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Insomnia occurs when a person has problems falling asleep (sleep onset) and/or staying asleep (sleep maintenance), and those problems cause sleepiness, slowed thinking, or other impairments during the day. Insomnia is often tied to sleep deprivation, which can have serious consequences for physical and mental health.
To address insomnia, many people turn to sleep aids. These include prescription drugs, over-the-counter medications, and dietary supplements. Every sleep aid for insomnia has potential benefits and downsides, and it’s important for individuals to be informed about their treatment options and talk with a doctor about the best option in their personal situation.
Data from the CDC shows that many adults take sleep aids frequently with more than 8% of adults using a sleep aid at least four times in the previous week. Use of prescription insomnia medications has increased among the elderly, including among people without a formal diagnosis of insomnia.
This research also reflects a trend toward higher usage of over-the-counter (OTC) sleeping pills as well as dietary supplements such as natural sleep aids. A survey by Consumer Reports, for example, found that about 20% of adults said that they used a natural sleep aid in the past year.
Most sleep aids for insomnia work because they have a sedative effect, which means that they make you feel sleepy. That sleepiness may happen rapidly to help you fall asleep or can have a prolonged effect to make it easier to sleep through the night.
The way that a sleep aid produces a sedative effect varies on its chemical composition. Depending on how they work and how they are regulated, sleeping pills for insomnia can be organized into several distinct types.
There are three types of sleep aids for insomnia: prescription medications, over-the-counter drugs, and dietary supplements.
Before a prescription drug can be sold, it must be approved by the Food and Drug Administration (FDA), which carefully reviews data from research studies about its effectiveness and safety. Once the drug is approved, a patient must get a prescription from their doctor in order to obtain the drug from a pharmacy.
Different classes of drugs cause sleepiness based on their chemical composition and how they affect the brain. Types of prescription drugs that are approved by the FDA for insomnia include:
Once a drug has been approved by the FDA for one use, doctors can prescribe it for other conditions, which is known as “off-label” use. Drugs such as antipsychotics and anticonvulsants are occasionally used off-label for insomnia, but there is less data about their safety and effectiveness in treating sleep problems.
Over-the-counter medications can be purchased without a prescription. These pills do not go through the same level of FDA review as prescription medications, but they still must meet certain regulatory standards before they can be sold.
Over-the-counter sleep aids are composed of antihistamines. Antihistamines are frequently used to manage allergies, but because of their sedative effect, they are also marketed as sleeping pills.
Antihistamine sleep aids may be sold as one-ingredient products, or the antihistamine may be combined with active ingredients for other issues such as cough, fever, or congestion. When added to other chemicals, OTC sleep aids are often labeled for “PM” use.
Although people may use them for health reasons, dietary supplements are not formal medications. They do not have to be approved by the FDA, and there is considerably less oversight of sleep aids sold as dietary supplements.
Natural sleep aids, such as melatonin, valerian, or kava, are examples of dietary supplement sleep aids. Brands can create sleep aids made of just one ingredient or a blend, which is why there is a huge diversity of these sleep aids available on the market.
Among the types of sleep aids for insomnia, dietary supplements tend to have the least amount of evidence from studies documenting their benefits and downsides.
The primary benefit of most sleep aids is that they induce drowsiness that lets you get more sleep. They can accomplish this by helping you get to sleep and/or by increasing the chances that you’ll stay asleep through the night.
By improving sleep in the short-term, many sleep aids can alleviate daytime drowsiness and impaired thinking from sleep deprivation. They may help reset your sleep schedule, enabling you to start down a path toward consistent sleep.
That said, most sleep aids are not meant for long-term use. As a result, treatment for insomnia often combines a sleep aid with practical steps, such as improving sleep hygiene, that can help you get quality sleep every night without relying on sleep medication.
Not everyone has the same reaction to a sleep aid, so there’s no hard-and-fast rule about which one works the best. Instead, doctors suggest insomnia treatments based on their patient’s specific situation, including their symptoms and their overall health.
To make these suggestions, doctors may draw on guidance from expert organizations like the American Academy of Sleep Medicine (AASM). AASM organizes panels of sleep experts who review the existing research and make general recommendations about sleep aids.
In the latest AASM guidelines for sleep aids for insomnia, certain prescription drugs are recommended depending on whether a person’s problem is with sleep onset or sleep maintenance. This is because certain sleep aids work quickly and wear off fast, and others start slowly and last a long time. AASM recommends against the use of over-the-counter sleeping pills and dietary supplements like melatonin and valerian.
Potential side effects can vary based on the specific sleep aid and whether the person taking it has any other health problems or medications that they take. In general, there are potential negative effects that can occur with almost all sleep medications, although the likelihood of these effects may be higher with some sleep aids.
In addition to this general list of potential side effects, there are risks that exist only with some sleep aids. For example, some sleeping pills may have detrimental effects on other health conditions. A number of sleep medications are tied to worsening symptoms of depression, and prescription sedatives can cause suppressed breathing that can exacerbate sleep apnea.
Many sleep aids can be habit-forming. This may lead to the drug being taken for too long or at too high of a dose, increasing the risk of side effects.
Abruptly stopping the use of some sleep aids can trigger a resurgence of insomnia symptoms or other withdrawal symptoms.
Because of the possibility of side effects, it is important to talk with a doctor before starting to take any sleep aid.
There is no sleep aid that is universally the safest. Depending on your personal health situation, certain drugs may be more or less risky than others. But this determination should be made by a health professional who can review your situation and discuss the benefits and risks of specific sleep aids in your unique case.
No sleep aid is a silver bullet, and there’s no one best sleep aid for everyone.
Instead, the best sleep aid for insomnia is the one that is most tailored to your needs including the nature of your insomnia, your age, your overall health, and any other medications that you may take. Taking these factors into account, you and your doctor can compare sleep aids and their potential benefits and downsides.
In some cases, the best way to get better sleep may not involve a sleep aid at all. Non-medical treatments for insomnia are often effective, and a doctor can review your options for both medical and non-medical treatments and help you decide what’s best given your circumstances. Improved sleep hygiene, including sticking to regular bed and wake times can be an alternative option for people struggling with sleep problems.
When taken by healthy adults, sleep aids are usually safe for short-term use as long as they are used as directed. However, given the potential for side effects, it’s always safest, regardless of the type of sleep aid, to take it under the guidance of a health professional.
To reduce the risk of negative effects, it’s important to take sleep aids safely. This means taking them at the right time and only with the recommended dosage. Extra doses should be avoided even if sleeping problems continue. In addition, sleep aids should not be mixed with other sedatives, alcohol, or recreational drugs.
For certain people, there may be added risks of taking sleep aids for insomnia. Examples include:
People in these groups or those who have coexisting health conditions should carefully review their options for insomnia treatment with a doctor to determine whether there is a sleep aid that is safe for them to take.