Sleeping Pills

What Are Sleeping Pills?

Sleeping pills are mental health medications designed to help individuals fall asleep faster by promoting relaxation and reducing anxiety. Some medications are also effective in helping individuals stay asleep throughout the night. They are often used in the short term to treat insomnia or other sleep disorders. These medications (also known as sleep aids, hypnotics, or sedatives) affect the brain’s neurotransmitters to promote relaxation and induce sleep.

Sleeping pills, such as antihistamines and benzodiazepines, make you feel drowsy and may help you fall asleep faster. While most drugs can help you fall asleep, some, such as suvorexant (Belsomra), may also help you stay asleep for longer periods, which can be useful for people who wake up during the night. Drugs that increase melatonin in your body, such as melatonin supplements, are useful for helping to regulate sleep, especially if your insomnia is caused by outward influences like shift work or jet lag.

Who Might Need Sleeping Pills?

The National Council on Aging reports that about 30% of adults have symptoms of insomnia, and 10% have insomnia that impacts their daily activities.

Sleep problems often increase with age, and according to a 2020 report from the CDC, the use of sleep aids rises accordingly. Data shows:

• 5.6% of those aged 18–44 use sleep aids
• 10.1% of those aged 45–64 use sleep aids
• 11.9% of those aged 65+ use sleep aids

If you have tried lifestyle changes but continue to experience significant problems with sleep, your healthcare provider may recommend sleeping pills. These medications can help provide relief right away for sleep problems that disrupt daily life, such as severe insomnia.

Types Of Sleeping Pills

There are several different types of sleeping pills, including over-the-counter options that can be purchased at your local pharmacy, as well as medications that require a prescription from your healthcare provider.

Over-the-Counter Sleeping Pills

Over-the-counter (OTC) sleeping pills don’t require a prescription from your healthcare provider and can be purchased at your local pharmacy or other retail locations. OTC sleep aids, such as diphenhydramine (Benadryl) and doxylamine (Unisom), commonly contain an antihistamine. While antihistamines are primarily used to treat allergies, they can cause drowsiness and are therefore used as sleep aids.

Supplements

Natural supplements, such as melatonin and valerian root, can help improve mental wellness and are widely available in stores. Melatonin is a hormone that helps regulate the sleep-wake cycle by telling your body when it’s time to sleep and when to wake up. Increasing melatonin levels by taking a supplement tells your body it’s time to sleep. Melatonin supplements are available over the counter, and research suggests that they might help reduce the time it takes to fall asleep and are especially helpful for managing jet lag and sleep disruptions caused by shift work^.

Similarly, valerian root is a natural herb commonly used in OTC sleep aids and is thought to have mild sedative properties, helping you to relax and fall asleep faster.

Some natural supplements have been shown to interact with other medications, so it’s always a good idea to talk with your healthcare provider before taking a supplement.

Prescription Sleeping Pills

Prescription sleeping pills are medications used to treat insomnia that require a prescription from your healthcare provider. They are generally prescribed for short-term use due to the risks of tolerance and dependency. The risks and benefits of various prescription sleeping pills differ, especially for people with certain medical conditions, such as liver disease or sleep apnea.

Prescription sleeping pills vary by how they work and include:

• Benzodiazepines , such as temazepam (Restoril), triazolam (Halcion), and estazolam (Prosom)
• Nonbenzodiazepines (also called Z drugs), such as zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata)
• Melatonin receptor agonists, such as ramelteon (Rozerem)
• Orexin receptor antagonists, such as suvorexant (Belsomra) and lemborexant (Dayvigo)
• Antidepressants, such as trazodone, amitriptyline, and doxepin (Silenor)

Your healthcare provider can discuss the risks and benefits of these medications with you to determine the best treatment option for you.

How Do Sleeping Pills Work?

Although each type of sleeping pill works differently, sleeping pills generally affect neurotransmitters in the brain to create a calming effect, reduce wakefulness, and promote sleep.

OTC sleeping pills work by blocking a natural chemical in the body called histamine. While histamines in the body work with the immune system and can help relieve allergies, histamines in the brain are involved in the sleep-wake cycle and play an important part in making you feel awake. By lowering the levels of histamine in the brain, OTC sleeping pills can cause drowsiness and allow you to fall asleep faster.

Prescription sleeping pills work in different ways to promote sleep and help maintain it. Similar to the OTC supplement melatonin, the melatonin receptor agonist ramelteon mimics the action of melatonin. This makes it suitable for long-term treatment of sleep-onset insomnia without the risk of dependency. Studies show that ramelteon is an effective option in older adults with chronic insomnia.

Benzodiazepines increase the neurotransmitter gamma-aminobutyric acid (GABA) activity, which induces sedation and relaxation. These medications are effective for helping with falling asleep, but they can be habit-forming and are generally recommended only for short-term use. Their effectiveness can decrease when taken over a long time due to tolerance.

Nonbenzodiazepines, such as zolpidem (Ambien) and eszopiclone (Lunesta), also act on GABA receptors but bind only to specific GABA receptors called GABA-A that are dedicated to promoting sleep. They are primarily used to help you fall asleep faster and are the most frequently prescribed drug class due to potentially fewer side effects and a lower risk of dependency than benzos.

Orexin receptor antagonists, like suvorexant, work by blocking a neurotransmitter in the brain called orexin that promotes wakefulness, thereby promoting sleep. They can help people fall asleep faster and stay asleep. However, these medications can cause next-day drowsiness and should be used with caution, particularly at higher doses.

Certain antidepressants that have sedative effects, such as trazodone, are often used off-label for insomnia, especially when an individual also has depression or anxiety. They have sedative properties due to their action on various neurotransmitters in the brain, including serotonin and norepinephrine. These medications cause drowsiness and help with sleep.

What Are Potential Sleeping Pill Side Effects?

As with any medication, sleeping pills can cause side effects. The most common side effects include:

• Dizziness
• Headache
• Drowsiness during the day
• Gastrointestinal issues, such as nausea, gas, or heartburn
• Dry mouth
• Increased risk of falls

Nearly 8 out of 10 people taking sleep medications report experiencing side effects such as drowsiness, confusion, or forgetfulness the next day. This can affect daily activities and the ability to perform tasks requiring alertness, such as driving or concentrating at school or work. More serious side effects can also occur, including memory problems, sleepwalking, or sleep-driving.

Long-Term Side Effects

Long-term use of sleeping pills can lead to various adverse effects that impact both physical and mental health.

Memory Problems And Confusion

One major concern is memory problems and confusion, particularly with medications like Ambien (zolpidem), which have been associated with memory loss and cognitive impairment, especially at higher doses and with prolonged use. This can cause difficulty recalling events or confusion about daily activities.

Depression And Suicidal Thoughts

Depression and suicidal thoughts have also been linked to the long-term use of certain sleeping pills. Medications that affect neurotransmitter balance, such as benzodiazepines and nonbenzodiazepines, can exacerbate or trigger depressive symptoms, potentially leading to severe mental health issues.

Tolerance And Addiction

Tolerance and addiction may develop as the body adjusts to the medication, requiring higher doses to achieve the same effect, leading to an increased risk of side effects. As the body becomes dependent on the medication, withdrawal symptoms like anxiety, agitation, and severe insomnia can present and make it challenging to stop taking the pills. Rebound insomnia, where sleep problems worsen upon stopping the medication, is also common and can make it difficult for individuals to discontinue using the medication.

Overdose

Overdose risks are increased with long-term use, especially when combined with other central nervous system (CNS) depressants like alcohol or opioids, potentially resulting in severe respiratory depression, coma, and even death. Additionally, long-term use can lead to organ damage or failure, particularly affecting the liver and kidneys.

What Are The Potential Risks Or Complications Of Prescription Sleeping Pills?

The risks of prescription sleeping pills vary depending on the type of medication and how long you use it. Some individuals may experience mood swings, irritability, or increased aggression. Physical health risks are also associated with long-term use of sleeping pills. These medications can affect balance and coordination, increasing the risk of falls and injuries, particularly in older adults.

Some prescription sleeping pills can cause complex sleep behaviors, such as sleepwalking and sleep driving, that may occur while you’re not fully awake. These behaviors can be dangerous since you often won’t remember doing these things when you wake up. People can experience these types of behaviors after their first dose or after they continue to use the drug.

Additionally, sleeping pills can exacerbate breathing problems in individuals with underlying respiratory conditions, such as sleep apnea. Combining sleeping pills with alcohol can also significantly increase the risk of serious breathing problems.

Can You Take Sleeping Pills While Pregnant?

Pregnancy can cause specific changes that may affect your sleep or worsen existing sleep disorders.

Approximately 80% of women experience sleep problems at some point during pregnancy.

Any medication you take during pregnancy can be passed to the fetus, so it’s best to try non-drug interventions first. It’s important to talk with your healthcare provider before taking any sleep aids, whether prescription or over-the-counter. They can help weigh the potential risks and benefits of taking a sleep medication and identify your safest options.

Are Sleeping Pills Safe For Children?

Sleeping pills should be used cautiously in children. Currently, no prescription sleeping pills are approved for use in children. Some parents give their children over-the-counter antihistamines that cause drowsiness to help them sleep, but the safest approach is to try non-drug measures, such as establishing a bedtime routine and limiting screen time before bed. The short-term use of melatonin is generally considered safe for children.

Always talk to your healthcare provider before giving your child any OTC medications or supplements.

How Effective Are Sleeping Pills?

In general, sleeping pills are most effective for short-term use (a few weeks) to help individuals through periods of acute insomnia or significant stress.

Studies show that the benefits of sleeping pills are modest. While these medications may help you fall asleep faster, they aren’t significantly effective in helping you get a good night’s sleep. Studies show that people who take sleep aids fall asleep about 10 to 20 minutes faster and sleep for only about 20 to 30 minutes longer than those who don’t take a sleep aid. Additionally, the sleep induced by sleeping pills may not always be restorative, as these medications can alter the natural sleep cycle, leading to a reduction in the time spent in deep sleep and REM sleep, which are important for physical and mental recovery.

Because of this, healthcare providers often recommend using sleeping pills as a temporary solution while addressing the underlying causes of insomnia through behavioral and lifestyle modifications at the same time.

How Can I Sleep Better Without Medication?

Exploring alternative treatments, such as cognitive-behavioral therapy (CBT), relaxation techniques, and good sleep hygiene practices, can offer more sustainable and effective solutions for long-term sleep health without the potential risks and side effects associated with sleeping pills.

Improving sleep without relying on sleeping pills involves adopting good sleep hygiene practices, making lifestyle changes, and using behavioral techniques. CBT is an effective way to treat chronic insomnia and is often recommended as a first-line treatment before considering sleeping pills. CBT can help you fall asleep faster, stay asleep longer, and improve your sleep quality.

The National Sleep Foundation suggests that good sleep habits include:

• Maintaining a regular sleep schedule by going to bed and waking up at the same time every day, even on weekends. This helps regulate your body’s internal clock
• Avoiding large meals, caffeine, and alcohol before bed. Caffeine is a stimulant and interferes with your ability to fall asleep, and while alcohol might make you feel sleepy initially, it can disrupt your sleep cycle and reduce the quality of your sleep
• Avoiding screens before bedtime. The blue light emitted by phones, tablets, and computers can interfere with your sleep-wake cycle. Try to turn off electronic devices at least an hour before bedtime.
• Exercising regularly. Regular exercise can help you fall asleep faster and enjoy deeper sleep. Aim for at least 30 minutes of moderate exercise most days of the week, but avoid vigorous activity close to bedtime.
• Getting outside during the day. Spending time outside or letting sunlight into your home during the day can help regulate your sleep-wake cycle.
• Creating a comfortable sleep environment. Keep your bedroom cool, dark, and quiet: use blackout curtains, earplugs, or a white noise machine if necessary.
• Managing stress and anxiety. Relaxing before bedtime may also help, such as reading a book, listening to soothing music, or meditating. Write down your thoughts and worries in a journal before bed to help clear your mind and reduce anxiety.

Can You Overdose On Sleeping Pills?

While sleeping pills are generally safe when used at the recommended dosages, it is possible to overdose on these medications. An overdose is more likely to occur when sleeping pills are taken at higher-than-recommended doses or combined with alcohol or other medications.

Although the symptoms of an overdose can vary depending on the specific medication involved, they generally include extreme drowsiness, confusion, and shallow breathing. Some people might experience nausea or vomiting. Severe cases can lead to respiratory depression, coma, and even death.

If an overdose is suspected, it’s important to get emergency medical help right away.

When Should I Contact My Healthcare Provider?

Always talk with a healthcare provider before starting or stopping any medication, including OTC sleep aids, to ensure they are safe and appropriate for your condition.

You should contact your healthcare provider if you’re taking sleeping pills and experience:

• Any unexpected or severe side effects, such as extreme drowsiness, confusion, dizziness, or difficulty breathing.
• The need to increase your dose to achieve the same effect or experience anxiety, agitation, or rebound insomnia if you stop taking the medication.
• Erratic sleep behaviors, such as sleepwalking or sleep-driving.
• Changes in your mood, depression, increased anxiety, or thoughts of self-harm.

If the sleeping pills are not improving your sleep quality or if your insomnia persists despite taking the medication, it is important to discuss alternative treatments with your healthcare provider. If you start taking new medications, including prescription, OTC, or herbal supplements, you should discuss potential interactions with your sleeping pills.

If you feel you need to stop taking your sleeping pills, contact your healthcare provider to discuss a safe tapering schedule to avoid withdrawal symptoms and rebound insomnia.

Finding A Balanced Path To Better Sleep

If sleep problems are regularly interfering with your daily activities, it’s important to see your healthcare provider to rule out any other causes, such as obstructive sleep apnea, that might be disrupting your sleep.

Sleeping pills can offer relief for individuals struggling with sleep disorders. Understanding how they work and their associated risks can help in making informed decisions about their use. If you are interested in learning more about sleeping pills or non-drug alternatives, such as CBT and good sleep hygiene practices, contact your healthcare provider today.