Colin Snow
Sleeping pills are available over the counter, as natural supplements, or by prescription. Prescription sleeping pills are generally stronger than over-the-counter pills, but they also carry a higher risk of dependency and addiction. Sleeping pills work in different ways, with some causing drowsiness, and others silencing the area of the brain that keeps you alert. Z-drugs, such as zolpidem (Ambien) and eszopiclone (Lunesta), are commonly prescribed for insomnia, but they have a risk of misuse and dependency. Benzodiazepines are another class of drugs used to treat insomnia, but they are also habit-forming and carry a risk of abuse and addiction. Melatonin is a natural alternative that promotes sleep and positively affects circadian rhythms. It is important to consult a healthcare provider before taking any sleep medication to ensure it is safe and appropriate for your individual needs and circumstances.
| Characteristics | Values |
|---|---|
| Drug Name | Estazolam (Prosom), Eszopiclone (Lunesta), Zaleplon (Sonata), Zolpidem (Ambien), Doxepin (Silenor), Ramelteon (Rozerem), Suvorexant (Belsomra), Daridorexant, Lemborexant, Quetiapine (Seroquel), Olanzapine (Zyprexa), Risperidone (Risperdal), Triazolam (Halcion), Clonazepam (Klonopin), Zolpidem ER (Ambien CR), Zopiclone, Temazepam, Diphenhydramine, Melatonin, Valerian |
| Drug Type | Z-drug, Antidepressant, Benzodiazepine, Antipsychotic, Natural Supplement |
| Availability | Prescription, Over-the-Counter (OTC), Natural Supplement |
| Treatment Duration | Short-term, Long-term |
| Dosage | 1 mg, 2 mg, 3 mg, 6 mg, 8 mg, 10 mg, 12.5 mg |
| Side Effects | Misuse, Dependency, Dizziness, Drowsiness, Grogginess, Headache, Nausea, Allergic Reactions, Memory Loss, Hallucinations, Mood Changes, CNS Depression |
| Precautions | Not recommended for pregnant or nursing women, Elderly patients may require lower doses, May interfere with other medications |
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What You'll Learn
Zolpidem (Ambien)
Zolpidem, also sold under the brand name Ambien, is a medication used for the short-term treatment of insomnia. It helps people fall asleep and stay asleep throughout the night. Zolpidem is a nonbenzodiazepine, or Z-drug, which acts as a sedative and hypnotic agent by modulating the GABAA receptor. It is typically taken by mouth as conventional tablets, extended-release tablets, or sublingual tablets. The recommended dosage is 5 mg or 10 mg, and it usually acts within 15–30 minutes and lasts 6–8 hours.
Zolpidem has been associated with several side effects, including daytime sleepiness, headache, nausea, and diarrhea. More severe side effects include memory problems, hallucinations, and complex sleep behaviours (CSBs). CSBs refer to activities performed while not fully conscious, such as sleepwalking, sleep-driving, and other activities like eating, talking on the phone, or sexual activity. These behaviours can result in serious injuries, and individuals may have no memory of these incidents the next morning. Zolpidem may also impair thinking and reactions, with individuals feeling sleepy the morning after taking the medication. Therefore, it is recommended to wait until fully awake before engaging in activities that require mental alertness, such as driving or operating machinery.
The risk of CSBs is higher when Zolpidem is combined with alcohol or other sleep medications. It is advised not to take Zolpidem if alcohol has been consumed during the day or before bed. Additionally, Zolpidem may be habit-forming, and misuse can lead to addiction, overdose, or even death. It is important to follow the prescribed dosage and not exceed the recommended amount. Zolpidem should be used with caution, especially in older adults, as they are more sensitive to the effects of hypnotics and are at an increased risk of falls and adverse events.
Zolpidem is generally recommended as a second-line treatment for insomnia after non-pharmacological approaches, such as cognitive behavioural therapy, have been explored. It is important to consult a healthcare professional before taking Zolpidem to ensure it is suitable for your specific circumstances.
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Eszopiclone (Lunesta)
Eszopiclone, also known by its brand name Lunesta, is a sedative or hypnotic drug used to treat insomnia. It is a central nervous system (CNS) depressant, which slows down the nervous system, helping users fall asleep faster and stay asleep throughout the night. It is available in tablet form, in doses of 1 mg, 2 mg, and 3 mg, and is taken orally.
Eszopiclone is a prescription medication, and its use should be directed by a doctor. It is typically recommended for short-term use, such as 1-2 days, and for no longer than 1-2 weeks. It is a federally controlled substance, as it carries a risk of misuse, abuse, and dependence. Side effects may include next-day drowsiness, dizziness, memory loss, worsening of depression, and suicidal thoughts or actions. In rare cases, abnormal thoughts and behaviours, as well as severe allergic reactions, have been reported. Due to these potential side effects, it is important to discuss the use of eszopiclone with a healthcare provider and carefully follow their instructions.
Eszopiclone may also cause complex sleep behaviours, such as sleepwalking or driving while asleep, which can result in serious injury or death. Therefore, individuals taking eszopiclone should refrain from driving or engaging in other dangerous activities until they know how the drug affects them. Additionally, it is recommended to avoid alcohol consumption while taking eszopiclone, as this can increase the risk of dangerous side effects.
While eszopiclone can be an effective treatment for insomnia, it is important to carefully consider the potential risks and side effects in consultation with a healthcare provider before taking this medication. It is also important to note that older adults may be more sensitive to the effects of eszopiclone, and dose adjustments may be necessary for this population.
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Doxepin (Silenor)
Doxepin, also known by its brand name Silenor, is a tricyclic antidepressant that is FDA-approved for treating insomnia characterised by difficulty staying asleep. It is available only with a prescription from a doctor, and is typically prescribed for short-term use of up to 3 months. Doxepin is usually taken once a day, within 30 minutes of bedtime, and should be taken exactly as directed. It is important to note that Doxepin is not suitable for those taking monoamine oxidase inhibitors, or those with glaucoma or urinary retention.
Doxepin works by slowing down activity in the brain to allow sleep. It is known to cause drowsiness, so it is important to refrain from driving or operating machinery until you know how your body reacts to the medication. It may also cause central nervous system (CNS) depression, where brain activity slows. Other potential side effects include sleep-related behaviours such as sleep-driving, sleep-walking, and preparing and eating food while asleep.
If you are taking other medications, it is important to consult your doctor before starting Doxepin, as it may interact with certain drugs, including antihistamines, hay fever medications, sleeping pills, and muscle relaxants. It is also important to note that Doxepin should not be taken within 3 hours of a meal.
If you have been taking Doxepin for a prolonged period or at a high dose, consult your healthcare provider before stopping as you may need to slowly taper down the dose.
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Ramelteon (Rozerem)
Ramelteon, also known by its brand name Rozerem, is a melatonin receptor agonist that helps treat insomnia in adults. It is a central nervous system (CNS) depressant, which means it slows down the nervous system to help you sleep. Unlike other prescription sleep medications, it is not a controlled substance and is not known to be habit-forming.
Ramelteon should be taken on an empty stomach about 30 minutes before bedtime. It is important to swallow the tablet whole without breaking, crushing, or chewing it. After taking the pill, one should refrain from any activity other than preparing for bed. It is also advised to avoid alcohol as it can increase the risk of side effects.
The most common side effects of Ramelteon are drowsiness, dizziness, and tiredness. It can also cause allergic reactions, changes in hormone levels, and decreased alertness or coordination, which may persist until the next day. In rare cases, it may lead to complex sleep behaviours, such as sleepwalking, sleep driving, preparing and eating food, making phone calls, and even having sex. These activities can be dangerous, and if experienced, one should stop taking the medication and consult their healthcare provider.
Ramelteon is available only by prescription, and the recommended dose is 8 mg once daily. It is important to weigh the risks and benefits of taking this medication, especially for breastfeeding women, the elderly, and the pediatric population, as there is limited data on its effects on these groups.
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Suvorexant (Belsomra)
Suvorexant, sold under the brand name Belsomra, is a dual orexin receptor antagonist (DORA) medication used to treat insomnia in adults. It is produced by Merck & Co. and is available only as a brand-name medication.
Suvorexant is indicated for insomnia characterised by difficulties with sleep onset and/or sleep maintenance. Clinical trials have shown that the drug reduces the time to fall asleep by up to 10 minutes, reduces middle-of-the-night insomnia by 15 to 30 minutes, and increases total sleep time by 10 to 20 minutes. Its effectiveness is considered modest, similar to other orexin antagonists, but lower than benzodiazepines and Z-drugs.
Suvorexant has an intermediate elimination half-life of 12 hours and a time to peak of 2 to 3 hours. It does not interact with GABA receptors like benzodiazepines and Z-drugs, but instead acts on orexin OX1 and OX2 receptors. This mechanism of action is distinct from other sleep aids.
Side effects of suvorexant include somnolence, excessive daytime sleepiness, headache, dizziness, abnormal dreams, dry mouth, and impaired next-day driving ability. Rarely, it may cause sleep paralysis, sleep-related hallucinations, complex sleep behaviours like sleepwalking, and suicidal ideation. Tolerance, dependence, withdrawal, and rebound effects do not appear to be significant concerns with suvorexant.
Suvorexant is a Schedule IV controlled substance in the United States, indicating a modest potential for misuse. In other countries, such as Australia, it is a prescription-only medicine and is not classified as a controlled drug. It is not available in generic formulations.
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Frequently asked questions
Prescription sleeping pills that can help you fall asleep include:
- Zolpidem (Ambien)
- Eszopiclone (Lunesta)
- Zaleplon (Sonata)
- Doxepin (Silenor)
- Ramelteon (Rozerem)
- Suvorexant (Belsomra)
- Lemborexant
- Daridorexant
- Benzodiazepines
Some OTC sleeping pills that can help you fall asleep include:
- Diphenhydramine
- Doxylamine
- Melatonin
- Valerian
The side effects of taking sleeping pills vary depending on the specific drug. Some common side effects include:
- Dizziness
- Drowsiness
- Grogginess
- Headache
- Dry mouth
- Urinary retention
- Hallucinations
- Mood changes
- Memory loss
- Allergic reactions
- Increased tolerance
- Misuse
- Dependency
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