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Sleep Aids: Prescription or Over-the-Counter?

Reviewed by Neha Pathak, MD on October 21, 2020

Do you find yourself tossing and turning at night? Maybe you spend hours staring at the ceiling as anxious thoughts run through your mind. Or perhaps you give up on sleep and stare at your phone late into the night. Insomnia is a common problem.  About 1 in every 3 adults has trouble sleeping at least some of the time.

Some simple steps may help you get more ZZZs. These include going to bed at a regular time, managing your stress, and staying away from caffeine or late-night snacks. But if you’ve done these things and still struggle to get enough sleep, you’ve probably wondered if it’s time to try a sleep aid.

Sleep Aid Types

There are different types of sleep aids. You can buy some of them at any drugstore. For others, you’ll need a prescription from your doctor.

Over-the-counter sleep aids

Over-the-counter sleep aids include antihistamines and natural supplements. Common ones include:

  • Diphenhydramine. Diphenhydramine is the active ingredient in many over-the-counter allergy medications as well as other sleep aids. It’s an antihistamine primarily used to treat allergies or the common cold. But because the drug makes many people drowsy, some people use it as a sleep aid. Elderly people should not use this medicine as it can cause dangerous side effects.
  • Doxylamine succinate. This antihistamine, sometimes used as a sleep aid, is also an ingredient in many nighttime cough and cold medicines.
  • Melatonin. This sleep aid is based on a hormone that’s important for your sleep and wake cycles.  Melatonin supplements might help with sleeping trouble related to jet lag. It may help you get to sleep faster, but its effects are usually mild.
  • Valerian. Valerian is an herbal supplement that’s commonly used for insomnia. While valerian is generally safe, it’s not clear how well it works to improve sleep or how much or for how long a person should take it. It may also interact with some prescription medications and boost the sedative effects of other sleep aids.

Over-the-counter sleep aids might help you get through the occasional bout of insomnia, but they probably won’t work long term. If you take antihistamines a lot, your body will get used to it and they won’t make you feel sleepy anymore.

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Prescription sleep aids

There are many types of prescription sleep aids. They work in different ways. Older sleep aids are sedatives known as benzodiazepines. Newer ones work in a similar way, but they have a different chemistry and aren’t benzodiazepines.

Some prescription sleep aids help you fall asleep. Others help you stay asleep. Some do both. Common ones include:

  • Eszopiclone (Lunesta)
  • Estazolam (Prosom)
  • Lemborexant (Dayvigo)
  • Ramelteon (Rozerem)
  • Suvorexant (Belsomra)
  • Temazepam (Restoril)
  • Triazolam (Halcion)
  • Zaleplon (Sonata)
  • Zolpidem (Ambien, Edluar, Intermezzo, Zolpimist)

Most prescription sleep aids act on particular brain receptors to slow you down. But if you use them all the time, they might stop working. It’s generally not a good idea to rely on sleep aids for too long.

Some antidepressants ease insomnia, too. This approach may work especially well if depression or anxiety is a root cause of your trouble sleeping. Antidepressants used to treat insomnia include:

  • Amitriptyline
  • Mirtazapine (Remeron)
  • Trazodone

Sleep Aid Risks and Side Effects

There’s a risk with any sleep aid that it might make you feel groggy or tired the next day. It’s never a good idea to drive or do other potentially hazardous tasks after you’ve taken a sleep aid.

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Side effects of over-the-counter antihistamine sleeping pills include:

  • Drowsiness during the day
  • Dizziness
  • Memory problems
  • Clumsiness
  • Constipation or inability to empty your bladder
  • Blurry vision
  • Dry mouth or throat
  • Nausea

Side effects of prescription sleep aids include:

  • Physical or psychological dependence
  • Poorer quality sleep
  • Drowsiness or sluggishness during the day
  • Headaches
  • Trouble swallowing or breathing
  • Nausea
  • Dizziness
  • Depression
  • Suicidal thoughts or actions

 

Sleep aid complications

It’s hard for many people to stop taking prescription sleep aids after they’ve started. They also can lead to long-term issues that include:

  • Memory loss
  • Mental health problems
  • Learning problems
  • Insomnia that gets worse when medication is stopped

Tips for Taking Sleep Aids

Experts offer these tips for taking sleep aids safely:

  • Try to form better sleep habits or make changes first before you try a sleep aid.
  • Talk to a doctor about the cause of your insomnia to decide the best way to treat it.
  • Continue with your good sleep practices even after you start sleep aids.
  • Don’t plan to take sleep aids long term.
  • Follow all safety guidelines and take prescription sleep aids as prescribed.
  • Don’t drink alcohol or take other sedatives with sleep aids.
  • Only take sleep aids when you have time to get a full night’s rest (at least 7 or 8 hours).
  • Watch for side effects.
  • When you stop taking sleeping aids, do so carefully. You may need to stop gradually.

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Keep in mind that other strategies might help you more than pills. These include:

  • Healthy sleep habits
  • Relaxation techniques such as meditation, yoga, tai chi, or deep breathing
  • Exercise
  • Cognitive-behavioral therapy

Sleep aids can’t replace good sleep habits, but for some people they do help in the short term. If you are struggling with insomnia, it’s a good idea to talk to your doctor about the best options to try.

WebMD Medical Reference

Sources

SOURCES:

Harvard Medical School: “Drugstore sleep aids may bring more risks than benefits.”

Mayo Clinic: “Insomnia,” “Sleep aids: Understand over-the-counter options,” “Prescription sleeping pills: what’s right for you?” “Valerian: A safe and effective herbal sleep aid?”

Medline Plus: “Diphenhydramine.”

Cleveland Clinic: “Sleeping Pills.”

SleepFoundation.org: “Should I Take a Sleep Aid? (And How to Use Them Safely).”

HelpGuide.org: “Sleeping Pills and Natural Sleep Aids.”

University of Michigan Institute for Healthcare Policy and Innovation: “1 in 3 older adults take something to help them sleep – but many aren’t talking to their doctors.”

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