Evie Summers
Sleep is an essential part of our lives, and when we struggle to fall or stay asleep, it can have a detrimental impact on our health and well-being. Sleeping pills are one option to help treat insomnia and other sleep disorders, but they often come with side effects and the risk of dependency and addiction. While some sleep aids, like benzodiazepines and Z-drugs, are habit-forming, there are non-habit-forming alternatives available, both over the counter and by prescription. These include natural supplements like melatonin, prescription medications like Ramelteon, and over-the-counter options such as Doxylamine and Diphenhydramine. This variety of options empowers individuals to choose the treatment that best suits their needs and preferences, helping them to achieve a good night's rest without the risk of forming a habit.
| Characteristics | Values |
|---|---|
| Non-habit forming sleeping pills | Doxepin, Ramelteon, Trazodone, Unisom, OTC medicinal sleep aids (e.g. antihistamines like Doxylamine succinate and Diphenhydramine) |
| Side effects | Doxepin: dry mouth, constipation, dizziness, increased blood pressure or heart rate, and increased risk of falls. Ramelteon: dizziness, nausea, next-day drowsiness, and rarely, worsening depression and thoughts of suicide. Trazodone: daytime sleepiness, dry mouth, dizziness, and rare risk of priapism. Unisom: none mentioned. OTC medicinal sleep aids: none mentioned. |
| Prescription requirements | Doxepin, Ramelteon: prescription required. Trazodone: second most prescribed sleeping pill in the U.S. Unisom: no prescription required. OTC medicinal sleep aids: no prescription required. |
| Alternative treatments | Natural sleep aids (e.g. melatonin), cognitive behavioral therapy (CBT) |
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What You'll Learn
Natural sleep aids like melatonin and valerian supplements
Melatonin is a hormone that is naturally produced by the body to help regulate sleep. Melatonin supplements are available over the counter and are often used to alleviate insomnia, overcome jet lag, or adjust to an earlier sleep schedule. Research shows that melatonin supplements may help people with insomnia fall asleep slightly faster and may be more beneficial for those with delayed sleep phase syndrome. It is recommended to take 1 to 3 milligrams of melatonin two hours before bedtime. However, it is important to note that melatonin supplements should be used short-term, and individuals with certain medical conditions, such as pregnancy, breastfeeding, autoimmune disorders, seizure disorders, or depression, should refrain from using them. Additionally, melatonin may interact with hypertension medications, potentially impacting blood sugar and blood pressure levels.
Valerian root is another popular natural sleep aid that has been used since ancient times. It is widely used in European countries like France, Germany, and Sweden. Valerian root is believed to improve sleep, reduce anxiety, and address various conditions such as insomnia, premenstrual syndrome (PMS), menopause, depression, and headaches. It is typically consumed as a dietary supplement in the form of tea, tinctures, capsules, or tablets, which can be purchased without a prescription. However, it is important to note that valerian root is not closely monitored by regulatory agencies like the FDA, so individuals should take additional measures to ensure they are purchasing reputable products. While valerian root is considered a safer alternative to prescription sleep aids, it is not advised as a long-term solution for insomnia.
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Over-the-counter (OTC) antihistamines like doxylamine succinate and diphenhydramine
It is important to note that these antihistamines are intended for short-term use and should not be taken for longer than two weeks at a time without consulting a healthcare provider. Many experts do not recommend antihistamines for treating insomnia, especially long-term, due to potential side effects. These side effects can include next-day drowsiness, dizziness, and an increased risk for dementia and Alzheimer's disease with long-term use. Additionally, antihistamines may not be suitable for everyone, such as pregnant or nursing individuals, and alternative treatments such as cognitive behavioral therapy (CBT) may be recommended instead.
When considering the use of OTC antihistamines as sleep aids, it is always advisable to consult a healthcare professional. They can provide guidance on appropriate dosage, potential interactions with other medications, and help assess whether antihistamines are a suitable option for your specific circumstances. It is important to remember that while antihistamines may help with occasional sleep difficulties, they are not a cure for chronic insomnia, and other treatments or lifestyle changes may be more effective in the long term.
In summary, OTC antihistamines like doxylamine succinate and diphenhydramine can be used as short-term sleep aids due to their drowsy side effects. However, they should be used with caution and under the guidance of a healthcare provider to avoid potential side effects and risks associated with long-term use. Exploring alternative treatments and improving sleep hygiene through practices like CBT can also be beneficial for improving sleep quality and treating insomnia.
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Non-benzodiazepines like Sonata
Sleeping pills are used to treat insomnia by making the user feel drowsy and relaxed. While they can be effective, they can also have side effects and are not recommended for long-term use due to the risk of dependence and addiction. One type of sleeping pill is non-benzodiazepines, which includes Sonata (zaleplon).
Sonata is a non-benzodiazepine or Z-drug of the pyrazolopyrimidine class. It is a sedative and hypnotic used to treat insomnia and is particularly effective for those who have difficulty falling asleep. Sonata works by improving sleep latency, reducing the time required to fall asleep, and may facilitate sleep induction rather than sleep maintenance. It is typically taken orally in doses of 5 mg, 10 mg, or 20 mg right before bedtime.
Zaleplon, the generic form of Sonata, has a unique advantage over other hypnotics due to its ultrashort 1-hour half-life, resulting in a lack of next-day residual effects on driving and other performance-related skills. This makes it safer in terms of driving performance compared to other hypnotics on the market. However, it is important to note that zaleplon has been associated with an increased risk of death, and it may not be effective in reducing premature awakenings due to its ultrashort elimination half-life.
While zaleplon has been found to have fewer rebound effects and is less chemically reinforcing than other nonbenzodiazepines, it still has the potential for recreational use and addiction. Some individuals may use it through methods other than those prescribed, such as insufflation, to induce faster effects. Anterograde amnesia is also a possible side effect, which can cause an individual to lose track of how much zaleplon they have ingested, leading to an increased risk of overdose.
As with all sleeping pills, it is important to consult a healthcare professional before taking Sonata to discuss the benefits and risks and determine if it is the right choice for your specific symptoms and medical history.
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Orexin receptor antagonists (ORAs)
Sleeping pills are used to treat insomnia by making individuals feel drowsy and relaxed. While they can be effective, they are not a cure for insomnia and are not recommended for long-term use due to the risk of dependence and addiction. Prescription sleeping pills, such as barbiturates, benzodiazepines, and Z-drugs, are stronger than over-the-counter options and require a healthcare provider's prescription.
ORAs have the potential to revolutionize the treatment of insomnia as they not only improve sleep but also appear to have no dependence- or tolerance-inducing effects. This makes them suitable for long-term treatment, which sets them apart from traditional sleep-promoting drugs. Additionally, ORAs do not require dose adjustments in patients with reduced renal function, as their pharmacokinetic profiles remain relatively unaffected.
Some examples of ORAs include suvorexant (Belsomra), lemborexant (Dayvigo), and daridorexant (nemorexant; Quviviq). These drugs have been approved for treating insomnia and are continually being studied for their potential benefits in treating other disorders. However, ORAs are not currently the first-line treatment for insomnia due to their cost and concerns about possible misuse. Side effects of ORAs may include somnolence, daytime sleepiness, sedation, headache, abnormal dreams, fatigue, and dry mouth.
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Ramelteon (Rozerem)
Ramelteon, also known by the brand name Rozerem, is a melatonin-based sleeping pill that helps people with insomnia fall asleep faster and stay asleep through the night. Unlike other prescription sleep medications, Ramelteon is not a controlled substance and is not known to be habit-forming. It is available only with a doctor's prescription and should be taken no more than 30 minutes before bedtime on an empty stomach.
While Ramelteon is not habit-forming, it does have some common side effects, including drowsiness and dizziness, which can persist into the next day. It is recommended that individuals taking Ramelteon do not drive or engage in other activities requiring alertness or coordination until they know how the medication affects them and they feel fully awake. Less common but more serious side effects include changes in mood, thoughts, or behaviour, such as depression and suicidal thoughts or actions, as well as hallucinations and complex sleep behaviours like sleepwalking, sleep driving, and preparing and eating food while not fully awake. These rare side effects can be dangerous, and individuals experiencing them should stop taking Ramelteon and contact their healthcare provider immediately.
Ramelteon may also cause severe allergic reactions in some individuals, and it can affect certain hormone levels in the body, though the implications of this are not yet understood. It is important for patients to discuss any other medications they are taking with their healthcare provider before starting Ramelteon, as it may interact with other substances. Additionally, Ramelteon should not be taken with alcohol, as this can increase the risk of side effects.
In terms of dosage, the maximum recommended dose of Ramelteon is 8 mg once daily. Higher doses, such as 16 mg, do not improve sleep but do increase the likelihood of side effects like fatigue, headaches, and tiredness. Ramelteon should be stored at room temperature between 68 F and 77 F (20 C and 25 C).
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Frequently asked questions
Non-habit-forming sleeping pills include Doxepin, Ramelteon, Trazodone, and Unisom. Doxepin is a prescription medication, while Ramelteon is a melatonin receptor agonist that is also available by prescription. Trazodone is an antidepressant that is often prescribed at low doses to help with sleep. Unisom is an over-the-counter (OTC) medicinal sleep-aid that uses antihistamines to create a drowsy effect and is considered non-habit-forming.
Doxepin is not habit-forming, but it can cause dry mouth, constipation, and dizziness. It can also increase heart rate and blood pressure, and raise the risk of falls, especially in older adults.
Ramelteon's side effects are generally mild, and it is not habit-forming. Common side effects include dizziness, nausea, and next-day drowsiness. However, in rare cases, it has been linked to worsening depression and thoughts of suicide.
Yes, melatonin is a natural sleep aid that can be purchased over the counter. It is the synthetic form of the natural hormone produced by the body to promote sleep. Some studies have found that an extended-release melatonin product may aid in maintaining sleep.
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