Ashwin Lewis
Sleep disturbances are common, with an estimated 50 to 70 million people in the United States experiencing chronic sleep or wakefulness conditions. A range of medications can help people fall asleep, stay asleep, or both. Sleeping pills are generally most effective when taken occasionally or over a short period as part of a broader plan to address the underlying causes of insomnia. The strongest sleeping pills are typically only available on prescription, but there are also over-the-counter options. This article will explore the different types of sleeping pills and their effects, including potential side effects and safety considerations.
| Characteristics | Values |
|---|---|
| Strongest sleeping pills | Benzodiazepines and nonbenzodiazepines |
| Sleeping pills available over the counter | Antihistamines such as promethazine, diphenhydramine (Benadryl), and doxylamine (Unisom) |
| Prescription sleeping pills | Eszopiclone (Lunesta), zolpidem (Ambien), zaleplon (Sonata), temazepam, ramelteon (Rozerem), suvorexant (Belsomra), trazodone (Desyrel), and doxepin (Silenor) |
| Side effects | Dizziness, light-headedness, confusion, muscle weakness, memory problems, headache, nausea, dry mouth, constipation, next-day impairment, complex sleep behaviours, misuse, and dependency |
| Precautions | Not recommended for more than 2 weeks without consulting a healthcare provider, potential side effects, medical conditions, other medications, risk of addiction, tolerance, rebound insomnia, and breathing problems |
| Elderly patients | Lower-dose medications or non-benzodiazepine options such as melatonin or newer drugs |
| Chronic insomnia | Daridorexant or lemborexant may offer sustained benefits with a potentially lower risk of dependence |
| Shift workers and travellers | Fast-acting medications or natural aids such as melatonin |
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What You'll Learn
Prescription vs. over-the-counter sleeping pills
Sleeping pills, also known as "hypnotics", generally fall into two categories: benzodiazepines and nonbenzodiazepines. Benzodiazepines are a group of drugs that have a sedative effect, slowing down the functioning of the body and brain. They work by stimulating a chemical in the brain called GABA, which leads to sedation, muscle relaxation, and reduced anxiety. Nonbenzodiazepines, or "Z-drugs", interact with GABA receptors in a more specific way and include eszopiclone (Lunesta), zolpidem (Ambien), and zaleplon (Sonata). These medications are approved for short-term use only.
Prescription sleeping pills are generally stronger than over-the-counter alternatives. Providers do not typically recommend using prescription sleeping pills long-term because they are not a cure for insomnia and carry a risk of dependence and addiction. They are usually only prescribed for short-term relief. Benzodiazepines, for example, carry a risk of serious side effects and are classified as Schedule IV controlled substances due to their potential for physical dependence, misuse, withdrawal, and addiction. You can build up a tolerance to these drugs, meaning higher doses may be required over time to achieve the same effects. Other potential side effects of benzodiazepines include dizziness and light-headedness, confusion, muscle weakness, and memory problems.
Over-the-counter sleep aids, on the other hand, are typically recommended for no more than two weeks without consulting a healthcare provider. This is because insomnia can be a symptom of an underlying medical condition that may require alternative treatment. Melatonin supplements, for example, are widely available over the counter and can be helpful for regulating the sleep-wake cycle, such as in cases of jet lag. Antihistamines, which are also available over the counter, can be used to treat insomnia, although they too carry the risk of side effects such as headache, dizziness, and nausea.
In summary, while prescription sleeping pills tend to be more potent than over-the-counter options, they also carry a greater risk of side effects and dependence. Over-the-counter sleep aids, on the other hand, are more easily accessible and may be sufficient for milder cases of insomnia or sleep disturbances due to jet lag or shift work. It is important to consult a healthcare provider before starting any sleep aid to ensure safe and effective use.
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Side effects of sleeping pills
Sleeping pills can be a short-term solution to sleeplessness, but they can also come with side effects and the risk of dependency. The most potent sleeping pills are generally only available on prescription, and the strongest tend to be benzodiazepines and nonbenzodiazepines (also called "Z drugs").
Sleeping pills can cause a range of side effects, from constipation to muscle weakness. Some common side effects of prescription sleeping pills include burning or tingling sensations in the hands, arms, feet, or legs. Over-the-counter antihistamines used as sleep aids can cause dry mouth, dizziness, and constipation. Prescription sedatives like zolpidem (Ambien) and eszopiclone (Lunesta) carry a risk of next-day impairment and complex sleep behaviours.
Approximately 8 out of 10 people experience a hangover effect the day after taking sleep medicine, feeling drowsy with muddled thinking and experiencing dizziness or balance problems. These daytime effects can negatively impact your ability to drive, work, or complete daily tasks. Sleeping pills can also interfere with normal breathing and be dangerous for people with certain chronic lung problems such as asthma, emphysema, or chronic obstructive pulmonary disease (COPD).
Older adults are more likely to experience health problems from sleeping pills because the drugs stay in their system longer. Drowsiness can persist into the day, and confusion and memory problems are also common side effects. These issues can lead to falls, broken hips, and car accidents in older adults. Sleeping pills can also worsen snoring and sleep apnea, and they may cause a rebound effect, where insomnia returns worse than before after stopping the medication.
It is important to consult a healthcare provider before starting any sleep aid, especially if you have an underlying medical condition. Sleeping pills should be used cautiously and only as directed, as an overdose can occur if mixed with alcohol or other medications and can be deadly.
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Risk of dependency and misuse
Sleeping pills, also known as "hypnotics", generally fall into two categories: benzodiazepines and nonbenzodiazepines. Benzodiazepines are sedatives that slow down the functioning of the body and brain. Nonbenzodiazepines, also known as "Z drugs", include eszopiclone (Lunesta), zolpidem (Ambien), and zaleplon (Sonata). Both types of sleeping pills are prescription-only.
Sleeping pills are most effective when taken occasionally or over a few weeks as part of a broader plan to treat the underlying causes of insomnia. They are not recommended for long-term use due to the risk of dependency and misuse. For example, benzodiazepines like Temazepam are not recommended for long-term treatment due to their potential for dependency and misuse. Similarly, suvorexant (Belsomra) may help a person fall asleep, but it also carries a risk of misuse and dependency.
Even over-the-counter sleep aids can cause side effects such as headaches, dizziness, and nausea. Antihistamines, which are commonly used as sleep aids, can cause dry mouth, dizziness, and constipation. While over-the-counter sleep aids are more easily accessible, they are still not recommended for long-term use. Diphenhydramine, the active ingredient in Benadryl, is an antihistamine that can cause drowsiness within an hour of taking it. However, it is not recommended for long-term use due to potential memory issues and a higher risk of serious side effects in older adults.
Prescription sleep aids can often relieve insomnia for short periods, but they also carry risks of side effects, misuse, and dependency. For example, zopiclone, a prescription sleep aid, can cause breathing problems and trouble waking up when taken with alcohol. Additionally, prescription sedative-hypnotics like zolpidem and eszopiclone can cause next-day impairment and complex sleep behaviours.
It is important to consult a doctor before starting any sleep medication to ensure safe and effective use. Doctors can help patients weigh the risks and benefits of different medications and determine the most appropriate treatment plan for their individual circumstances.
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Short-term relief from insomnia
Sleeping pills are typically not recommended for long-term use due to the risk of dependence and addiction, and they may not be significantly effective in promoting a good night's rest. Instead, they are generally recommended for short-term relief from insomnia.
For elderly patients, lower-dose medications or non-benzodiazepine options, such as melatonin or newer drugs, may be safer. Melatonin is a naturally occurring substance in the body that promotes sleep and positively affects circadian rhythms. Ramelteon (Rozerem) is the only FDA-approved prescription melatonin receptor agonist for treating insomnia and is not a controlled substance. It is generally prescribed for longer-term use.
Z-drugs, such as zolpidem (Ambien, Intermezzo, Zolpimist, or Ambien CR) and eszopiclone (Lunesta), are prescription-only sleep aids that can be prescribed for short-term insomnia relief. Zolpidem may also be used to treat sleep maintenance issues. However, these medications carry a risk of next-day impairment and complex sleep behaviours, such as sleepwalking or driving while asleep.
Other prescription medications for short-term insomnia relief include estazolam (Prosom), which may help with falling and staying asleep, and triazolam (Halcion), which is typically prescribed for 7 to 10 days. Doxepin (Silenor) is a tricyclic antidepressant that is FDA-approved for treating insomnia characterised by difficulty staying asleep. While it is only available by prescription, it is not a controlled substance.
It is important to consult a healthcare professional before taking any sleep medication to ensure it is suitable for your individual circumstances and to understand the potential side effects and risks.
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Melatonin as a sleeping pill
Sleeping pills are generally available only on prescription, but there are a few over-the-counter options as well. Melatonin is one such over-the-counter sleeping pill. Melatonin is a naturally occurring hormone in the body that rises in the evening, promoting sleep by putting you into a state of quiet wakefulness. While most people's bodies produce enough melatonin for sleep, some may want to try a supplement if they are experiencing insomnia, jet lag, or need to adjust their sleep schedule. Melatonin is also a good option for elderly patients, shift workers, and travellers as it has a lower risk of dependence compared to other drugs. It is important to note that melatonin is not regulated by the Food and Drug Administration (FDA) as it is considered a food supplement and not a medication.
If you are considering melatonin for sleep, it is recommended to take 1 to 3 milligrams two hours before bedtime. Melatonin can be taken nightly for up to two months, after which you should stop and assess your sleep. Melatonin supplements may be unsafe for those who are pregnant or breastfeeding, or have certain medical conditions such as autoimmune disorders, seizure disorders, or depression. It is always best to consult your healthcare provider before starting any new sleep aid, including melatonin.
While melatonin can be helpful for some people, it is important to be aware of potential side effects. Some people have reported experiencing headaches, dizziness, and nausea while taking melatonin. Additionally, melatonin supplements may raise blood sugar and increase blood pressure in individuals taking certain hypertension medications. To optimize the effects of melatonin, it is recommended to reduce exposure to blue and green light from electronic devices, as this light can interfere with melatonin's sleep-promoting effects.
Overall, melatonin can be a safe and effective option for those seeking short-term assistance with sleep issues. However, it is important to follow the recommended dosage, be mindful of potential side effects, and consult a healthcare professional if you have any concerns or underlying health conditions.
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Frequently asked questions
Sleeping pills are generally recommended for short-term use and are most effective when taken as part of a broader plan to treat the underlying causes of insomnia. The most potent sleeping pills are prescription-only and include benzodiazepines, nonbenzodiazepines, and melatonin receptor agonists.
Examples of prescription-only sleeping pills include zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata), and ramelteon (Rozerem).
Over-the-counter alternatives include antihistamines such as diphenhydramine, doxylamine, and promethazine. However, these are not recommended for long-term use due to potential side effects and safety concerns.
