Evie Summers
Sleeping pills, also known as hypnotics, are medications that help people fall asleep and stay asleep. They are of two main types: benzodiazepines and non-benzodiazepines. Benzodiazepines are sedatives that slow down the functioning of the body and brain, making it easier to fall asleep and reducing the likelihood of waking up in the middle of the night. Non-benzodiazepines, also known as Z-drugs, are newer drugs that act in a similar way to benzodiazepines but are generally shorter-acting and less likely to cause a hangover effect the next day. Sleeping pills vary in terms of how quickly they work, how long their effects last, and the side effects they may cause. While some sleeping pills are available over the counter, the strongest sleeping pills are generally available only by prescription.
| Characteristics | Values |
|---|---|
| Strongest sleeping pills | Benzodiazepines and nonbenzodiazepines |
| Sleeping pills availability | Prescription and over-the-counter |
| Prescription sleeping pills | Lunesta, Ambien, Sonata, Doxepin (Silenor), Ramelteon (Rozerem), Suvorexant (Belsomra), Estazolam (Prosom), Lemborexant, Daridorexant, Zolpidem, Zaleplon, Zopiclone, Quetiapine (Seroquel), Olanzapine (Zyprexa), Risperidone (Risperdal) |
| Over-the-counter sleeping pills | Melatonin, Diphenhydramine, Antihistamines |
| Side effects | Dizziness, drowsiness, light-headedness, confusion, muscle weakness, memory problems, dependence, withdrawal, hangover effect, allergic reactions, edema, increased thoughts of suicide, complex sleep behaviours, impaired CNS |
| Precautions | Not recommended for pregnant or breastfeeding women, not for more than 3 weeks, not safe to stop taking suddenly, consult a doctor before starting any sleep aid |
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What You'll Learn
Sleeping pill prescription requirements
Sleeping pills are generally classified as either prescription or over-the-counter medications. While prescription sleeping pills are stronger, they also carry more risks and side effects. It is important to consult a healthcare provider before taking any sleeping pills, as they can advise on the most suitable treatment plan for your specific circumstances.
Prescription sleeping pills are available only with a prescription from a healthcare provider. These pills are stronger than over-the-counter options and are typically recommended for short-term relief. They are not a cure for insomnia and carry a risk of dependence and addiction, hence the need for a prescription and medical supervision. Examples of prescription sleeping pills include:
- Benzodiazepines: These include drugs such as Zolpidem (Ambien), Eszopiclone (Lunesta), and Zaleplon (Sonata). Benzodiazepines work by stimulating the chemical GABA in the brain, leading to sedation, muscle relaxation, and reduced anxiety. They are classified as Schedule IV controlled substances due to their potential for abuse and addiction.
- Z-drugs: This class of drugs includes Zolpidem, Eszopiclone, and Zaleplon, which are non-benzodiazepine medications. They work by slowing down brain activity and are often prescribed instead of benzodiazepines due to their shorter duration of action.
- Doxepin (Silenor): This is a tricyclic antidepressant that is FDA-approved for treating insomnia characterised by difficulty staying asleep. It is a prescription-only medication but is not a controlled substance.
- Suvorexant (Belsomra) and Daridorexant (Quviviq): These are newer medications that have been classified as Schedule IV controlled substances. They work by blocking orexin receptors in the brain, which are associated with wakefulness.
- Antipsychotics: While no antipsychotic is FDA-approved for treating insomnia, some medications like Quetiapine (Seroquel), Olanzapine (Zyprexa), and Risperidone (Risperdal) may be prescribed off-label for insomnia in patients already being treated for psychiatric disorders due to their sedating effects.
Over-the-counter sleeping pills do not require a prescription and are typically available at pharmacies. While they are generally weaker than prescription pills, they can still cause side effects and should be used with caution. Common over-the-counter options include:
- Antihistamines: Diphenhydramine (found in ZzzQuil) and Doxylamine (Unisom) are common antihistamines used for sleep. They work by blocking histamines, which cause alertness. However, they may cause side effects like dry mouth and urinary retention.
- Melatonin: This is a natural hormone that regulates sleep and can be taken as a supplement to promote sleep. It is often recommended for older adults or those needing rapid sleep onset, as it has fewer side effects compared to other sleeping pills.
In conclusion, sleeping pill prescription requirements vary depending on the type of pill. While some pills are available over the counter, prescription pills require a healthcare provider's supervision due to their stronger effects and potential for addiction and side effects. It is important to consult a medical professional to determine the most suitable treatment plan, which may include lifestyle changes, psychological treatments, sleep supplements, or a combination of these approaches.
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Natural sleep aids
Sleeping pills are generally available only on prescription, but there are several natural sleep aids available over the counter. Natural sleep aids are dietary supplements that are usually plant-based, a vitamin or mineral, or supplemental amounts of something produced by the body. They tend to have fewer side effects than prescription sleep medications. However, it is important to consult your doctor before starting any new supplement as they are not regulated as strictly as medications.
- Melatonin: Melatonin is a hormone that is naturally released in the brain when it is time to sleep. It is triggered by the body's response to reduced light exposure. However, exposure to unnatural light from phones, laptops, or TVs can prevent its release, making it hard to fall asleep. Melatonin supplements are available over the counter and have become a popular sleep aid. They have been found to reduce the time people need to fall asleep and improve overall sleep quality. However, melatonin can reduce the effectiveness of some medications and cause unwanted side effects when combined with others.
- Magnesium: This mineral has been known to help promote sleep.
- Lavender: This plant can help you relax and fall asleep.
- Valerian Root: This natural remedy may help you sleep better.
- CBD: Some studies have found that CBD can relieve anxiety and act as a natural sleep aid. It has been found to enhance sleep quality and reduce anxiety within the first month for nearly 67% of participants in a study. However, more research is needed before it can be routinely recommended for sleep disorders. It is also not recommended for people who are pregnant or nursing.
- Warm milk: Warm milk has long been associated with chemicals that simulate the effects of tryptophan on the brain, promoting sleep.
- Chamomile tea and tart cherry juice: These drinks may help with sleep, although there is little scientific proof.
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Benzodiazepines vs. non-benzodiazepines
Sleeping pills, also known as hypnotics, can be broadly categorized into two types: benzodiazepines and nonbenzodiazepines. Benzodiazepines are a group of drugs that have a sedative effect on the body. They slow down the functioning of the body and brain, making it easier to fall asleep and reducing the likelihood of waking up in the middle of the night. They work by increasing the effects of gamma aminobutyric acid (GABA) in the brain and body. GABA is responsible for lessening activity in the parts of the brain that control emotions, memory, reasoning, and essential functions like breathing.
Nonbenzodiazepines, on the other hand, are drugs that activate the same receptors as benzodiazepines and cause the release of GABA, making them effective in treating insomnia and related sleep disorders. Examples of nonbenzodiazepines include eszopiclone (Lunesta), zolpidem (Ambien), and zaleplon (Sonata). These nonbenzodiazepine medications, often referred to as "Z-drugs," are similar in terms of side effects and how they work. The choice between these medications often depends on individual symptoms, medical history, and affordability.
Benzodiazepines are typically classified as short-acting or long-acting. Short-acting benzodiazepines are commonly used as sleeping pills, while long-acting benzodiazepines are used for treating anxiety. However, this distinction is not absolute, as lower doses of sleeping pills may help with anxiety during the day, and some anxiety medications may aid in sleep when taken at night. Benzodiazepines differ in their potency levels, with some causing stronger chemical reactions in the body than others. For example, 15-30 milligrams of flurazepam is generally equivalent to 0.25-0.5 milligrams of clonazepam.
While benzodiazepines can be effective in treating sleep disorders, they come with certain risks and side effects. Common side effects include dizziness, light-headedness, confusion, muscle weakness, and memory problems. They are generally recommended for short-term use due to their potential for abuse, addiction, and dependence. Additionally, studies have suggested a link between benzodiazepine use and an increased risk of cancer, as well as a higher likelihood of death within a 2.5-year period compared to non-users.
In summary, the choice between benzodiazepines and nonbenzodiazepines as sleeping pills depends on various factors, including individual symptoms, medical history, and the potential risks and side effects associated with each type of medication. It is always advisable to seek medical advice and consult a healthcare provider before starting any sleep medication.
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Sleeping pill side effects
Sleeping pills can cause a range of side effects, and it is recommended that you do not use them long-term. Over-the-counter sleep aids should not be taken for more than two weeks without consulting a healthcare provider. This is because insomnia can be a sign of an underlying medical condition that may require alternative treatment.
Sleeping pills can cause constipation, diarrhoea, muscle weakness, digestive problems, and worsen snoring and sleep apnea. They can also cause a hangover effect, with around 8 out of 10 people feeling drowsy, dizzy, and confused the next day. This can negatively impact your ability to drive, work, or study.
Sleeping pills can also cause parasomnia, a disruptive sleep disorder where people may sleepwalk, eat, take medication, talk, or even drive while unaware of their actions. This can be dangerous.
Prescription sleeping pills like zolpidem and eszopiclone have a risk of next-day impairment and complex sleep behaviours. Newer medications like daridorexant have been associated with headaches. Antihistamines, which are also used to treat insomnia, can cause dry mouth, dizziness, and constipation.
It is important to seek medical advice before taking sleeping pills, as your healthcare provider will be able to establish the reasons behind your insomnia and create a treatment plan that may include lifestyle changes, psychological treatments, sleep supplements, and sleeping pills.
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Sleeping pill alternatives
Sleeping pills are generally available only on prescription, but there are a number of over-the-counter and natural alternatives. Sleeping pills are most effective when taken occasionally or over a few weeks, as part of a broader plan to treat the underlying causes of insomnia.
Some common prescription sleeping pills for insomnia include Lunesta, Ambien, and Sonata. These are non-benzodiazepine medications that have sedative effects. Benzodiazepines are generally recommended for short-term use only and are not suitable for those with sleep apnea. Antipsychotics are not recommended by the American Academy of Sleep Medicine for sleep problems but may be prescribed off-label for those already being treated for psychiatric disorders.
Over-the-counter alternatives can help with jet lag or shift work but should be used with caution. Diphenhydramine, for example, acts within an hour and lasts 4-6 hours but may cause dry mouth and urinary retention. Melatonin is another over-the-counter option that helps promote sleep by raising melatonin levels. It is useful for occasional insomnia and jet lag and comes in short-acting and long-acting forms.
Natural alternatives to sleeping pills include establishing good sleep habits and making lifestyle changes. Cognitive behavioural therapy can also help treat insomnia by addressing the underlying causes.
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Frequently asked questions
Sleeping pills (also known as "hypnotics") fall into two broad categories: benzodiazepines and nonbenzodiazepines. The strongest sleeping pills are generally available only on prescription, but there are a few over-the-counter options available as well.
Some examples of prescription sleeping pills include zolpidem, zopiclone, temazepam, suvorexant, lemborexant, Lunesta, Ambien, Sonata, estazolam (Prosom), and doxepin (Silenor).
Some over-the-counter options include antihistamines like diphenhydramine, which can help with jet lag or shift work, but should be used with caution.
