Evie Summers
Sleep disturbances are common, with an estimated 50 to 70 million people in the United States experiencing chronic sleep or wakefulness conditions. While lifestyle changes and cognitive behavioural therapy are recommended as the first line of treatment, sleep medication can be a helpful short-term solution for those struggling with insomnia or other sleep issues. This article will explore the different types of sleep medications available, their effectiveness, and potential side effects to help readers make an informed decision about which sleeping pill may be the best option for them. It is important to consult a doctor before starting any new sleep medication to ensure safety and effectiveness.
| Characteristics | Values |
|---|---|
| Purpose | Fall asleep, stay asleep, or both |
| Dosage | 3mg, 6mg, 8mg, 150mg, 25mg-100mg, 400mg |
| Drug Names | Doxepin, Silenor, Ramelteon, Rozerem, Prosom, Estazolam, Trazodone, Mirtazapine, Remeron, Quetiapine, Seroquel, Olanzapine, Zyprexa, Risperidone, Risperdal, Eszopiclone, Lunesta, Zolpidem, Ambien, Zaleplon, Sonata, Lemborexant, Dayvigo, Daridorexant, Quviviq, Belsomra, Diphenhydramine, ZzzQuil, Doxylamine, Unisom, L-tryptophan, Valerian |
| Drug Types | Antidepressants, Antihistamines, Benzodiazepines, Nonbenzodiazepines, Melatonin, Natural Remedies |
| Side Effects | CNS depression, memory problems, dizziness, increased risk of falls, hallucinations, vivid nightmares, sleepwalking, daytime sleepiness, headaches, allergic reactions, edema, increased thoughts of suicide, priapism, blood pressure issues, heart rate issues |
| Risks | Misuse, dependency, addiction, rebound insomnia, withdrawal symptoms |
| Other Considerations | Not recommended for pregnant/nursing people, people with glaucoma, or people taking monoamine oxidase inhibitors; may interact with other medications, alcohol, and supplements; not recommended for long-term use; may not be effective for everyone |
| Alternatives | Lifestyle changes, cognitive behavioral therapy |
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What You'll Learn
Prescription vs. over-the-counter sleep aids
Sleeping pills are available over the counter (OTC) or by prescription. Anyone over the age of 18 can buy OTC sleep medications at drugstores or other retail outlets without a prescription. OTC sleep aids often contain antihistamines, which can treat allergies but also make you drowsy. Melatonin and valerian are also common OTC sleep aids. Melatonin is a naturally occurring substance in the body that promotes sleep, while valerian is an herb that is supposed to aid relaxation and sleep.
Prescription sleeping pills are stronger than OTC ones and carry a higher risk of dependence and addiction. They are not a cure for insomnia and are usually only prescribed for short-term relief. Benzodiazepines are an example of prescription sleeping pills. They are classified as Schedule IV controlled substances due to their risk for abuse, addiction, and dependence. Other prescription sleep aids include eszopiclone (Lunesta), zolpidem (Ambien), and zaleplon (Sonata). These are also Schedule IV controlled substances.
It is important to note that both OTC and prescription sleep aids can cause side effects such as constipation, diarrhea, muscle weakness, and digestive problems. They can also worsen snoring and sleep apnea. Additionally, when you stop taking a sleep aid, your insomnia may come back worse than before, a phenomenon known as rebound insomnia. This is more likely with prescription sleep aids, as your body can become dependent on them.
Before taking any sleep aid, it is important to talk to your doctor to understand the options, benefits, and risks. They can help you evaluate the efficacy of different treatments and discuss any potential side effects or interactions with other medications.
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Potential side effects
Sleeping pills can cause a range of side effects, from constipation to muscle weakness. Some people walk or eat in their sleep (parasomnia). Approximately 8 out of 10 people experience a hangover effect the day after taking sleep medicine. They feel drowsy, have muddled thinking and experience dizziness or balance problems. These daytime effects can negatively impact your ability to drive, work, go to school and complete daily tasks.
Sleeping pills can also cause confusion, memory issues and balance problems, especially in older adults, increasing the risk of falls and hip fractures. They can also cause central nervous system (CNS) depression, where brain activity slows down. Other potential side effects include allergic reactions, dizziness, fatigue, irritability, and long-term side effects such as depression, particularly in patients with liver and kidney disease.
One of the main risks of sleeping pills is that users can become dependent on them. This means they become less effective over time, and users will need to use higher doses to fall asleep. They will also find it harder to sleep well without them. Users may also begin to feel unwell or experience worse insomnia when they try to stop. The long-term use of sleeping pills affects brain function, changes the structure of sleep, and leads to sleeping pill dependency, drug tolerance, and other side effects, including poor memory, brain degeneration, and, in some cases, Alzheimer's disease.
Some sleep medications interact with other substances, including other medications, alcohol, and vitamin supplements. For this reason, a person should consult a doctor before starting any new sleep medication.
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Risk of misuse and dependence
Sleeping pills are intended for short-term use and are not recommended for long-term use due to the risk of dependence and addiction. When taken night after night, the body may start to depend on sleeping pills, and stopping the medication may lead to rebound insomnia, where insomnia returns but is worse than before. Sleeping pills can also cause parasomnias, which are sleep disorders consisting of unusual behaviours, emotions, and perceptions during sleep. Examples include sleepwalking, nightmares, night terrors, teeth grinding, and talking in one's sleep. Some people may also experience more extreme and potentially dangerous behaviours while under the influence of sleeping pills, such as eating, driving, or engaging in sexual activity while asleep.
All sleeping aids have been reported to cause at least some level of psychological dependency, and prescription drugs, particularly benzodiazepines and barbiturates, are linked to physical dependence and addiction. Additionally, a person may find that the effectiveness of the drugs decreases over time as their body adapts to the medication. It is important to note that certain medications, such as Ramelteon (Rozerem), have a low likelihood of misuse or dependency and are prescribed for longer-term use.
The risk of addiction is lowered if sleeping pills are taken exactly as prescribed. However, individuals with a personal or family history of substance misuse may want to avoid sleeping pills altogether. Instead, they can adopt healthy habits such as exercising, limiting caffeine intake, avoiding electronic screens before bedtime, and maintaining a consistent sleep schedule. These behavioural modifications are the safest long-term approach to dealing with insomnia.
While sleeping pills can provide short-term relief, they are not a cure for insomnia and should be used with caution due to the potential for misuse and dependence. It is always advisable to consult a healthcare provider before starting any sleep medication to understand the risks and side effects fully.
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Natural sleep remedies
Sleep disturbances are common, with 50 to 70 million people in the United States experiencing chronic sleep or wakefulness conditions. While there are prescription medications available to help with sleep, they often come with side effects and risks of misuse and dependency.
Melatonin Supplements
Melatonin is a hormone that is naturally released in the brain in response to reduced light exposure, signalling to the body that it's time to sleep. However, exposure to unnatural light from phones, laptops, or TVs can prevent the release of melatonin, making it hard to fall asleep. Melatonin supplements are available over the counter and can help ease sleep issues like jet lag and trouble falling or staying asleep. It's important to note that melatonin supplements are unregulated, and side effects may include headache, dizziness, and nausea.
Herbal Teas and Supplements
Herbal teas, tinctures, and other supplements may help induce sleepiness. Chamomile tea, for example, has been used for centuries as a popular herbal sleep remedy due to its calming and relaxing effects. Passionflower tea is another option, as it contains GABA, a brain chemical that affects mood and sleep. However, even natural sleep aids can cause side effects, so it's important to talk to a doctor before trying any new supplement.
Magnesium Supplements
Magnesium supplements have been shown to improve sleep in older people and those with restless leg syndrome. They can be obtained through foods like nuts and leafy greens, but it's important to speak to a doctor before taking supplements as too much magnesium can lead to cramps and nausea.
Lifestyle Changes
Making adjustments to your sleeping habits can also improve sleep quality. This includes limiting screen time before bed as the light from smartphones and other devices can interfere with sleep. If you need to get up during the night, using a flashlight instead of turning on the lights can help minimize visual disruption. Drinking warm milk, chamomile tea, or tart cherry juice before bed can also promote sleep, although there is limited scientific proof of their effectiveness. Finally, avoiding exercise within two hours of bedtime can help, as physical activity can raise your core body temperature, signalling to your body that it's time to be awake.
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Short-term vs. long-term use
Sleeping pills are typically recommended for short-term use only. This is because, over time, the body can become dependent on them, and stopping them abruptly can lead to withdrawal symptoms and rebound insomnia. Additionally, the risk of side effects such as memory problems, falls, and even death increases with long-term use.
Sedating medications, including sleeping pills, can cause drowsiness the following day, impairing a person's ability to drive or operate machinery. They may also cause people to perform actions such as driving, walking, eating, or making phone calls while asleep, a phenomenon known as sleepwalking.
Healthcare providers generally advise trying other methods to improve sleep before resorting to sleeping pills. This is especially true for older adults, as they may experience side effects such as confusion, memory issues, and balance problems, increasing their risk of falls and hip fractures.
Some examples of non-drug treatments include:
- Changing one's sleeping environment
- Cognitive behavioural therapy (CBT)
- Improving sleep hygiene and habits
- Making lifestyle changes
If non-drug treatments are ineffective, prescription sleeping pills may be a good short-term solution for insomnia. Some examples of prescription sleeping pills include:
- Benzodiazepines: These are generally recommended for short-term use due to their risk for abuse, addiction, and dependence. Examples include triazolam (Halcion) and temazepam.
- Nonbenzodiazepines or "Z-drugs": These are also prescription-only sleep aids and include eszopiclone (Lunesta), zolpidem (Ambien), and zaleplon (Sonata). Similar to benzodiazepines, they are recommended for short-term use due to their potential for misuse and dependence.
- Orexin receptor antagonists (ORAs): These work by blocking natural chemicals that signal wakefulness. Examples include suvorexant (Belsomra), lemborexant (Dayvigo), and daridorexant (Quviviq). ORAs are not habit-forming, but they can be more expensive than other options.
- Ramelteon (Rozerem): This is the only FDA-approved prescription melatonin receptor agonist for treating insomnia. It is not a controlled substance as it has not been found to have the potential for misuse and addiction. It can be prescribed for longer-term use.
Over-the-counter (OTC) sleeping pills are also available and may be suitable for short-term use. Doxylamine, an antihistamine, is one of the strongest OTC sleep aids. However, it can cause extreme fatigue and is not recommended for long-term use. Melatonin and valerian root are other OTC options that may help with sleep.
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Frequently asked questions
There is no single best sleeping pill, as different medications work for different people. Sleeping pills are also not recommended for long-term use due to the risk of dependency and other side effects. It is important to consult a doctor before starting any new sleep medication.
Prescription sleeping pills that can be used short-term include:
- Doxepin (Silenor)
- Ramelteon (Rozerem)
- Trazodone
- Zolpidem (Ambien)
- Zaleplon (Sonata)
- Eszopiclone (Lunesta)
Over-the-counter sleeping pills that can be used occasionally include antihistamines such as:
- Diphenhydramine (Benadryl, ZzzQuil)
- Doxylamine (Unisom)
Some natural sleep remedies that can be used as alternatives to sleeping pills include:
- Valerian root
- Lavender essential oil
- Melatonin supplements
