Colin Snow
Sleep is an essential part of a healthy lifestyle, but for many people, falling and staying asleep can be a challenge. Sleep aids and medications are available to help with occasional sleeplessness or more chronic conditions. Sleeping pills are one option, but they can have side effects and are not recommended for long-term use. Natural sleep aids, such as melatonin and valerian supplements, are also available over the counter and may help promote sleep. Other prescription medications for sleep include Doxepin (Silenor), Zolpidem (Ambien, Intermezzo, Zolpimist), and Triazolam (Halcion). It's important to be aware of the potential side effects and risks associated with any sleep medication and to consult a healthcare provider before taking them.
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What You'll Learn
Over-the-counter sleep aids
Over-the-counter (OTC) sleep aids are medications that can be purchased without a prescription. They are typically used to treat occasional sleeplessness or short-term sleep problems and are not recommended for long-term use. OTC sleep aids are easily accessible at drugstores and retail locations, but it is advised to consult a healthcare provider before taking them to understand the potential side effects, drug interactions, and risks.
One category of OTC sleep aids contains antihistamines, which are commonly used to treat allergies but can also cause drowsiness. Diphenhydramine and doxylamine succinate are sedating antihistamines found in many non-prescription sleep medicines. While they can help induce sleep by reducing histamine levels in the brain, they may also lead to side effects such as daytime drowsiness, dry mouth, blurred vision, constipation, and difficulty urinating.
Natural sleep aids, such as melatonin, valerian, and cannabidiol (CBD), are also available over the counter. Melatonin is a hormone naturally produced by the body to regulate the sleep-wake cycle, and OTC melatonin is its synthetic version. Valerian is an herb that is believed to promote relaxation and sleep. CBD, derived from the cannabis plant, is being studied for its potential in treating insomnia due to its anxiety-relieving properties. However, it is important to note that supplements like these are not regulated as strictly as other medications, and their effectiveness may vary.
Additionally, creating good sleep habits, also known as sleep hygiene, can significantly improve sleep quality. This includes practices such as maintaining a consistent sleep schedule, establishing a relaxing bedtime routine, and creating a comfortable sleep environment. Incorporating soothing teas into your routine is another natural way to promote relaxation and improve sleep.
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Prescription hypnotics
Some examples of prescription hypnotics include:
Benzodiazepines
Benzodiazepines are a class of drugs that can be useful for the short-term treatment of insomnia. They work by inhibiting NREM stage 1 and 2 sleep, but they can disrupt sleep architecture and reduce slow-wave sleep. Examples of benzodiazepines include triazolam (Halcion), temazepam, estazolam, nitrazepam, and diazepam. It is important to note that the use of benzodiazepines beyond 2 to 4 weeks is not recommended due to the risk of dependence.
Nonbenzodiazepine Receptor Agonists
Nonbenzodiazepine receptor agonists, such as zaleplon, zolpidem, and eszopiclone, interact with GABA receptors and produce fewer adverse effects than benzodiazepines. Zolpidem, for example, has a rapid onset and short duration of action, making it a good choice for treating sleep-onset insomnia. It is available in immediate-release and extended-release forms.
Melatonin Receptor Agonists
Melatonin receptor agonists, such as ramelteon (Rozerem), promote sleep by affecting melatonin receptors and positively impacting circadian rhythms. They are indicated for insomnia characterized by difficulty falling asleep.
Antipsychotics
In some cases, antipsychotics with sedation as a side effect may be used off-label to treat insomnia. However, it is important to note that the risks of these medications may outweigh the benefits, and they can have serious adverse effects even at low doses.
Other Hypnotics
Other hypnotic drugs that have been used historically or in specific contexts include quinazolinones, barbiturates, and early somniferous drugs such as chloralurethan and paraldehyde.
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Natural sleep aids
There are many natural sleep aids that can help you fall asleep faster or stay asleep throughout the night. Melatonin, a hormone that is naturally released in the brain four hours before we feel sleepy, is one of the most popular natural sleep aids. Melatonin supplements have been shown to improve both daytime and nighttime sleep, especially in older adults. However, it is important to note that melatonin can reduce the effectiveness of some medications and produce unwanted side effects when combined with others. It may not be recommended for people who have received organ transplants, experience depression, or have a bleeding or seizure disorder.
Other natural sleep aids include magnesium and valerian root. Some studies have also found that CBD and THC, which are derived from the cannabis plant, can help people fall asleep, stay asleep, and improve overall sleep quality. However, it is important to note that marijuana and products containing THC may create dependence, and withdrawal from them can aggravate sleep problems.
In addition to supplements, there are also behavioural adjustments that can be made to improve sleep. Reducing exposure to light from smartphones, laptops, or TVs before bed can help, as unnatural light prevents the release of melatonin. It is also recommended to avoid working out within two hours of bedtime, as this can raise your core body temperature, signalling to your body that it is time to wake up.
Some natural drinks that may help improve sleep include warm milk, chamomile tea, and tart cherry juice. While there is not much scientific proof that these drinks work, they are generally safe to consume and may be worth trying.
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Non-drug therapies
If you are struggling with sleep, there are several non-drug therapies that can help. These therapies are particularly recommended for those aged 65 and over, as there may be safer ways to improve sleep than medication.
Cognitive Behavioural Therapy for Insomnia (CBT-I)
Cognitive Behavioural Therapy for Insomnia (CBT-I) is the most prominent non-drug treatment for insomnia. It is recommended as the first-line treatment for chronic insomnia in adults by the American Academy of Sleep Medicine. CBT-I targets behavioural, cognitive, and physiological factors that perpetuate insomnia. It aims to modify and alter maladaptive behaviours and distorted beliefs about sleep. CBT-I can be delivered in different formats, such as face-to-face individual or group therapy, or digitally delivered self-help formats. Research has shown that CBT-I has positive and long-lasting effects on insomnia.
SleepioRx
SleepioRx is a digital therapeutic intended for the treatment of chronic insomnia/insomnia disorder. It is a prescription device delivering CBT-I and can be accessed anytime and anywhere. SleepioRx helps individuals address the root cause of their sleep problems and shift their mindset about sleep.
Natural Sleep Aids
There are several natural sleep aids that can be helpful. These include:
- Warm milk: Believed to be associated with chemicals that simulate the effects of tryptophan on the brain, which is involved in the sleep-wake transition.
- Chamomile tea: Believed to have flavonoids that may interact with benzodiazepine receptors in the brain that are involved with the sleep-wake transition.
- Tart cherry juice: While there isn't much scientific proof that this works, there's no harm in trying it.
- Melatonin supplements: Melatonin is a hormone that is naturally released in the brain four hours before we feel sleepy. Unnatural light exposure from phones, laptops, or TVs can prevent its release. Melatonin supplements are available over the counter but be sure to consistently buy the same brand as dosages may differ.
Other Tips
- Keep your room cool: The ideal temperature for your thermostat is between 65 and 72 degrees.
- Reduce light exposure: The light from smartphones and other electronic devices can interfere with sleep. If you need to get up at night, use a flashlight instead of turning on the lights.
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Short-term medication
There are several over-the-counter (OTC) medications that can help with short-term sleep issues. These include antihistamines such as diphenhydramine and doxylamine succinate, which are found in many non-prescription sleep and allergy medicines. Melatonin supplements are also available without a prescription and can help promote sleep by aiding the body's natural melatonin levels, which control the sleep-wake cycle. Valerian is another natural supplement that is said to aid relaxation and sleep.
It is important to note that while these OTC medications can be easily purchased, it is recommended that you consult a healthcare provider before taking them, as they can have side effects and risks. For example, antihistamines can cause drowsiness the next day, and melatonin supplements may lead to nausea, headaches, and daytime sleepiness.
Additionally, there are prescription medications that can be used for short-term sleep issues. Zolpidem, with brand names like Ambien and Intermezzo, is a medication that may help with falling asleep and staying asleep. Doctors typically prescribe it for short-term insomnia relief, and it is important to start with the lowest possible dose. Triazolam (Halcion) is another option that doctors can prescribe for the short-term treatment of insomnia, typically for 7 to 10 days. Doxepin, sold under the brand name Silenor, is a sleep aid that may be suggested by doctors for people with insomnia for up to 3 months.
It is important to discuss these medications with your healthcare provider, as they can have side effects and are not suitable for everyone. For example, pregnant people should not take Restoril and should consult a doctor before taking Zolpidem or Lunesta.
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Frequently asked questions
There are several over-the-counter (OTC) medications available to help with sleep. These include antihistamines like diphenhydramine and doxylamine succinate, which can be found in many non-prescription sleep and allergy medicines. Melatonin is another natural supplement that can aid sleep. It is a hormone that the body produces naturally to promote sleep.
Yes, there are prescription sleep medications, often referred to as sleeping pills, that can be prescribed by a doctor. These include Silenor (Doxepin), Restoril, Halcion (Triazolam), Zolpidem, Lunesta, and Rozerem (Ramelteon).
Sleep aids can cause side effects such as daytime sleepiness, confusion, parasomnia (sleepwalking or eating), nausea, headaches, and memory problems. More severe side effects may include hallucinations, mood changes, and CNS (central nervous system) depression.
Yes, other nondrug therapies like cognitive behavioural therapy (CBT) can help improve sleep by addressing the stressors that keep you awake. Additionally, making changes to your lifestyle and sleep habits is often the best long-term treatment for sleep problems.
