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Sleeping Pills: The Pros and Cons

Which sleeping pill is right for you? Get the pros and cons with this decision chart.

WebMD Feature

Reviewed by Celia E. Dominguez, MD

Reaching for the first sleep aid you find when insomnia hits? Not all sleeping pills are the same. Each class of sleep aid works a bit differently from the other, and side effects vary.

It's important to ask key questions before choosing your sleep medicine.

How long does it take for the sleeping pill to take effect?
How long do the effects last?
What's the risk of becoming dependent on the sleeping pill, physically or psychologically?

All sleep medicines have the potential for causing dependence. In the large majority of cases, however, this is psychological dependence, not physical.

Talk with your doctor, and use this chart to help you decide which sleeping pill is right for you.

Drug	How It Works	Duration of Effects	Side Effects	Dependence Risk
Diphenhydramine	Acts on histamine receptors in the brain to cause drowsiness.	4-6 hours (sleepiness may last longer)	Daytime sleepiness; confusion and difficulty urinating in older people.	Low
Selective GABA Medicines Ambien (zolpidem tartrate) Ambien CR (zolpidem tartrate extended release) Lunesta (eszopiclone) Sonata (zaleplon)	Binds to a specific type of GABA receptor in the brain.	6-8 hours	Usually few. Memory disturbances, hallucinations, behavior changes possible.	Medium (usually low)
Sleep-Wake cycle Modifiers Rozerem (ramelteon)	Stimulates melatonin receptors in the brain area that controls the sleep-wake cycle.	4-6 hours	Headache, drowsiness, dizziness. Uncommonly, problems with sex drive. Loss of menses or problems getting pregnant.	Low
Benzodiazepines Ativan (lorazepam) Halcion (triazolam) Restoril ( temazepam) Valium (diazepam) Xanax ( alprazolam)	Binds to general GABA receptors in the brain.	Varies (from 4 hours to more than 12)	Sedation, loss of muscle coordination, dizziness, habit-forming.	Higher
Tricyclic Antidepressants Adapin (doxepin) Aventyl (nortriptyline) Elavil ( amitriptyline) Pamelor (nortriptyline) Sinequan (doxepin) Trazodone (desyrel)	Binds to multiple brain receptors including acetylcholine; sedating.	Not well studied	Low at usual doses for insomnia. Dizziness, blurry vision, difficulty urinating, cardiac arrhythmias possible. Trazodone can cause prolonged, painful erections.	Low

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