Herbie Murray
Sleeping pills are medications that can help people with sleep disorders like insomnia fall asleep and stay asleep. They are typically recommended as a last resort when other methods, such as improving one's sleeping environment or cognitive-behavioural therapy, have failed to improve one's sleep. Sleeping pills can be purchased over the counter or with a prescription, with prescription pills generally being stronger. Various factors differentiate sleeping pills, such as how quickly they work, how long their effects last, and what side effects they may cause. This article will explore and compare different sleeping pills to help you decide which one may be better suited to your needs.
| Characteristics | Values |
|---|---|
| How sleeping pills work | Sleeping pills treat insomnia by making you feel drowsy and relaxed. They work in different ways, depending on their ingredients. For example, antihistamines block histamines, which are substances in your body that cause alertness. Benzodiazepines stimulate GABA, a chemical in your brain, leading to sedation, muscle relaxation, and reduced anxiety. Z-drugs slow down brain activity. |
| Types | Prescription and over-the-counter (OTC) sleeping pills are available. Prescription pills are generally stronger than OTC pills. Examples of prescription pills include zolpidem, zopiclone, temazepam, suvorexant, lemborexant, doxepin (Silenor), ramelteon (Rozerem), estazolam (Prosom), Lunesta, zaleplon (Sonata), and sublingual zolpidem. OTC options include diphenhydramine, which is an antihistamine. |
| Effectiveness | Sleeping pills are generally better at helping people fall asleep rather than stay asleep. Some pills, like zaleplon (Sonata), are specifically prescribed to help people fall asleep, especially if they don't have chronic insomnia. Sublingual zolpidem is meant for those who wake up halfway through the night and only have a few hours left until they need to get up. |
| Onset and Duration | Different sleeping pills have different onset times and durations. For example, zolpidem acts within 15-30 minutes and lasts for 6-8 hours. Diphenhydramine acts within an hour and lasts for 4-6 hours. Suvorexant and lemborexant have a slower onset. |
| Side Effects | Sleeping pills can cause various side effects, including drowsiness, dizziness, dry mouth, urinary retention, constipation, muscle weakness, and memory problems. Some pills, like Lunesta, may cause complex sleep behaviors such as sleepwalking or driving while asleep. Others, like trazodone, may cause thoughts of suicide. Approximately 8 out of 10 people experience a hangover effect the day after taking sleep medicine. |
| Risks and Dependence | Sleeping pills are intended for short-term use due to the risks associated with long-term use, including dependence and potential for misuse. Benzodiazepines, for example, are classified as controlled substances due to their risk for abuse, addiction, and dependence. Sleeping pills may also cause memory problems, falls, and, in rare cases, death. |
| Precautions | Sleeping pills should be used with caution, especially in elderly patients, pregnant or nursing people, and children or adolescents. Healthcare providers recommend trying alternative methods to improve sleep before resorting to sleeping pills, as the long-term risks often outweigh the benefits. |
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What You'll Learn
Prescription vs over-the-counter sleeping pills
There are a variety of sleeping pills available, both over-the-counter and prescription. The choice of a strong sleeping pill should always be tailored to individual circumstances and needs.
Prescription sleeping pills are generally stronger than over-the-counter options. They are recommended for short-term relief and are not considered a cure for insomnia. Benzodiazepines, for example, are a group of prescription sleeping pills that are effective for short-term use (less than four weeks) to treat insomnia. They work by stimulating a chemical in the brain called GABA, which leads to sedation, muscle relaxation, and reduced anxiety. However, long-term use of these pills is not recommended due to the risk of serious side effects, dependence, and addiction. Other prescription sleeping pills include Z-drugs like zolpidem (Ambien) and eszopiclone (Lunesta), which work by slowing down brain activity. Prescription sleep medications can cause a range of side effects, including constipation, muscle weakness, and hangover effects the next day, such as drowsiness and dizziness.
Over-the-counter sleeping pills are widely available and can be purchased without a prescription. Melatonin supplements, for instance, are commonly found over the counter. They can help regulate the sleep-wake cycle, making them a good option for jet lag. Diphenhydramine is another over-the-counter option that acts within an hour and lasts 4-6 hours. However, it may cause side effects such as dry mouth and urinary retention. It is important to consult a healthcare provider before taking any over-the-counter sleeping pills, especially for children, as there is a risk of overdose.
In summary, prescription sleeping pills are stronger and more effective for treating insomnia, but they come with a higher risk of side effects, dependence, and addiction. Over-the-counter options are more readily available and may be sufficient for milder sleep issues or regulating the sleep-wake cycle. It is always recommended to consult a healthcare professional before starting any sleep aid to determine the best treatment option based on individual needs and circumstances.
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Natural sleep aids
There are many natural sleep aids that can help you fall asleep faster or stay asleep throughout the night. These are usually plant-based, vitamins or minerals, or supplemental amounts of substances produced by the body.
Melatonin
Melatonin is a hormone that is naturally released in the brain four hours before we feel sleepy. It is triggered by the body's response to reduced light exposure, which should happen at night. However, exposure to unnatural light from phones, laptops, or TVs can prevent its release. Melatonin supplements are available over the counter and can help with sleep. A 2022 study found that melatonin improved both daytime and nighttime sleep in older adults. It may also improve overall sleep quality in individuals with sleep disorders. However, melatonin can reduce the effectiveness of some medications and cause side effects when combined with others. It may not be recommended for people who have received an organ transplant, experience depression, or have a bleeding or seizure disorder.
Magnesium and Valerian Root
Magnesium and valerian root are also natural sleep aids that can help you sleep better.
Cannabinoids
Some natural sleep aids contain cannabinoids such as delta-tetra-hydrocannabinol (THC) and cannabidiol (CBD). Some studies suggest that these substances help people fall asleep, stay asleep, and enjoy higher-quality sleep. Marijuana, a drug created from the cannabis plant, is known to help people fall asleep. However, marijuana and THC products can be addictive, and withdrawal can aggravate sleep problems. CBD has been found to relieve anxiety and act as a sleep aid, with one study showing that it improved sleep quality in 67% of participants. However, more research is needed before CBD can be routinely recommended for sleep disorders, and it is not recommended for those who are pregnant or nursing.
Other Tips
Other natural ways to improve your sleep include:
- Reducing exposure to unnatural light at night by using a flashlight instead of turning on the lights if you need to get up
- Adjusting your bedtime temperature by sleeping in layers
- Avoiding working out within two hours of bedtime
- Drinking warm milk, chamomile tea, or tart cherry juice (although there is little scientific proof that these drinks work)
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Side effects
Sleeping pills can cause a range of side effects, from constipation to muscle weakness. Some people experience a “hangover effect” the day after taking sleep medicine, feeling drowsy, confused, and dizzy. These daytime effects can negatively impact your ability to drive, work, or complete daily tasks.
Sleeping pills can also cause digestive problems, including gas, heartburn, and nausea. They may worsen snoring and sleep apnea, and long-term use can lead to rebound insomnia, where insomnia returns worse than before. Additionally, sleep medicines should not be mixed with other sedatives or alcohol due to the risk of overdose. Some prescription sleep medicines may also bring on parasomnia, a disruptive sleep disorder where individuals may walk, eat, or engage in other dangerous behaviours while still mostly asleep.
The long-term use of sleeping pills can affect brain function and lead to structural changes in sleep patterns, pill dependency, and drug tolerance. It may also result in poor memory, brain degeneration, and an increased risk of Alzheimer's disease and depression. Older adults and individuals at risk of falls should exercise caution when taking sleep aids due to the potential for accidental falls. Respiratory depression during sleep is another severe adverse effect that may lead to death.
Some specific prescription sleep medications and their side effects include:
- Doxepin (Silenor): May cause central nervous system (CNS) depression, where brain activity slows down.
- Restoril: Various side effects, though the exact nature of these is not specified.
- Triazolam (Halcion): A benzodiazepine with the potential for dependency and misuse, therefore not recommended for long-term use.
- Ramelteon (Rozerem): A low likelihood of misuse or dependency, but can still cause side effects, including allergic reactions.
- Suvorexant (Belsomra): Risk of misuse, dependency, and CNS impairments that affect driving and other activities.
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Safety concerns
While sleeping pills can be effective in treating insomnia and other sleep disorders, they are associated with several safety concerns that individuals should be aware of before use. Firstly, sleeping pills are generally recommended for short-term use only, as long-term use increases the risk of dependence and may lead to withdrawal symptoms upon discontinuation. Additionally, many sleeping pills have side effects that can range from mild, such as constipation and muscle weakness, to more severe, including confusion, sleepwalking, and even complex behaviours like driving while asleep. Approximately 8 out of 10 people experience a hangover effect the day after taking sleep medicine, which can impair their ability to perform tasks that require alertness, such as driving.
The American Academy of Sleep Medicine does not recommend over-the-counter (OTC) sleep aids for treating insomnia due to concerns about their safety and effectiveness. While OTC options may provide temporary relief for jet lag or shift work-related sleep issues, they should be used with caution and not for more than two weeks without consulting a healthcare provider. This is because insomnia can be indicative of underlying medical conditions that require alternative treatments. Furthermore, some sleep medications interact with other substances, including alcohol and vitamin supplements, which can lead to adverse effects.
For certain prescription sleeping pills, such as Lunesta (eszopiclone), the U.S. Food and Drug Administration has issued warnings about next-day impairment and has lowered the recommended dose. Higher doses of Lunesta can impair an individual's central nervous system, making driving and other complex tasks dangerous. People with reduced liver function and those experiencing depression or suicidal thoughts should also avoid Lunesta. Similarly, the FDA has lowered the recommended doses for certain drugs containing zolpidem (Ambien, Ambien CR, Edluar, and Zolpimist) due to the risk of next-morning impairment.
Benzodiazepines, a common type of prescription sleeping pill, carry their own set of safety concerns. While they can be effective in inducing sleep, they are recommended for short-term use, usually less than four weeks, due to the risk of dependence and withdrawal symptoms. Additionally, older adults may experience increased sensitivity to the sedative effects and side effects of benzodiazepines, so lower doses or non-benzodiazepine alternatives may be safer for this population.
Overall, it is crucial to consult a healthcare provider before starting any sleep aid, as they can advise on potential side effects, interactions, and alternative treatments. Cognitive-behavioural therapies, sleep hygiene improvements, and non-drug therapies like melatonin supplements are often recommended as safer first-line approaches to improving sleep.
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Non-medical solutions
While sleeping pills can be effective in aiding sleep, they often come with side effects and pose a risk of dependency and misuse. Before opting for sleeping pills, it is advisable to explore non-medical solutions, which can be equally effective in improving sleep quality. Here are some non-medical alternatives to consider:
Lifestyle Changes and Healthy Sleep Habits
Adopting healthy sleep habits is crucial for improving sleep quality. This includes maintaining a consistent sleep schedule, creating a relaxing bedtime routine, and ensuring your bedroom is cool, dark, and free from distractions. Avoid consuming large meals, caffeine, or alcohol close to bedtime, as these can disrupt sleep. Establishing a healthy sleep environment and routine can significantly enhance your sleep without the need for medication.
Cognitive-Behavioral Therapy (CBT)
CBT is a recommended approach to address sleep issues. It involves identifying and changing negative thoughts and behaviours that affect sleep. CBT can help you manage stress, anxiety, and any underlying psychological factors contributing to insomnia. By improving your relationship with sleep and developing healthier coping strategies, CBT can lead to long-lasting improvements in sleep quality.
Natural Sleep Aids and Supplements
Natural sleep aids, such as melatonin, are a safer alternative to prescription sleeping pills. Melatonin is a naturally occurring hormone that regulates sleep. It is available as a supplement and can help improve sleep quality, particularly for those experiencing jet lag or shift work sleep disorders. Additionally, certain herbal remedies, like valerian root and chamomile, have been traditionally used to promote relaxation and improve sleep. Always consult a healthcare professional before taking any supplements to ensure they are safe for you.
Mindfulness and Relaxation Techniques
Practising relaxation techniques, such as deep breathing, progressive muscle relaxation, or meditation, can help calm the mind and body, making it easier to fall asleep. Incorporating mindfulness into your daily routine can reduce stress and anxiety, improving overall sleep quality. Relaxation techniques are simple yet powerful tools that can be easily learned and practised at home.
Exercise and Physical Activity
Regular physical activity can improve sleep quality and duration. Engaging in moderate-to-vigorous exercise during the day can tire the body and promote a more restful night's sleep. However, avoid strenuous exercise close to bedtime, as it may have a stimulating effect, making it harder to fall asleep. Finding an exercise routine that works for you can be a natural and healthy way to improve your sleep patterns.
Remember, it is always advisable to consult with a healthcare professional before starting any new sleep aid or treatment. They can provide personalised advice and help you find the best approach to improve your sleep without relying on medication.
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Frequently asked questions
Over-the-counter sleeping pills typically contain antihistamines, which induce sleep by blocking histamines that cause alertness. Some common antihistamines include diphenhydramine and doxylamine. It is important to note that over-the-counter options may have side effects such as dry mouth and urinary retention.
Prescription sleeping pills include benzodiazepines, which stimulate the GABA chemical in the brain, leading to sedation and reduced anxiety. Examples of benzodiazepines are triazolam (Halcion) and clonazepam (Klonopin). Other prescription options include zaleplon (Sonata) and sublingual zolpidem, which is a low dose that dissolves under the tongue.
Natural sleep aids include melatonin, which is a hormone that promotes sleep by influencing when you fall asleep and wake up. Valerian is another natural alternative that has a calming effect on the nervous system.
Sleeping pills can have various side effects, including dizziness, drowsiness, constipation, and muscle weakness. More severe side effects may include memory problems, falls, and in rare cases, death. It is important to consult a healthcare professional to understand the risks before taking any sleep medication.
Yes, healthcare providers often recommend trying alternative methods to improve sleep before resorting to sleeping pills. These methods include cognitive behavioral therapy (CBT), changing your sleeping environment, and keeping a sleep diary to track your sleep patterns.
