Colin Snow
Sleep disturbances are common, with 50 to 70 million people in the United States experiencing chronic sleep or wakefulness conditions. Sleeping pills are one way to combat this, but they can have side effects and cause dependency, so they are not recommended for long-term use. Over-the-counter and prescription sleeping pills are available, but you should always consult a doctor before taking any medication. This article will explore the different types of sleeping pills available and how they work to help you decide if they are the right choice for you.
| Characteristics | Values |
|---|---|
| How they work | Sleeping pills work differently depending on their type. Some cause drowsiness, while others silence the area of the brain that keeps you alert. |
| Side effects | Sleeping pills can cause constipation, muscle weakness, digestive problems, worsened snoring and sleep apnea, and a hangover effect. They can also lead to dependency and worsen insomnia if used long-term. |
| Risks | Sleeping pills can cause daytime drowsiness and impaired thinking, which can negatively impact daily activities such as driving and working. They may also interact with other substances and medications. |
| Types | Over-the-counter (OTC) sleeping pills often contain antihistamines, which block histamines that cause alertness. Prescription sleeping pills include benzodiazepines, which stimulate the GABA chemical in the brain, leading to sedation and muscle relaxation. |
| Ingredients | Common ingredients in antihistamines include diphenhydramine and doxylamine. Doxepin (brand name Silenor) is another prescription sleep aid. |
| Natural alternatives | Melatonin is a hormone that promotes sleep by influencing sleep and wake cycles. Valerian has a calming effect on the nervous system. |
| Prescription guidelines | Doctors typically prescribe sleeping pills for short-term insomnia relief. They will often start with the lowest possible dose and adjust as needed. |
| Research findings | Studies have found that sleeping pill use is associated with excess mortality, but the specific medications contributing to this risk are unclear. Sleeping pills are often prescribed to patients who do not complain of insomnia or short sleep. |
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What You'll Learn
Prescription sleep aids
Sleeping pills can have side effects and are not recommended for long-term use. Non-drug treatments and behavioural changes are often the first port of call for treating insomnia, but prescription sleep aids can be effective for short-term relief.
Prescription sleep medications work in different ways. Benzodiazepines, for example, stimulate the chemical GABA in the brain, which leads to sedation, muscle relaxation, and reduced anxiety. Z-drugs, such as zolpidem, work by slowing brain activity and are also associated with a risk of dependency. Doctors will usually start with the lowest possible dose and increase it if necessary. Zolpidem can cause drowsiness and a lack of alertness the morning after taking it, so activities that require focus and alertness, such as driving, should be avoided.
Other prescription sleep aids include doxepin, sold under the brand name Silenor, which doctors may suggest for use for up to three months. Estazolam (Prosom) is another short-term treatment for insomnia, available in 1 mg or 2 mg tablets. Ramelteon (Rozerem) is a melatonin antagonist that promotes sleep and positively affects circadian rhythms. It is prescribed for longer-term use and has a low likelihood of misuse or dependency.
It is important to consult a doctor before starting any new sleep medication, as they can interact with other substances and medications.
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Over-the-counter sleep aids
Over-the-counter (OTC) sleep aids can help with occasional insomnia, but they are not a long-term solution. It is recommended that you first try nondrug treatments and lifestyle adjustments, such as limiting caffeine, creating a comfortable sleep environment, and sticking to a bedtime routine.
Most OTC sleeping pills contain antihistamines, which work by blocking histamines, the substances in your body that cause alertness. Common ingredients in antihistamines include diphenhydramine (also known as Benadryl) and doxylamine. Diphenhydramine is also used to treat allergy symptoms, such as sneezing or itching, and both substances can cause drowsiness. Side effects may include dry mouth, blurred vision, and fatigue, and these can be severe if you're over 65 years old. Doxylamine is available OTC as a tablet, capsule, oral liquid, and chewable tablet, and is sold under the brand Unisom SleepTabs.
"Natural" OTC sleep aids may contain melatonin or cannabidiol (CBD). Melatonin is a hormone that your body produces naturally to regulate your sleep and wake cycles. OTC melatonin is a synthetic version, which may be helpful for people experiencing jet lag or difficulty falling asleep at a normal time. CBD can cause side effects such as fatigue, diarrhoea, and low appetite.
It is important to exercise caution when taking OTC sleep aids, as they can cause side effects and interact with other medications. You should consult your healthcare provider and pharmacist before taking any new medication, and avoid mixing sleep aids with alcohol or prescription drugs.
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Natural sleep aids
There are many natural sleep aids available that can help you fall asleep faster and improve your sleep quality. Melatonin, a hormone that is naturally released in the brain when it's time to sleep, is one of the most popular natural sleep aids. It is available as an over-the-counter supplement and has been found to be effective in improving sleep in older adults and individuals with sleep disorders. However, melatonin may not be suitable for everyone and can interfere with certain medications.
Another natural sleep aid that has gained interest is cannabidiol (CBD), which is often derived from the cannabis plant. CBD has been found to relieve anxiety and improve sleep quality in individuals with anxiety. However, it is important to note that CBD is still classified as a controlled substance in some states, and more research is needed to establish its long-term safety.
Other natural sleep aids include valerian root, which has a calming effect on the nervous system, and magnesium. Some natural remedies for improving sleep involve lifestyle changes, such as avoiding screen time before bed due to the interfering light, maintaining a cool bedroom temperature, and avoiding working out within two hours of bedtime to prevent raising your core body temperature. Warm milk, chamomile tea, and tart cherry juice are also recommended by some as natural sleep aids, although there is limited scientific proof of their effectiveness.
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Side effects
Sleeping pills can have a range of side effects, and it is advised that they are not used long-term. Approximately 8 out of 10 people experience a "'hangover'" effect the day after taking sleep medicine, feeling drowsy and confused, with dizziness and balance problems. This can negatively impact your ability to drive, work, or go to school.
Sleeping pills can also cause muscle weakness, digestive problems, including constipation, diarrhoea, gas, heartburn, and nausea. They may worsen snoring and sleep apnea. Long-term use of sleeping pills can lead to dependency, with rebound insomnia a common side effect when trying to stop taking them. It is advised that you speak to a healthcare professional about safely stopping the medication, as it may take months to stop taking them.
Sleeping pills can cause parasomnia, a disruptive sleep disorder where people may sleepwalk, eat, talk, or even drive while unaware of their actions. This can be dangerous and is difficult to detect. Other side effects include a burning or tingling sensation in the hands, arms, feet, or legs.
The long-term use of sleeping pills can affect brain function, with potential negative consequences such as poor memory, brain degeneration, and an increased risk of Alzheimer's disease. They may also lead to depression and a risk of accidental falls. Respiratory depression during sleep is a severe potential side effect and can lead to death.
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Dependency
Sleeping pills can be effective in the short term, but they do carry a risk of dependency and addiction. The risk is that the brain becomes reliant on the pills to fall asleep, and over time, a tolerance can develop, requiring higher doses to achieve the same effect. This can lead to a cycle of dependency, where the body becomes psychologically and physically dependent on the medication.
The risk of dependency and addiction is why sleeping pills are typically only recommended for short-term relief. They are not a cure for insomnia, and long-term use can lead to the brain adapting to the changes the pills induce, resulting in withdrawal symptoms when trying to stop. This can cause a vicious cycle, where the individual starts using the pills again to relieve the withdrawal symptoms.
The development of dependency and addiction can vary between individuals. Some people may develop a dependency after just a few uses, while others may take sleeping pills long-term without becoming addicted. However, anyone can develop an addiction to sleeping pills, regardless of gender, age, race, or socioeconomic status. Certain factors, such as a genetic predisposition, can increase the risk for some individuals.
Withdrawal symptoms from sleeping pills can be unpleasant and may include rebound insomnia, anxiety, shivering, dizziness, and irritability. The process of withdrawing from sleeping pills can be physically and mentally challenging, and it is recommended to gradually reduce the dose over several weeks or months with medical guidance to minimise withdrawal symptoms.
Treatment for sleeping pill dependency and addiction typically involves a combination of medical care and therapy. Cognitive-behavioural therapy (CBT) is a common approach, helping individuals address underlying issues and develop healthier coping mechanisms. Inpatient care is also an option, typically lasting between 30 to 90 days, depending on the individual's needs.
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Frequently asked questions
Most over-the-counter (OTC) sleeping pills contain antihistamines, which work by blocking histamines, the substances in your body that cause alertness. Common ingredients in antihistamines include diphenhydramine and doxylamine.
Melatonin is a hormone that promotes sleep by influencing when you fall asleep and wake up. Valerian has a natural calming effect on your nervous system and helps to promote a better night's sleep.
Doctors can prescribe estazolam (Prosom) for the short-term treatment of insomnia. They may also prescribe zolpidem-containing drugs, which can cause drowsiness and lack of alertness in the morning. Ramelteon (Rozerem) is a melatonin antagonist that may help a person fall asleep and is prescribed for longer-term use.
Sleeping pills can cause a range of side effects, including constipation, muscle weakness, digestive problems, and worsened snoring and sleep apnea. Approximately 8 out of 10 people experience a hangover effect the day after taking sleep medicine, feeling drowsy and dizzy. Sleeping pills can also cause dependency, and your body may start to depend on them if taken night after night.
Often, nondrug treatments and behavioural changes are all you need for improved sleep. A healthcare provider can help you figure out what's causing your insomnia and suggest the best plan to help you rest easier.
