Colin Snow
Sleep is an essential part of a person's overall health, and for those who have trouble achieving it, sleep aids can be a solution. Sleeping pills are available over the counter or by prescription, and they work in different ways. While sleeping pills can help people fall asleep and stay asleep, they also carry risks of side effects, misuse, and dependency. This text will explore the most effective sleeping pills and discuss their benefits and drawbacks.
| Characteristics | Values |
|---|---|
| Prescription sleep aids | Doxepin (Silenor), Triazolam (Halcion), Ramelteon (Rozerem), Suvorexant (Belsomra), Trazodone (Desyrel), Estazolam (Prosom), Zolpidem, Eszopiclone, Daridorexant, Lemborexant |
| Over-the-counter sleep aids | Antihistamines (e.g., diphenhydramine (ZzzQuil), doxylamine (Unisom)), melatonin, L-tryptophan, valerian, Benadryl Allergy, Advil PM, Tylenol PM |
| Side effects | Dependence, rebound insomnia, parasomnia, next-day impairment, complex sleep behaviours, CNS impairments, allergic reactions, edema, increased thoughts of suicide, headache, dizziness, nausea, dry mouth, constipation, muscle weakness |
| Precautions | Consult a doctor before starting any new sleep medication, especially if you have liver problems, are an older adult, or are mixing with other sedatives or alcohol |
| Alternatives | Cognitive-behavioural therapy, improving sleep hygiene (e.g., avoiding large meals, caffeine, and alcohol before bed; maintaining a cool bedroom temperature; limiting screen time before bed) |
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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. They can be obtained either over the counter or with a prescription. The choice of a sleeping pill should be tailored to individual circumstances, and a healthcare provider should always be consulted before starting any sleep aid.
Prescription Sleeping Pills
Prescription sleeping pills are generally stronger than over-the-counter options. They include benzodiazepine sedative hypnotics like Ativan (lorazepam) and Restoril (temazepam), non-benzodiazepine hypnotic sedatives like Ambien (zolpidem) and Lunesta (eszopiclone), and melatonin receptor agonists such as Rozerem (ramelteon). Prescription sleeping pills can often provide short-term relief for insomnia, but they carry risks of side effects, misuse, and dependency. For example, Restoril may cause various side effects, and it has the potential for dependency and misuse, so doctors do not recommend it for long-term treatment. Similarly, benzodiazepines can be addictive and lead to substance use disorders, so healthcare providers typically prescribe them for less than four weeks. Additionally, approximately 8 out of 10 people experience a hangover effect the day after taking prescription sleep medicine, feeling drowsy and dizzy.
Over-the-Counter Sleeping Pills
Over-the-counter (OTC) sleeping pills include antihistamines such as diphenhydramine (Benadryl or ZzzQuil) and doxylamine (Unisom or Unisom SleepTabs), melatonin supplements, L-tryptophan, and valerian. While these options are more readily accessible, the American Academy of Sleep Medicine does not recommend OTC sleep aids for treating sleep onset or sleep maintenance insomnia due to insufficient evidence of their safety and effectiveness. Most OTC sleeping pills are not recommended for more than two weeks without consulting a healthcare provider, as insomnia could be a sign of an underlying medical condition. Additionally, OTC sleep aids can also cause side effects such as dry mouth, dizziness, and constipation.
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Side effects and risks
Sleeping pills can have side effects and risks, so they are typically not recommended for long-term use. Healthcare providers usually prescribe them for short-term relief only. The potential side effects and risks vary depending on the type of sleeping pill.
Antihistamines
Commonly found in over-the-counter (OTC) sleeping pills, antihistamines work by blocking histamines, which are substances in the body that cause alertness. Side effects of antihistamines include dry mouth, dizziness, and constipation. Older adults, children under 16, and pregnant women should avoid taking diphenhydramine, as the risks may outweigh the benefits.
Melatonin
Melatonin is a synthetic hormone that mimics the natural hormone in the brain that stimulates sleep. It is often prescribed to those who have trouble falling asleep, work late or in shifts, and seniors. Melatonin has a lower risk of rebound insomnia and withdrawal symptoms. However, it can cause side effects such as headaches, dizziness, and nausea.
Z-drugs
Z-drugs, including zolpidem (Ambien) and eszopiclone (Lunesta), are fast-acting and can induce sleepiness, calm anxiety, and promote sound sleep. However, they have a risk of next-day impairment and complex sleep behaviours, such as sleepwalking or eating while still mostly asleep. Z-drugs also carry a risk of misuse, dependency, and addiction.
Benzodiazepines
Benzodiazepines are prescription sleeping pills that can lead to substance use disorders and addiction. They can cause side effects such as memory issues, balance problems, and an increased risk of falls and hip fractures. Benzodiazepines are typically only prescribed for short-term use to lower the risk of dependence.
Other Risks
Sleeping pills may interact with other medications, substances, or supplements, leading to serious side effects or loss of effectiveness. Mixing sleep aids with other sedatives or alcohol can increase the risk of serious side effects, such as breathing problems, and even overdose. Additionally, long-term use of sleeping pills can affect brain function, change the structure of sleep, and lead to dependency, drug tolerance, and other side effects, including poor memory, brain degeneration, and respiratory depression during sleep, which may be life-threatening.
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Drug interactions
Sleeping pills can be habit-forming and may have adverse side effects, so they should not be used as a long-term solution. It is important to consult a healthcare professional before taking any sleep medication, especially if you are already taking other medications or supplements. Mixing sleep aids with other sedatives, alcohol, or certain other medications can be dangerous and lead to serious side effects, including overdose.
Some prescription sleep medications, such as eszopiclone (Lunesta), zolpidem (Ambien), and zaleplon (Sonata), are classified as Schedule IV controlled substances due to their potential for misuse and dependency. These medications interact with GABA receptors in the brain, enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that promotes sleep and reduces anxiety. Benzodiazepines, another class of prescription sleep aids, also work by stimulating GABA. However, they carry a higher risk of addiction and are typically prescribed for short-term use.
Over-the-counter (OTC) sleep aids, on the other hand, typically contain antihistamines, which promote sleep by blocking histamines that cause alertness. Common antihistamines found in OTC sleep aids include diphenhydramine and doxylamine. While these may be effective for occasional use, they can also cause side effects such as daytime drowsiness and cognitive impairment.
Additionally, certain dietary supplements, such as melatonin, can interact with other medications by increasing or decreasing their potency. Melatonin is a hormone that naturally promotes sleep. However, when combined with other sedating medications or herbal remedies, it can increase drowsiness. It is important to inform your doctor or pharmacist if you are taking any other medications or supplements before starting melatonin or any other sleep aid.
For individuals with chronic insomnia, newer medications like daridorexant or lemborexant may offer sustained benefits with a potentially lower risk of dependence compared to older drugs. Doxepin (Silenor) is another prescription medication used to treat insomnia, but it is not recommended for those taking monoamine oxidase inhibitors or certain types of antidepressants.
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Dosage and duration
Prescription Sleeping Pills
Prescription sleeping pills can be highly effective in treating insomnia and typically provide short-term relief. Doctors may prescribe triazolam (Halcion) for insomnia, usually for 7 to 10 days. The dosage for triazolam is either 0.25 mg or 0.5 mg, and it should not be exceeded beyond 0.5 mg daily. Doxepin (Silenor), another prescription option, is available in 3 and 6 mg doses, and doctors may recommend its use for up to 3 months. Other prescription sleep aids, such as estazolam (Prosom), are also available for short-term treatment.
Over-the-Counter (OTC) Sleep Aids
OTC sleep aids are generally considered safe for occasional use but should not be relied upon for extended periods without consulting a healthcare provider. Most OTC sleeping pills contain antihistamines like diphenhydramine (ZzzQuil) and doxylamine (Unisom). Melatonin is another popular OTC option that promotes sleep by influencing your natural sleep and wake cycles. While these options are more readily available, it is still important to use them with caution and follow the recommended dosages.
Natural Sleep Aids
Natural sleep aids, such as supplements and vitamins, may also help with sleep. Valerian, for example, has a calming effect on the nervous system. However, it is important to consult a healthcare practitioner before taking any supplements to understand their potential side effects and to ensure you are obtaining them from a reputable manufacturer.
Chronic Insomnia
For individuals with long-term sleep difficulties, newer medications like daridorexant or lemborexant may offer sustained benefits with a potentially lower risk of dependence compared to older drugs. These medications are designed for chronic insomnia and may provide an alternative to traditional sleeping pills.
Remember, the dosage and duration of any sleeping pill or aid should be carefully discussed with your healthcare provider. They will consider your individual circumstances, including age, health conditions, and potential side effects, to determine the safest and most effective course of treatment.
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Natural alternatives
While prescription medications such as doxepin (Silenor) and triazolam (Halcion) are often used to treat insomnia, they may not be suitable for long-term use due to the risk of side effects, misuse, and dependency. As a result, many people are turning to natural alternatives to help them sleep.
Herbal and natural supplements have gained popularity as treatments for insomnia and sleep disorders due to their perceived safety and effectiveness. Valerian, hops, chamomile, passionflower, and lavender are all plants with sedative effects that can help promote rest and sleep. For example, a 2016 study found that chamomile tea improved sleep in postpartum mothers, and a 2014 study showed that non-alcoholic beer with hops improved sleep quality in university students. Additionally, lavender was found to improve sleep quality in postpartum mothers in a 2015 study, and red ginseng extract was found to be helpful for people struggling to fall asleep in a 2013 study.
Some natural supplements function by modulating neurotransmitters like GABA and serotonin, promoting relaxation, and regulating sleep-wake cycles. Melatonin is a naturally occurring substance in the body that governs our circadian rhythms, and melatonin supplements can help people fall asleep and improve sleep quality. However, melatonin supplements have been associated with side effects like headaches, dizziness, and nausea.
It is important to note that while herbal and natural supplements are generally considered safe, they are not without risks. For example, kava has been linked to rare but serious adverse effects, including liver toxicity. The quality and purity of these supplements can also vary, and they may interact with other medications, so it is important to consult a healthcare provider before taking any new supplement.
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Frequently asked questions
There are many different types of sleeping pills available, both over-the-counter and prescription. Prescription sleeping pills are generally stronger than over-the-counter pills. Some common prescription medications include doxepin (Silenor), trazodone (Desyrel), and estazolam (Prosom). It is important to consult a doctor before taking any sleep medication to ensure safe use and avoid potential side effects.
Common over-the-counter sleep aids include antihistamines such as diphenhydramine (ZzzQuil) and doxylamine (Unisom), melatonin, L-tryptophan, and valerian. While these may help with occasional sleeplessness, they are not recommended for long-term use without consulting a healthcare provider.
Sleeping pills can have various side effects, including constipation, dizziness, and headaches. They may also carry risks of misuse, dependency, and interaction with other substances. It is important to discuss potential side effects with a healthcare provider before taking any sleep medication.
Yes, there are several alternatives to sleeping pills that can improve sleep. Cognitive-behavioral therapy (CBT) is an effective tool for treating insomnia and improving sleep habits. Other behavioral changes, such as avoiding screens before bedtime, reducing caffeine intake, and establishing a consistent sleep schedule, can also help promote better sleep without the need for medication.
