Gina Johnson
Sleep is essential for our health and well-being, but many people struggle to get a good night's rest. Sleep issues are common, with approximately 50 to 70 million people in the United States experiencing chronic sleep or wakefulness conditions. To address these concerns, various medications are available to aid in falling asleep, staying asleep, or both. These include over-the-counter options and prescription medications, each with its own unique characteristics, effectiveness, and potential side effects. While these sleeping pills can provide relief for those struggling with sleep, it is important to carefully consider the risks and always consult a healthcare provider before starting any sleep aid. This article will explore the different types of sleeping pills available, their mechanisms of action, and the considerations to keep in mind when using these medications.
| Characteristics | Values |
|---|---|
| Sleeping pills type | Over-the-counter, Prescription |
| Prescription sleeping pills examples | Zolpidem, Eszopiclone, Doxepin, Ramelteon, Suvorexant, Lemborexant, Daridorexant, Zopiclone, Temazepam, Lunesta, Belsomra, Ambien, Dayvigo, Quviviq, Restoril, Unisom, ZzzQuil |
| Over-the-counter sleeping pills examples | Melatonin, Antihistamines, Diphenhydramine |
| Side effects | Dizziness, Nausea, Headache, Dry mouth, Drowsiness, Grogginess, Urinary retention, Allergic reactions, Addiction, Tolerance, Rebound insomnia, Parasomnia, Sleepwalking, Sleep-driving, Worsening of snoring and sleep apnea |
| Precautions | Check with a healthcare provider before taking sleeping pills, Do not mix with alcohol or other medications, May take months to stop taking the pills |
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What You'll Learn
Prescription vs. over-the-counter sleeping pills
Sleeping pills are medications that can help people fall asleep, stay asleep, or both. While prescription sleeping pills are stronger than over-the-counter ones, they are also associated with a higher risk of side effects, misuse, and dependency.
Over-the-counter (OTC) sleep aids are easily accessible without a prescription. However, it is recommended to consult a healthcare provider before taking them as they can interfere with other medications or aggravate existing health conditions. Common OTC sleeping pills contain antihistamines, such as diphenhydramine and doxylamine, which work by blocking histamines that cause alertness. Other OTC options include melatonin supplements, which are widely available and can be useful for regulating sleep-wake cycles in cases of jet lag. While OTC sleep aids are generally safer, they can still cause side effects such as headaches, dizziness, and nausea.
Prescription sleeping pills, on the other hand, are recommended by healthcare providers for short-term relief in cases of severe or chronic insomnia. They are stronger and more effective than OTC options but come with a higher risk of side effects and dependency. Benzodiazepines, for example, are a group of prescription sleeping pills that are effective for short-term use due to their potential for physical dependence, misuse, withdrawal, and addiction. Z-drugs, such as zolpidem (Ambien) and eszopiclone (Lunesta), are another type of prescription sleep aid that works by slowing down brain activity. These Z-drugs may cause parasomnia, a disruptive sleep disorder where individuals may sleepwalk, eat, or even drive without being fully awake. Other prescription sleep aids include doxepin (Silenor), a tricyclic antidepressant that is FDA-approved for treating insomnia, and ramelteon (Rozerem), a melatonin receptor agonist that promotes sleep and positively affects circadian rhythms.
While prescription sleeping pills can be effective for short-term relief, healthcare providers generally do not recommend their long-term use due to the risk of dependence and addiction. Additionally, prescription sleep medications can cause various side effects, including constipation, muscle weakness, and next-day impairment, which can negatively impact daily tasks. Therefore, it is crucial to consult a healthcare provider to determine the best treatment option based on individual needs and circumstances.
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Natural sleep aids
While prescription and over-the-counter sleeping pills are available, natural sleep aids are also an option for those who want to avoid the potential side effects and risks of traditional sleep medications. Natural sleep aids are typically plant-based or consist of vitamins or minerals that are already present in our diets. They can also be supplemental amounts of substances that are produced by the body, such as melatonin.
Melatonin
Melatonin is a hormone that is naturally released in the brain by the body's response to reduced light exposure, which should occur at night. However, exposure to artificial light from sources such as phones, laptops, or TVs can prevent its release, making it difficult to fall asleep. Melatonin supplements have become a popular sleep aid, with a 2022 study finding that they improved both daytime and nighttime sleep in older adults. They have also been found to be effective for people experiencing jet lag and may improve overall sleep quality in individuals with sleep disorders. It's important to note that melatonin supplements are not regulated by the FDA, so the dosage and ingredients may vary between manufacturers.
Magnesium and Valerian Root
Magnesium and valerian root are also natural sleep aids that may help improve sleep quality.
CBD
CBD has been found to relieve anxiety and act as a natural sleep aid. A review of 34 studies concluded that CBD could help alleviate symptoms of insomnia when used alone or with equal amounts of THC. However, it's important to note that CBD is still classified as a controlled substance in some states, and there is limited research on its long-term safety.
Lifestyle Changes
In addition to supplements, there are natural lifestyle changes that can improve sleep. These include:
- Reducing exposure to artificial light at night, including from smartphones, and using a flashlight instead of turning on bright lights if you need to get up.
- Adjusting your bedtime temperature by sleeping in layers.
- Avoiding working out within two hours of bedtime, as it can raise your core body temperature and signal to your body that it's time to wake up.
- Drinking warm milk, chamomile tea, or tart cherry juice before bed. While there isn't much scientific proof that these drinks improve sleep, there are no harmful side effects, and they can provide a natural treatment without drug interactions.
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Z drugs
Z-drugs are a group of non-benzodiazepine medications that can be prescribed to treat insomnia. They are commonly prescribed due to their ability to reduce sleep latency without altering sleep architecture. Z-drugs include zolpidem, zopiclone, eszopiclone (also known as Lunesta), and zaleplon (Sonata).
Zolpidem is one of the most widely prescribed Z-drugs and is available in oral tablets, oral spray, and sublingual formulations. It is approved for the treatment of initial insomnia, with an extended-release formulation also available for middle insomnia. Zolpidem typically acts within 15-30 minutes and lasts for 6-8 hours, but it may cause next-day impairment and complex sleep behaviours, such as sleepwalking, sleep driving, and taking other medications.
Eszopiclone is the levorotatory stereoisomer of zopiclone and has a longer half-life, making it effective for both sleep initiation and maintenance. It is prescribed for insomnia and has been shown to decrease sleep latency and improve sleep maintenance.
Zaleplon is the shortest-acting Z-drug and is indicated for sleep initiation, particularly following middle-of-the-night awakenings. It has a lower likelihood of causing next-morning hangover effects due to its shorter half-life.
While Z-drugs can be effective in treating insomnia, they are not recommended for long-term use due to the risk of tolerance and dependence. They can impair physical and cognitive performance and have been associated with detrimental effects on memory, particularly anterograde amnesia. Additionally, Z-drugs may cause complex sleep behaviours, where individuals engage in activities such as sleepwalking, sleep eating, or driving while not fully awake, and may not remember these behaviours the next day.
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Benzodiazepines
Some common benzodiazepines include:
- Alprazolam (Xanax): Used for treating anxiety disorders, panic disorder, and premenstrual dysphoric disorder.
- Quazepam (Doral): Approved for treating insomnia and sleep problems.
- Remimazolam (Byfavo): Used for pre-anesthesia before surgeries and procedures.
- Temazepam (Restoril): Approved for treating insomnia.
- Triazolam (Halcion): Approved for treating insomnia.
It is important to note that not all benzodiazepines are approved for use in the United States, and some may be illegal, such as flunitrazepam (Rohypnol), which is infamous for its use as a "date rape" drug. Benzodiazepines can also be addictive and lead to substance use disorders, so healthcare providers carefully monitor their use.
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Antidepressants
Doxepin (Silenor) is the only FDA-approved antidepressant for the treatment of insomnia. It is a tricyclic antidepressant that is FDA-approved for treating insomnia characterised by difficulty staying asleep. It produces sedating effects at low doses and helps people stay asleep. Doxepin is generally not associated with dependence or withdrawal symptoms. Research shows that doxepin may be effective in improving sleep for up to 3 months, but more research is needed on its long-term use and safety.
Trazodone is another antidepressant that is widely prescribed as a nighttime sleep aid for patients with acute insomnia. It has a sedative effect, inducing a relaxed, sleepy feeling. However, it can cause side effects such as dizziness, fainting, irregular heartbeat, and, in rare cases, priapism in men. There are also heightened risks for patients under 24, particularly regarding mental health.
Other tricyclic antidepressants, such as amitriptyline and nortriptyline, have been prescribed off-label for treating insomnia, but this is rare due to the many potential side effects. Selective serotonin reuptake inhibitors (SSRIs) have also been studied for their effectiveness in treating insomnia, with some showing significant improvements in subjective sleep measures.
It is important to note that antidepressants as sleep aids should generally be avoided by people without a diagnosis of depression. This is because the duration of sedative effects in these medications is shorter than in other sleep aids, and the potential side effects may cause more risk than benefit. As with any medication, it is crucial to consult a doctor before taking antidepressants as sleeping pills to ensure they are safe and appropriate for your individual needs.
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Frequently asked questions
There are various alternatives to Ambien, including:
- Hetlioz (tasimelteon)
- Neupro (rotigotine transdermal system)
- Silenor (doxepin)
- Lunesta (eszopiclone)
- Restoril
- Rozerem
- Antidepressants
- Over-the-counter antihistamines
Some natural alternatives to sleeping pills include:
- Drinking warm milk
- Using lavender
- Avoiding electronics before bedtime
- Eating enough protein and complex carbohydrates
Ambien has been linked to various side effects, including:
- Next-day drowsiness and mental confusion
- Potential suicidal thoughts or behavioural changes
- Engaging in activities such as driving, eating, or having sex and then having no recollection of doing so
Some non-pill methods to help with sleep include:
- Cognitive behavioural therapy (CBT)
- Relaxation techniques
- Keeping the room at a comfortable temperature
- Using a white noise machine
One natural sleeping aid from India is neem ki goli, which means neem pills and can be found in any South Asian store.
