Sleeping Pills: Prescription or OTC?

From the WebMD Archives

Many Americans suffer from insomnia and commonly turn to prescription medications and over-the-counter sleeping aids for relief. About one in four Americans report taking some type of medication every year to help them sleep.

If you find yourself struggling after a few restless nights of sleep -- perhaps trouble falling asleep, repeated awakenings, or waking up feeling tired, you may decide to try over-the-counter sleeping pills or consult your doctor about prescription sleep medications.

But before you do, you should be aware of the different types of over-the-counter and prescription sleeping medications, potential side effects, safety concerns, and alternatives.

OTC vs. Prescription Drugs

The most common agent in over-the-counter sleeping aids is diphenhydramine, an antihistamine. It usually has a relaxing effect that makes you feel drowsy, but it may cause some grogginess the next day. Some popular OTC sleep aids also include pain relievers, which you may not need to take for insomnia or sleep problems.

Although over-the-counter sleep medications are available without prescription and are generally considered safe, you should check with the pharmacist about any potential side effects or adverse drug interactions with other drugs you are taking for other health conditions like high blood pressure.

You should be careful to take them only as directed especially if you're taking other drugs that also contain antihistamines, like cold or allergy medications. Also, antihistamines can cause confusion in the elderly.

"The over-the-counter stuff can work in a pinch, but it's generally not good for long-term use," says Tracey Marks, MD, psychiatrist in Atlanta and author of Master Your Sleep.

If you're having a sleep problem that lasts a few days, talk to your doctor about your concerns. You may have an underlying health problem, like a sleep disorder or depression.

Depending on the cause of your sleeping problem, he or she may prescribe a sleep medication, which is the most common treatment for insomnia.

One group of sedative-hypnotics is called benzodiazepine agonists, which are divided into benzodiazepines or nonbenzodiazepines. Developed in the 1960s, they carry some risks of addiction. A newer class of sleep drugs, known as gamma-aminobutyric acid (GABA) medication, is thought to be less addictive.


One concern with benzodiazepines, says Marks, is that they may interfere with slow-wave sleep, the kind of deep sleep you need to feel physically restored.

Another group of hypnotics is known as melatonin agonists. They are not a knockout drug, the kind that makes you feel drowsy, says Marks. These compounds work with your circadian rhythm, or body clock, as a sleep maintenance medication taken daily.

Taking prescription sleep medication is only recommended under the close supervision of your doctor. You should discuss all the risks and potential side effects and ask your doctor to review the dosage instructions with you. And remember, you should never take medication prescribed for someone else, even once.

Know the Risks and Side Effects

There are a number of safety concerns regarding prescription sleep drugs. The FDA has issued warnings for prescription sleep drugs including Ambien, Lunesta, Rozerem, and Sonata because they may cause allergic reactions, impairment the next day, sleep walking, and even sleep driving. The FDA has lowered the recommended dosages in the cases of some drugs.

The agency recommends taking the following precautions when using sleep drugs:

  • Don't take them with alcohol.
  • Don't take more than the prescribed dose.
  • Don't take with other sedating medication.

Getting a Good Night's Sleep

Most sleeping pills are not designed for long-term use, says Marks. The goal is to get off of them and get at the root of what's actually interfering with your sleep.

There are other strategies to improve sleep, such as using meditation or exercise to decrease stress. The National Sleep Foundation suggests that sleeping aids are most effective when used in conjunction with other kinds of treatment, such as cognitive behavioral therapy.

WebMD Feature Reviewed by Michael J. Breus, PhD on March 02, 2011



Sleep in America Poll, National Sleep Foundation, 2008.

Tracey Marks, MD, psychiatrist; author, Master Your Sleep.

William Kohler, MD, medical director, Florida Sleep Institute, Spring Hill, Fla.

News release, FDA.

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