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Sleeping problems are commonplace, and one of the most prevalent sleep disorders is insomnia, which affects between 10 and 30 percent of adults in the United States.
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.
How Commonly Used Are Sleep Aids for Insomnia?
Sleeping pills or other sleep aids are a common component of treatment for insomnia. Studies have found consistently rising rates of sleep aid use with one study estimating around 19% of adults
taking at least one sleep medication in the last month.
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.
How Do Sleep Aids for Insomnia Work?
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.
What Are the Types of Sleep Aids for Insomnia?
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:
- Z Drugs: These medications slow down activity in the brain, which prompts a sedative effect.
- Orexin receptor antagonists: These drugs block production of orexin, a chemical in the brain that makes you feel alert.
- Benzodiazepines: Benzodiazepines are like Z drugs in that they decrease brain activity to induce sleepiness. These were among the first prescription drugs to be used for insomnia.
- Melatonin receptor agonists: This type of medication increases the level of the hormone melatonin in the body, which promotes sleepiness.
- Antidepressants: These drugs were first designed to treat depression but were later found to have a sedative effect. Only one antidepressant is formally approved by the FDA for insomnia.
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.
What Are the Potential Benefits of Sleep Aids for Insomnia?
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.
What Sleep Aids for Insomnia Work the Best?
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.
What Are the Potential Risks of Sleep Aids for Insomnia?
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.
- Lingering next-day effects: As many as 80% of people taking sleep aids say that the sedative effect may persist after they have woken up, creating excess drowsiness or slowed thinking when a person should be alert. This issue is most worrisome for people who drive in the morning and may be at a higher risk of auto accidents.
- Confusion or loss of coordination: A strong sedative effect can make a person feel confused, dizzy, or unable to concentrate. As a result, they may be at risk for falls or other accidents right before bed or during the night.
- Abnormal behavior: After taking sleep aids, some people engage in strange behavior while remaining partially asleep and unaware of their actions. This behavior can range from simple things like talking, to more complex actions like sleepwalking or trying to drive.
- Allergic reaction: These responses are quite rare, but some people have allergic reactions to sleep aids.
- Drug interaction: A sleep aid may interact with other medications and potentially change their potency or how they affect the body.
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 they are less carefully regulated, dietary supplements are more likely to have mislabeled dosage information or be tainted with chemicals not listed on the bottle.
Because of the possibility of side effects, it is important to talk with a doctor before starting to take any sleep aid.
What Are the Safest Sleep Aids for Insomnia?
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.
What’s the Best Sleep Aid for Insomnia?
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.
Are Sleep Aids for Insomnia Safe?
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:
- Older adults: Problems of disorientation and risk of falls from sedative medications make some sleep aids dangerous for older adults.
- Children: Even at lower doses, children can have different reactions to drugs than adults. Given a child’s ongoing physical and mental development, those reactions can be detrimental to their health.
- Pregnant and breastfeeding women: Depending on the sleep aid, there may be health risks for a woman or her child when these medications are taken during pregnancy or while breastfeeding.
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.
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