk of misuse and are not recommended for long-term use. It is important to understand the risks and side effects of any sleeping medication before starting treatment and to consult a doctor if any severe side effects occur.
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Treatment plans
If medication is required, prescription sleeping pills are generally stronger than over-the-counter options. They should be taken only for short periods of time due to the risk of dependence and rebound insomnia. Doctors may suggest people with insomnia use Silenor (Doxepin) for up to 3 months. It is available in 3 and 6 mg doses, with the smaller doses intended for insomnia and larger doses for depression and anxiety. It is not a controlled substance, but it does have several side effects, including dry mouth, constipation, dizziness, and increased risk of falls.
Other prescription medications for insomnia include Ramelteon (Rozerem), a melatonin antagonist that promotes sleep and positively affects circadian rhythms. It is prescribed for longer-term use and comes in an 8 mg dose. Suvorexant (Belsomra) is another medication that may help a person fall asleep and maintain sleep, but it is only available as a brand-name medication. Estazolam (Prosom) is a short-term treatment option for insomnia, but it has a risk of misuse and dependence.
Z-drugs like Lunesta are controlled substances with a risk of misuse and dependence. They can cause complex sleep behaviors like sleepwalking or driving while asleep, and higher doses can impair the central nervous system even when awake. Benzodiazepines like triazolam (Halcion) are also FDA-approved to treat insomnia, but they are habit-forming and not recommended for long-term use.
Newer medications like daridorexant or lemborexant may offer sustained benefits for chronic insomnia with a potentially lower risk of dependence. Melatonin is another option, especially for shift workers and travelers who need rapid sleep onset or short-duration effects. It is important to note that sleep medications can have significant side effects, including memory problems, falls, and, in rare cases, death.
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Natural alternatives
Natural sleep aids are over-the-counter supplements that help you fall asleep faster and stay asleep throughout the night. They are usually plant-based or consist of vitamins or minerals that are already present in our diets. Melatonin, for instance, is a naturally occurring substance in the body that promotes sleep and positively affects circadian rhythms. Doctors may prescribe melatonin for longer-term use, unlike other medications that are indicated for short-term use. Ramelteon (Rozerem) is an example of a medication that promotes sleep by affecting melatonin receptors.
Some natural sleep aids have side effects that warrant caution. For example, melatonin can reduce the effectiveness of some medications and produce unwanted side effects when combined with others. This natural sleep aid may not be recommended for people who have received an organ transplant, experience depression, or have a bleeding or seizure disorder. Kava, another natural sleep aid, has been associated with rare but serious adverse effects, including liver toxicity. It is important to consult your doctor before starting any new supplement, as natural does not always mean safe for everyone.
There are also easy, natural fixes that can improve your sleep. Charlene Gamaldo, M.D., medical director of Johns Hopkins Center for Sleep at Howard County General Hospital, recommends warm milk, chamomile tea, and tart cherry juice for patients with sleep trouble. Although there isn’t much scientific proof that these nighttime drinks work to improve sleep, there’s no harm in trying them.
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Frequently asked questions
Sleeping pills are not recommended for long-term use due to their side effects and potential for dependence. The best-rated sleeping pill will depend on individual circumstances and the type of insomnia experienced. It is always best to consult a healthcare professional before taking any sleep medication.
Prescription sleeping pills include Doxepin (Silenor), Ramelteon (Rozerem), Estazolam (Prosom), Lunesta, and Zolpidem (Ambien CR).
Non-drug treatments and behavioural changes are often recommended for improving sleep. Natural sleep aids such as melatonin are also available over the counter. Cognitive behavioural therapy (CBT) is another alternative that may be better at improving sleep quality.
