Ashwin Lewis
Sleep medications are typically a short-term solution for insomnia, often caused by shift work, stress, or underlying medical conditions. While there are over-the-counter options available, the strongest sleeping pills are generally prescription-only. These include zopiclone, eszopiclone (Lunesta), estazolam (Prosom), doxepin (Silenor), suvorexant (Belsomra), and ramelteon (Rozerem). Each medication has its own benefits and drawbacks, and a doctor will prescribe the most suitable option based on individual circumstances. It is important to exercise caution when taking sleep medication due to potential side effects, interactions with other substances, and the risk of addiction and dependence.
| Characteristics | Values |
|---|---|
| Drug Name | Doxepin (Silenor), Eszopiclone (Lunesta), Estazolam (Prosom), Lemborexant (Dayvigo), Ramelteon (Rozerem), Suvorexant (Belsomra), Zopiclone |
| Drug Type | Tricyclic Antidepressant, Hypnotic Sedative, Short-acting Benzodiazepine, Orexin Antagonist, Melatonin Antagonist, CNS Depressant, N/A |
| Dosage | Doxepin: 3mg or 6mg, Eszopiclone: 1mg, 2mg or 3mg, Estazolam: 150mg or 400mg, Ramelteon: 8mg, Zopiclone: 7.5mg |
| Usage | Doxepin: For up to 3 months, Eszopiclone: Supervised by a medical practitioner, Estazolam: Short-term, Ramelteon: Long-term, Suvorexant: Adults with difficulty sleeping, Zopiclone: Occasional |
| Side Effects | Doxepin: N/A, Eszopiclone: Diminishing effects, sleepwalking, impaired CNS, Estazolam: Misuse, dependency, addiction, dizziness, light-headedness, confusion, muscle weakness, memory problems, Ramelteon: Allergic reactions, Suvorexant: N/A, Zopiclone: N/A |
| Precautions | Doxepin: Consult a doctor, Eszopiclone: Consult a doctor, Estazolam: Avoid alcohol, Ramelteon: None, Suvorexant: N/A, Zopiclone: Do not exceed the prescribed dose |
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What You'll Learn
Prescription vs over-the-counter sleep pills
Sleep aids are available over the counter and by prescription. While prescription sleeping pills are stronger than over-the-counter ones, they are generally not recommended for long-term use due to the risk of serious side effects, misuse, and addiction.
Over-the-counter sleep aids are readily available without a prescription. They are typically antihistamines, which work by blocking histamines in the body that cause alertness. Common ingredients in over-the-counter sleep aids include diphenhydramine, found in Benadryl, and doxylamine, found in Unisom SleepTabs. While these medications can be effective in helping people fall asleep, they have not been shown to improve long-term health and should be used sparingly.
Prescription sleep aids, on the other hand, are recommended by a healthcare provider and can be more effective in treating insomnia and sleep disturbances. Benzodiazepines, such as Ativan (lorazepam) and Restoril (temazepam), are commonly prescribed for short-term relief of insomnia. They work by stimulating a chemical in the brain called GABA, leading to sedation, muscle relaxation, and reduced anxiety. However, long-term use of benzodiazepines is not recommended due to the risk of physical dependence, misuse, withdrawal, and addiction. Z-drugs, such as zolpidem (Ambien) and eszopiclone (Lunesta), are also commonly prescribed sleep aids. While they can be effective, they carry a risk of misuse and dependency, and higher doses can impair an individual's CNS even when awake.
Melatonin receptor agonists, such as ramelteon (Rozerem), are another type of prescription sleep aid. They are considered the first line of therapy for insomnia because they do not cause physical dependence or abuse and typically do not cause morning sedation. Suvorexant (Belsomra) is another prescription sleep aid that may help individuals fall asleep and maintain sleep. Doxepin, sold under the brand name Silenor, is another prescription option that may be suggested for up to 3 months of use.
It is important to note that not all sleep issues require medication. Often, non-drug treatments and behavioural changes can significantly improve sleep quality. Individuals should consult a healthcare professional to determine the best treatment option for their specific needs and circumstances.
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Side effects and health risks
Sleeping pills can cause a range of side effects, from constipation or diarrhoea to muscle weakness. Other digestive problems may include gas, heartburn, and nausea. They can also worsen snoring and sleep apnea.
Sleeping pills can also cause a "hangover effect", with approximately 8 out of 10 people experiencing side effects the day after taking sleep medicine. This may include fatigue, dizziness, and irritability.
Long-term use of sleeping pills can lead to dependency, drug tolerance, and other adverse effects. These include poor memory, brain degeneration, and an increased risk of Alzheimer's disease. They may also lead to depression and a risk of accidental falls. In some cases, respiratory depression during sleep can occur, which may lead to death.
Some prescription sleep medications, such as zolpidem and eszopiclone, carry a risk of next-day impairment and complex sleep behaviours. Newer medications, like daridorexant, have been associated with headaches.
It is important to consult a healthcare provider before starting any sleep aid, as insomnia may be a sign of an underlying medical condition. Additionally, sleep aids may interact with other medications, substances, alcohol, or vitamin supplements.
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Natural sleep aids
While there are prescription medications available to help with sleep, such as Doxepin (Silenor), Ramelteon (Rozerem), and Estazolam (Prosom), these often carry risks of side effects, misuse, and dependency. Natural sleep aids, on the other hand, are over-the-counter supplements that can help you fall asleep faster or stay asleep throughout the night. These are usually plant-based or vitamins and minerals already present in our diets.
Melatonin
Melatonin is a hormone 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 improvements in both daytime and nighttime sleep, as well as overall sleep quality in individuals with sleep disorders. However, melatonin can reduce the effectiveness of some medications and may not be suitable for people with certain medical conditions. It is important to note that melatonin supplements are not regulated by the FDA, so dosages and ingredients may vary.
Magnesium and Valerian Root
Magnesium and valerian root are also natural sleep aids that may help improve your sleep quality.
CBD and THC
Some studies suggest that cannabidiol (CBD) and delta-tetra-hydrocannabinol (THC), which are natural or synthetic cannabinoids, can help with sleep. CBD has been found to relieve anxiety and improve sleep quality. THC, on the other hand, is a component of marijuana, which has sleep-promoting properties. However, it is important to note that marijuana and THC products can create dependence, and withdrawal can aggravate sleep problems.
In addition to these supplements, there are also lifestyle changes and natural remedies that can improve your sleep:
- Avoid working out within two hours of bedtime.
- Avoid exposure to unnatural light from smartphones, laptops, or TVs before bed as it can interfere with melatonin production.
- Use a flashlight instead of turning on the lights if you need to get up at night.
- Sleep in layers to adjust your bedtime temperature.
- Drink warm milk, chamomile tea, or tart cherry juice. While there isn't much scientific proof, these drinks are believed to have sleep-promoting properties.
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Short-term use and dependency
Sleeping pills are typically recommended for short-term use, as they can be highly effective in the short term, but they may become less effective over time as the body gets accustomed to them. This can lead to tolerance, dependency, and addiction. Sleeping pills are most effective when taken occasionally or over a few weeks, in conjunction with other treatments, such as therapy or lifestyle changes, to address the underlying causes of insomnia.
Prescription sleeping pills are generally considered to be stronger than over-the-counter options. However, over-the-counter antihistamines, such as promethazine, diphenhydramine, and some antidepressants, can also be used to induce drowsiness and aid sleep. These are typically recommended for short-term use as well, often for no more than two weeks without consulting a healthcare provider.
Sleeping pills with a high risk of dependency and addiction include the "Z-drugs," which are similar to benzodiazepines in their effects. Benzodiazepines, such as estazolam (Prosom), are short-acting and influence the brain's chemistry to calm the nervous system, making it easier to fall and stay asleep. However, they are generally recommended for short-term use due to the risk of addiction. Similarly, Lunesta, a Z-drug, is a hypnotic sedative that interacts with the central nervous system to improve sleep quality and duration. It is a controlled substance with a risk of misuse and dependency.
To minimise the risk of dependence and tolerance, healthcare providers may recommend taking sleeping pills on an "as-needed" basis, rather than regularly. Additionally, older adults or those with chronic insomnia may be prescribed newer medications, such as daridorexant or lemborexant, which may offer sustained benefits with a potentially lower risk of dependence compared to older drugs.
It is important to consult a doctor or healthcare provider before starting any sleep medication, as they can help determine the most suitable treatment plan based on individual circumstances. They can also advise on potential side effects, interactions with other medications, and strategies to minimise dependence.
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Sleep medication alternatives
While prescription sleep medication can be effective in treating insomnia and other sleep disturbances, they often come with risks of side effects, misuse, and dependency. Additionally, they may interact with other substances such as alcohol, medications, and vitamin supplements. As such, it is always advisable to consult a doctor before taking any sleep medication.
Natural Sleep Aids
Natural remedies and lifestyle changes can often help improve sleep without the need for prescription medication. Here are some options:
- Melatonin supplements: Melatonin is a hormone that is naturally released in the brain a few hours before we feel sleepy. However, exposure to unnatural light from phones, laptops, or TVs can prevent its release, disrupting sleep. Melatonin supplements are available over the counter and can help regulate sleep. However, it is important to note that they are unregulated, so the dosage and ingredients may vary between manufacturers.
- Valerian root: Valerian is an herbal plant whose dried root is made into pills, teas, or other formulas to improve sleep. Research is mixed, but some evidence suggests it can help people fall asleep faster and sleep more soundly.
- Herbal teas: Teas containing herbal blends such as passionflower, chamomile, or valerian can be relaxing and help prepare the body for sleep. Chamomile tea, in particular, is believed to contain flavonoids that interact with benzodiazepine receptors in the brain involved in the sleep-wake transition.
- Warm milk: Warm milk has long been associated with chemicals that simulate the effects of tryptophan in the brain, which may promote sleepiness.
- Tart cherry juice: This may support melatonin production and a healthy sleep cycle.
- Lavender essential oil: While there is no established physiological effect on the sleep system, lavender can help you relax and unwind, which may indirectly improve sleep.
Lifestyle Changes
In addition to natural sleep aids, making certain lifestyle changes can improve sleep:
- Exercise: Moderate aerobic exercise can increase the amount of nourishing slow-wave (deep) sleep. However, avoid exercising within two hours of bedtime, as it can release endorphins and raise your core body temperature, making it harder to fall asleep.
- Limit screen time: The light from smartphones, laptops, and TVs can interfere with sleep. If you need to get up at night, use a flashlight instead of turning on the lights to minimize visual disruption.
- Avoid alcohol: Alcohol can interfere with sleep and should be especially avoided if taking certain sleep medications.
While these alternatives can help improve sleep, it is important to consult a healthcare professional if sleep problems persist, as they can recommend or prescribe the most appropriate treatment for your specific needs.
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Frequently asked questions
Sleeping pills (also known as "hypnotics") generally fall into two categories: benzodiazepines and nonbenzodiazepines. The strongest sleeping pills are usually only available on prescription. Some common prescription sleep aids include:
- Doxepin (Silenor)
- Eszopiclone (Lunesta)
- Estazolam (Prosom)
- Lemborexant (Dayvigo)
- Ramelteon (Rozerem)
- Suvorexant (Belsomra)
Sleep medications can carry risks of side effects, misuse, and dependency. They may also interact with other substances, including medications, alcohol, and supplements. It is important to consult a doctor before starting any sleep medication. Side effects of sleep medications can include:
- Dizziness
- Light-headedness
- Confusion
- Muscle weakness
- Memory problems
- Edema
- Allergic reactions
- Increased thoughts of suicide
Sleep issues may be addressed through a combination of lifestyle changes, psychological treatments (such as cognitive behavioural therapy), and sleep supplements. Natural sleep aids, such as those containing tart cherry, chamomile, or Vitamin B6, can also help improve sleep quality.
