Sleeping Pills & Natural Sleep Aids
What’s Best for You? What You Need to Know About Sleep Aids and Sleeping PillsIt’s the middle of the night, and you’re staring at the bedroom ceiling, thinking about work, or bills, or the kids. Sleep just won’t come, so you again reach for a sleeping pill, But did you know sleeping pills and sleep aids vary in safety and effectiveness and are rarely meant for more than short-term use? Persistent insomnia is usually a symptom of an underlying medical or psychological problem that cannot be cured with sleeping pills. Instead, learn about safer and more effective ways to end sleepless nights.
This information is not intended to be a substitute for medical advice. Consult your physician before taking any sleep medications, discontinuing their use, or changing the prescribed dosage.
In general, sleeping pills and sleep medications are most effective when used sparingly for short-term situations, such as traveling across time zones or recovering from a medical procedure. Sometimes sleep aids and medications are used briefly at the beginning of behavioral treatment for insomnia, especially if the sleep deprivation has been severe. If sleeping pills are used over the long term, they are best used “as needed” to avoid dependence and tolerance. Working with your healthcare professional is essential to ensure you get the maximum benefit and can safely monitor potential side effects.
The trouble with sleeping pills, over-the-counter (OTC) sleep aids & medications
The idea that a pill can instantly solve your sleep problems is very appealing. Unfortunately, sleeping pills don't cure the underlying cause of insomnia, and in fact can often make the problem worse in the long run. Concerns regarding over-the-counter (OTC) and prescription sleep aids include:
- Side effects. Side effects can be severe, including prolonged drowsiness the next day, confusion, and forgetfulness.
- Drug tolerance. You may, over a period of time, build up a tolerance to sleep aids, and you will have to take more and more for them to work, which in turn can lead to more side effects.
- Drug dependence. You may come to rely on sleeping pills to sleep, and will be unable to sleep or have even worse sleep without them.
- Withdrawal symptoms. If you stop the medication abruptly, you may have withdrawal symptoms, such as nausea, sweating and shaking.
- Drug interactions. Sleeping pills can interact with other medications. This can worsen side effects and sometimes be dangerous, especially with prescription painkillers and other sedatives.
- Rebound insomnia. If you need to stop taking sleeping pills, sometimes the insomnia can become even worse than before.
- Masking an underlying problem. There may be an underlying medical or mental disorder, or even a sleep disorder, causing your insomnia that can’t be treated with sleeping pills.
All prescription sleeping pills have side effects, which can vary depending on the specific drug, the dosage, and how long the drug lasts in your system. Common side effects include headache, muscle aches, constipation, dry mouth, daytime sleepiness, trouble concentrating, dizziness, unsteadiness, and rebound insomnia.
Some serious risks of sleeping pills
Sedative-hypnotic drug products (benzodiazepines and non-benzodiazepines) can cause severe allergic reaction, facial swelling, memory lapses, hallucinations, suicidal thoughts or actions, and complex sleep-related behaviors like sleep-walking, sleep-driving (driving while not fully awake, with no memory of the event) and sleep-eating (eating in the middle of the night with no recollection, often resulting in weight-gain). If you experience any unusual sleep-related behavior, consult your doctor immediately.
The main ingredient in over-the-counter sleeping pills is an antihistamine. Antihistamines, in brand name medications such as Benadryl, are generally taken for allergies, hay fever and common cold symptoms. While the positive effects have not been substantiated through research, the side effects, such as next-day drowsiness, can be common and severe.
Common OTC sleep medications include:
- Diphenhydramine (found in brand names like Nytol, Sominex, Sleepinal, Compoz)
- Doxylamine (brand names such as Unisom, Nighttime Sleep Aid)
Some other OTC sleep aids combine antihistamines with the pain reliever Acetaminophen (found in brand names like Tylenol PM and Aspirin-Free Anacin PM). Others, such as NyQuil, combine antihistamines with alcohol.
OTC sleep aids are meant to be used for short-term insomnia only. Sleep experts generally advise against the use of over-the-counter (OTC) sleep aids because of side effects, questions about their effectiveness, and lack of information about their safety over the long-term.
Side effects of OTC sleep aids and sleeping pills
The antihistamines used in OTC sleep aids can produce common side effects, some of them severe. As with any medication, it is advisable to consult your doctor before taking over-the-counter sleep aids. This is especially important if you have glaucoma, trouble urinating due to an enlarged prostate gland, or a breathing problem such as emphysema or chronic bronchitis. Talk to your doctor if you're currently taking an antidepressant such as a monoamine oxidase inhibitor (MAOI) or did so as recently as two weeks ago. Also check with your doctor first if you take any other drugs for depression or Parkinson's disease. Women who breast-feed should avoid OTC sleep aids.
Common side effects of OTC sleep aids and sleeping pills
- Moderate to severe drowsiness the next day
- Dizziness and forgetfulness
- Clumsiness, feeling off balance
- Constipation and urinary retention
- Blurred vision
- Dry mouth and throat
There are several different types of prescription sleeping pills, classified as sedative hypnotics. In general, these medications act by working on receptors in the brain to slow down the nervous system. Some medications are used more for inducing sleep, while others are used for staying asleep. Some last longer than others in your system (a longer half life ), and some have a higher risk of becoming habit forming.
Benzodiazepine sedative hypnotic sleeping pills
Benzodiazepines are the oldest class of sleep medications still commonly in use. Benzodiazepines as a group are thought to have a higher risk of dependence than other insomnia sedative hypnotics. All are classified as controlled substances. Primarily used to treat anxiety disorders, benzodiazepines that have been approved to treat insomnia include estazolam (brand name ProSom), flurazepam (Dalmane), quazepam (Doral), temazepam (Restoril), and triazolam (Halcion).
Drawbacks to benzodiazepine sleeping pills
- You can become both physically and psychologically dependent on benzodiazepines. When you're on the pills for a period of time, you may believe that you can’t sleep without them, and once you stop taking them, you may actually experience physical withdrawal symptoms like anxiety and rebound insomnia.
- Sleeping pills can lose their effectiveness if used on a nightly basis, because the brain receptors become less sensitive to their effects. In as little as three to four weeks, benzodiazepines can become no more effective than a sugar pill.
- The overall quality of your sleep can be reduced, with less restorative deep sleep and dream sleep.
- You may experience next day cognitive slowing and drowsiness (the hangover effect), which may be even worse than the sluggishness you feel from actual sleep deprivation.
- Even if the medication is effective while taking it, insomnia returns once you stop.
Non-benzodiazepine sedative hypnotic sleeping pills
Some newer medications don’t have the same chemical structure as a benzodiazepine, but act on the same area in the brain. They are thought to have fewer side effects, and less risk of dependency, but are still considered controlled substances. They include zalepon (Sonata), zolpidem (Ambien), and eszopiclone (Lunesta), which have been tested for longer-term use, up to six months.
Drawbacks to non-benzodiazepine sleeping pills
Generally, non-benzodiazepines have fewer drawbacks than benzodiazepines, but that doesn’t make them suitable for everyone. Some may find this type of sleep medication ineffective at helping them sleep, while the long-term effects remain unknown. The U.S. Food and Drug Administration (FDA) recently directed the manufacturers of Ambien and similar sleeping pills to lower the standard dosage due to the serious risk of morning grogginess while driving, especially in women patients. Other side effects include:
- Drug tolerance
- Rebound insomnia
- Headaches, dizziness, nausea, difficulty swallowing or breathing
- In some cases, dangerous sleep-related behaviors such as sleep-walking, sleep-driving, and sleep-eating
- New or worsening depression; suicidal thoughts or actions
Melatonin receptor agonist hypnotic sleeping pills
Ramelton (Rozerem) is the newest type of sleep medication and works by mimicking the sleep regulation hormone melatonin. It has little risk of physical dependency but still has side effects. It is used for sleep onset problems and is not effective for problems regarding staying asleep.
Ramelteon’s most common side effect is dizziness. It may also worsen symptoms of depression and should not be used by those with severe liver damage.
Antidepressants used as sleeping pills
The FDA has not approved antidepressants for the treatment of insomnia, nor has their use been proven effective in treating sleeplessness. However, some physicians believe insomnia is related to depression. As with all depression medication, there is a small but significant risk of suicidal thoughts or worsening of depression, particularly in children and adolescents.
If you decide to try sleeping pills, sleep aids, or sleep medications, talk to your doctor about:
- Other medications you are taking, including non-prescription medications such as pain relievers and allergy medicines, as well as herbal supplements. Combining medications can be very dangerous.
- Specific instructions for decreasing and/or terminating use. In some cases, stopping medication abruptly can cause uncomfortable side effects and even rebound insomnia.
- Using the medications intermittently, rather than nightly, in order to decrease the negative side effects and to increase the sleeping pills’ efficiency when you do use them. This is not appropriate with all medications, as some cause withdrawal symptoms when stopped abruptly.
- Other medical conditions you have. Some sleep medications can have serious side effects for people with medical problems such as high blood pressure, liver problems, glaucoma, depression, and breathing difficulties.
Important tips when taking sleeping pills
When taking sleeping pills, sleep aids, or sleep medications, remember to:
- Only take a sleeping pill when you will have enough time to get a full night of sleep (seven to eight hours). Otherwise you may feel very drowsy the next day.
- Carefully read the package insert that comes with your medication. Pay careful attention to the potential side effects.
- Never drink alcohol near the time you take a sleeping pill. Not only will alcohol disrupt your sleep even more, it can interact dangerously with the sleeping pill.
- Never drive a car or operate machinery after taking a sleeping pill. This tip is especially important when you first start taking a new sleep aid, as you may not know how it will affect you.
- Follow directions closely, starting with a very small dose and increasing gradually, according to the doctor’s prescription. Find out whether you should take your medication with or without food. For some medications, certain foods must be avoided.
Many people with insomnia choose herbal remedies for treatment, although their effectiveness is unclear. Some remedies, such as lemon balm or chamomile tea are generally harmless, while others can have more serious side effects and can interfere with prescribed medications, which can be dangerous. St. John’s Wort, for example, can limit the effectiveness of many prescribed medications such as blood thinners, birth control pills, and some anticancer medications. Check with your healthcare professional if you are trying an herbal remedy.
Herbal sleep aids
There are several herbs thought to help sleep, including chamomile, valerian root, kava kava, lemon balm, passionflower, lavender, and St. John’s Wort. Many people drink chamomile tea for its gentle sedative properties, although it may cause allergic reactions in those with plant or pollen allergies. While there is some data showing valerian to be useful for insomnia, at high doses it can cause vivid dreams, blurred vision, changes in heart rhythm, and excitability.
Melatonin as a sleep aid
Melatonin is a naturally occurring hormone that increases at night. It is triggered by darkness and its levels remain elevated throughout the night until suppressed by the light of morning. Although most studies have found melatonin to be no more beneficial than a sugar pill (placebo), there have been some positive results when used to help jet lag and night shift workers. Simple exposure to light at the right time, however, might be just as effective.
Tryptophan and L-tryptophan as sleep aids
Tryptophan is a basic amino acid used in the formation of the chemical messenger serotonin, a substance in the brain that helps tell your body to sleep. L-tryptophan is a common byproduct of tryptophan, which the body can change into serotonin. Some studies have shown that L-tryptophan can help people fall asleep faster. Results, however, have been inconsistent.
Research has shown that changing your sleep environment and bedtime behaviors is one of the most effective ways to combat insomnia. Even if you decide to use sleeping pills or medications in the short term, experts recommend making changes in your lifestyle and bedtime behavior as a long-term remedy to sleep problems. Behavioral and environmental changes can have more of a positive impact on sleep than sleeping pills, sleep aids, or other medications, without the risk of side effects or dependence.
Cognitive behavioral therapy (CBT) as an alternative to sleeping pills
Many people complain that frustrating, negative thoughts and worries prevent them from sleeping at night. Cognitive-behavioral therapy (CBT) is a form of psychotherapy that treats problems by modifying dysfunctional or destructive thoughts, emotions and patterns of behavior. CBT is a relatively simple treatment that can improve sleep by changing your behavior before bedtime as well as changing the ways of thinking that keep you from falling asleep. It also focuses on improving relaxation skills and changing lifestyle habits that affect sleeping patterns.
CBT vs. sleeping pills
A recent study at Harvard Medical School found that cognitive behavior therapy (CBT), including relaxation exercises and the adoption of good sleep habits, was more effective at treating chronic insomnia than prescription sleep medication. CBT produced the greatest changes in patients’ ability to fall asleep and stay asleep, and the benefits remained even a year after treatment ended.
Source: National Institutes of Health (NIH)
Relaxation techniques as an alternative to sleeping pills
Relaxation techniques that can relieve stress and help you sleep include simple meditation practices, progressive muscle relaxation, yoga, tai chi, and the use of deep breathing. With a little practice, these skills can help you unwind at bedtime and improve your sleep better than a sleeping pill or sleep aid. Try:
- A relaxing bedtime routine. Focus on quiet, soothing activities, such as reading, gentle yoga, or listening to soft music before bed. Keep the lights low to naturally boost melatonin.
- Abdominal breathing. Most of us don’t breathe as deeply as we should. When we breathe deeply and fully, involving not only the chest, but also the belly, lower back, and ribcage, it can actually help the part of our nervous system that controls relaxation. Close your eyes and try taking deep, slow breaths, making each breath even deeper than the last. Breathe in through your nose and out through your mouth. Make each exhale a little longer than each inhale.
- Progressive muscle relaxation is easier than it sounds. Lie down or make yourself comfortable. Starting with your feet, tense the muscles as tightly as you can. Hold for a count of 10, and then relax. Continue to do this for every muscle group in your body, starting with your feet and working your way up to the top of your head.
Exercise as an alternative to sleeping pills
Studies have shown that exercise during the day can improve sleep at night. When we exercise we experience a significant rise in body temperature, followed a few hours later by a significant drop. This drop in body temperature makes it easier for us to fall and stay asleep. The best time to exercise is late afternoon or early evening, rather than just before bed.
Aerobic exercises are the best to combat insomnia as they increase the amount of oxygen that reaches the blood. Try exercise such as jogging, walking briskly, using a stationary bike or treadmill, dancing, or jumping rope. Check with your doctor first to make sure you are healthy enough for physical activity and remember to stretch before and after your workouts.
How much exercise will improve sleep?
One study by Stanford University of Medicine researchers concluded that people who performed regular, moderately intense aerobic exercise for 30 to 40 minutes four times a week, slept almost an hour longer than those who did no exercise at all. As well as enjoying better quality sleep, the exercisers were also able to cut the time it took to fall asleep by half.
Source: National Institutes of Health
More help for sleep
- Can't Sleep? – Causes, Cures, and Treatments for Insomnia
- How to Sleep Better – Tips for Getting a Good Night’s Sleep
- How Much Sleep Do You Need? – Sleep Cycles & Stages, Lack of Sleep, and How to Get the Hours You Need
- Not Sleeping Well? – There May Be a Medical Cause
Sleep pill alternatives
- How to Stop Worrying – Self-Help Strategies for Anxiety Relief
- Relaxation Techniques for Stress Relief – Finding the Relaxation Exercises That Work for You
- Natural Supplements That Work – Alternative Medicines for Improving Mental Health
Resources and references
General information about sleep aids, sleeping pills, and sleep medication
Taking Sleep Medications for Insomnia – Guidelines to make sure that you use sleep medications and sleeping pills safely and properly. (American Academy of Sleep Medicine)
Can't Sleep? What to Know About Insomnia – An overview of insomnia and the sleep aids, sleeping pills, and over-the-counter sleep medications commonly used to treat it. (National Sleep Foundation)
Myths and Facts – Myths and facts about sleeping smart. (National Sleep Foundation)
Natural sleep aids, over-the-counter sleeping pills & herbal supplements
Do Drugstores Have the Cure for Your Insomnia? Taking a Closer Look at Common Treatments – An investigative article that looks at various over-the-counter sleep aids, including antihistamines, melatonin, and herbal remedies, and reports on their effectiveness. (American Academy of Sleep Medicine)
Over-the-counter sleep aids and supplements: What's best and safe? – Review of available over the counter sleep aids and herbal supplements. (Mayo Clinic)
Melatonin and Sleep – Discussion of the natural sleep aid melatonin’s effects on insomnia. (National Sleep Foundation)
Valerian – A review of the use of valerian for treating insomnia and other sleep disorders. (Office of Dietary Supplements, National Institutes of Health)
Prescription sleeping pills and sleep medications
Prescription sleeping pills: What's right for you? – Common uses of sleeping pills, sleep medications, and other effective treatments for insomnia. (Mayo Clinic)
Best Buy Drugs for Insomnia (PDF) – provides a review of insomnia medications and their side effects. (Consumer Reports)
Medline Plus: Drugs and Supplements – Prescription and over-the-counter medication information from the National Institutes of Health. (Medline Plus)
Taking Sleep Medications for Insomnia – Guidelines to make sure that you use sleep medications and sleeping pills safely and properly. (American Academy of Sleep Medicine)
Insomnia: Medications – General guidelines on prescription sleeping pills and sleep medications for insomnia, as well as natural remedies. (University of Maryland Medical Center)
Alternatives to sleeping pills and over-the-counter (OTC) sleep aids & medications
Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills – Discusses benefits of CBT versus popular sleep medications and sleeping pills. (Mayo Clinic)
Cognitive Behavioral Therapy of Insomnia – How CBT is used as an alternative to sleeping pills to treat insomnia. (Psychology Today)
Cognitive Behavioral Therapy for Insomnia – What is CBT and how does it work as a natural sleep aid? (National Sleep Foundation)