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Sleeping problems are commonplace in America with around 35% of adults failing to get the recommended amount of sleep per night. To try to get better rest, many people take sleep aids, which include prescription drugs, over-the-counter medications, and dietary supplements.
The CDC reports that more than 8% of adults say that they used a sleep aid multiple times in the previous week. With so many types of medications available, many people struggle to compare sleep aids and know which can best help them sleep.
Ultimately, every sleep aid offers potential benefits and poses certain risks. This in-depth look at the different types of sleep aids and how they work is designed to help you understand your options. With this information, you can talk with your doctor to identify the best sleep aid in your case and ensure that you take it safely.
Working closely with your doctor is the best way to compare and pick a sleep aid. A health professional can recommend the best sleep medication for your situation, accounting for factors including:
Whether you’re considering prescription drugs, over-the-counter medications, or dietary supplements, your doctor can explain the potential benefits and risks and help make sure that you take the right dosage at the right time of night.
The American Academy of Sleep Medicine (AASM) is a medical society that organizes expert panels to help guide treatment for sleep problems. AASM’s recommendations for sleep medications offer useful information about sleep aids for insomnia, but your doctor can best explain how those recommendations apply in your individual circumstances.
In some cases, the best sleep aid may not be a medicine at all. Non-drug treatments such as a type of counseling called cognitive behavioral therapy for insomnia (CBT-I) or a focus on sleep hygiene can often make it easier to get to sleep. These approaches may be combined with medications as part of a plan to get better sleep over the long-term without relying on sleep aids.
Prescription sleep medications are only available from a pharmacy, and to obtain them you must have a prescription from your doctor.
Insomnia occurs when a person can’t fall asleep or stay asleep even when they have the chance to do so. It is the most common sleep disorder, and many prescription sleep aids are designed to treat insomnia.
Several kinds of drugs may be used. While they are chemically different, they have many similar effects and potential side effects. The following sections review the types of prescription drugs for insomnia to help you compare your options.
“Z drugs” are a type of sedative-hypnotic medication that makes people feel sleepy. The drug names feature the letter Z, which is how they derive this informal name.
Specific Z Drugs Approved To Treat Insomnia: Zolpidem, eszopiclone, zaleplon
Indicated Usage: Z drugs are approved by the FDA for short-term therapy for insomnia. Some Z drugs can help with both getting to sleep and sleeping through the night, but one only works to fall asleep.
Z-Drug Name | Common Brand Name(s) | FDA-Approved for Insomnia | AASM Recommended for Falling Asleep? | AASM Recommended for Staying Asleep? |
---|---|---|---|---|
Zolpidem | Ambien, Edluar, Zolpimist | Yes | Yes | Yes |
Eszopiclone | Lunesta | Yes | Yes | Yes |
Zaleplon | Sonata | Yes | Yes | No |
Side Effects and Precautions
Who Shouldn’t Use Z Drugs
When taken at the proper timing and dosage, Z drugs are safe for most people. Older adults who are at higher risk of falls should use caution before taking Z drugs.
Studies have found that women are frequently more affected than men by the same dose of these drugs, increasing the risks of next-day impairment. For that reason, women check with their pharmacist about their prescribed dose and inform their doctor if they have any lasting effects of these drugs in the morning.
These sleep aids should not be combined with alcohol, opiates, or other pain medications. Generally, sedatives should not be combined. This can lead to worsening respiratory function.
Orexin receptor antagonists are a newer class of drugs that induce sleep by affecting the sleep-wake cycle. They accomplish this by decreasing production of orexin, a chemical in the brain that causes alertness.
Specific Orexin Receptor Antagonists Approved To Treat Insomnia: Suvorexant, lemborexant
Indicated Usage: Orexin receptor antagonists are approved by the FDA for the treatment of insomnia related to both sleep onset and sleep maintenance. The AASM, though, has not recommended these drugs for help with falling asleep.
Orexin Receptor Antagonist Drug Name | Common Brand Name(s) | FDA-Approved for Insomnia? | AASM Recommended for Falling Asleep? | AASM Recommended for Staying Asleep? |
---|---|---|---|---|
Suvorexantmen | Belsomra | Yes | No | Yes |
Lemborexant | Dayvigo | Yes | – | – |
When AASM recommendations were published in 2017, they did not mention lemborexant, which was not approved by the FDA until late 2019. Although AASM does not have a recommendation for or against lemborexant, recent studies indicate that it may help with both sleep onset and sleep maintenance.
Side Effects and Precautions
Who Shouldn’t Use Orexin Receptor Antagonists
When taken for the prescribed length of time and at the right dosage, these drugs are typically safe for healthy adults. Older adults and people at risk of falls should take these sleep aids with caution.
A melatonin receptor agonist is a drug that increases the amount of melatonin in the body. Melatonin is a hormone that is naturally produced in response to darkness. Melatonin helps the body regulate its internal clock, also known as its circadian rhythm.
Specific Melatonin Receptor Agonists Approved To Treat Insomnia: Ramelteon
Indicated Usage: Ramelteon is approved by the FDA to treat insomnia related to initially falling asleep.
Melatonin Receptor Agonist Drug Name | Common Brand Name(s) | FDA-Approved for Insomnia? | AASM Recommended for Falling Asleep? | AASM Recommended for Staying Asleep? |
---|---|---|---|---|
Ramelteon | Rozerem | Yes | Yes | No |
Side Effects and Precautions
Ramelteon is generally well-tolerated. While it can cause some similar side effects, the risk is generally lower than with other prescription sleep medications.
Who Shouldn’t Use Melatonin Receptor Agonists
Most people can use ramelteon safely. It should not be used by people with sleep maintenance insomnia and should be used with caution in people who have other health conditions that could be affected by this drug.
Benzodiazepines are sedative-hypnotic drugs that work by slowing brain activity to help make you sleepy. These drugs were among the earliest prescription medications for insomnia, but newer drugs are now more likely to be used as an initial therapy. Sometimes called “benzos” for short, benzodiazepines may also be used for anxiety disorders and seizures.
Specific Benzodiazepines Approved To Treat Insomnia: Temazepam, triazolam, estazolam, quazepam, flurazepam
Indicated Usage: Benzodiazepines are approved for short-term use , generally lasting 7-10 days, to treat insomnia. The AASM recommends some benzodiazepines only to help fall asleep while others may help fall asleep and stay asleep.
Benzodiazepine Drug Name | Common Brand Name(s) | FDA-Approved for Insomnia? | AASM Recommended for Falling Asleep? | AASM Recommended for Staying Asleep? |
---|---|---|---|---|
Temazepam | Restoril | Yes | Yes | Yes |
Triazolam | Halcion | Yes | Yes | No |
Estazolam | ProSom | Yes | No | No |
Quazepam | Doral | Yes | No | No |
Flurazepam | Dalmane | Yes | No | No |
Side Effects and Precautions
Who Shouldn’t Use Benzodiazepines
Benzodiazepines are generally not recommended for older adults because of the risk of cognitive impairments that may lead to accidents or falls.
Because of their potential effect on breathing, benzodiazepines are less often used in people who have obstructive sleep apnea. Benzodiazepines should not be used by patients who are also taking opioid drugs.
Antidepressants treat the mood disorder depression. Because these medications can have a sedative effect, they have also been used as sleep aids.
Specific Antidepressants Approved To Treat Insomnia: Doxepin
Indicated Usage: Only one antidepressant has been approved by the FDA specifically for insomnia, and the AASM recommends its use only for helping people stay asleep through the night.
Other drugs approved by the FDA for depression may be prescribed for insomnia even though they are not specifically approved for this. This is known as off-label use, and some drugs that may be used in this way are trazodone, amitriptyline, and mirtazapine.
AASM does not recommend any of these or other antidepressants for off-label use in treating insomnia. A research review found that there is a lack of rigorous evidence about the safety and effectiveness of most antidepressants when used for treating sleeping problems.
Antidepressant Drug Name | Common Brand Name(s) | FDA-Approved for Insomnia? | AASM Recommended for Falling Asleep? | AASM Recommended for Staying Asleep? |
---|---|---|---|---|
Doxepin | Silenor | Yes | No | Yes |
Side Effects and Precautions
Who Shouldn’t Use Antidepressants
Antidepressants like doxepin are often not recommended for older adults because of their effects on cognition and possible cardiovascular effects.
Antipsychotics are drugs that are meant to help people who have mental health disorders in which they struggle to know what is and isn’t real. It also used to treat bipolar disorder, which for many can present as cyclical insomnia.
Some antipsychotics have a sedative effect, but none have been approved by the FDA or recommended by AASM for treating sleeping problems. They may be most useful when prescribed for patients who have co-occurring mental health conditions and insomnia.
Anticonvulsants are designed to stop or reduce seizures or other unwanted muscle activity.
Although they can have a sedative effect, no anticonvulsants are FDA-approved for insomnia, and the AASM does not recommend their use. They must be prescribed off-label when given for sleeping problems.
Over-the-counter (OTC) sleep aids can be purchased in pharmacies and many other stores without a prescription. They must meet certain FDA standards, but they are not individually approved and regulated in the same way as prescription drugs.
OTC sleep aids are antihistamines, a type of allergy medication that commonly have a sedative effect. Two generic antihistamines are found in many brands of OTC sleep aids. These products may contain the antihistamine alone or in combination with other ingredients. Drugs labeled “PM” often contain antihistamine sleep aids.
Specific over-the-counter sleep aids: Diphenhydramine, doxylamine succinate
Indicated usage: Antihistamine sleep aids may be taken for short-term problems with falling or staying asleep; however, AASM does not recommend the use of these drugs for insomnia.
Generic Drug Name | Examples of Common Brand Name(s) | AASM Recommended for Falling Asleep? | AASM Recommended for Staying Asleep? |
---|---|---|---|
Diphenhydramine | Benadryl, Sominex, ZzzQuil | No | No |
Doxylamine | Unisom SleepTabs | – | – |
The AASM’s recommendations do not specifically address doxylamine. A separate analysis of existing research concluded that there is limited evidence supporting OTC antihistamines as a treatment for insomnia.
Side Effects and Precautions
Who Shouldn’t Use Over-the-Counter Sleep Aids
Older people should be cautious about taking OTC sleep aids because of their detrimental effects on coordination and concentration. People with coexisting health conditions should be aware of the effects of antihistamines and talk with a pharmacist or doctor about possible adverse reactions.
Dietary supplements do not require a prescription and are widely available in drug stores, supermarkets, and health stores. They are not tightly regulated and do not require specific FDA approval in order to be sold.
Supplements with melatonin or valerian root are among the most popular sleep remedies, but many other products, including many natural sleep aids, are available from different brands.
Indicated Usage: Dietary supplements do not go through the same kind of rigorous testing as prescription drugs. As a result, there is far less scientific evidence about their safety, effectiveness, and indicated usage. This problem becomes amplified by the wide array of products that use diverse blends of ingredients.
The intended use should be described on each product along with a list of the ingredients and recommended dosage. In most cases, dietary supplement sleep aids are meant to be taken before bed to assist with falling or staying asleep.
In reviewing available evidence, the American Academy of Sleep Medicine chose not to recommend melatonin or valerian as treatments for insomnia. AASM found too little data about other natural sleep aids or dietary supplements to make a recommendation.
Side Effects and Precautions
Most dietary supplements can be used safely by otherwise healthy adults; however, there can be unwanted adverse effects.
Who Shouldn’t Use Dietary Supplements
It is often safe for healthy adults to take natural sleep aids and other dietary supplements; however, because many of these products have not been extensively tested, their effects may be unpredictable.
Older adults should be cautious because of the potentially strong sedative effects of some sleep aids as well as the potential to interact with other medications.
Pregnant women should talk with their doctor before taking any sleep aid, including dietary supplements like natural sleep aids. Some sleep medications can have harmful effects during pregnancy for either a woman or their baby. Breastfeeding women should also consult with a doctor before taking any sleep aid.
Parents should use caution before giving their child any kind of sleep aid. Most sleep medications are tested primarily in adults, and their safety and effectiveness in children may be unclear. A pediatrician can offer the most tailored advice about the optimal sleep aid for a child’s situation.
The cost of sleep aids can vary considerably. For prescription medication, the cost depends on a person’s health insurance coverage and whether a generic version of the drug is available.
The price of over-the-counter medications and dietary supplements depends on the brand, formulation, and where they are purchased. Shoppers can frequently compare prices online or in different stores.
No matter what kind of sleep aid you use, it’s important to take precautions. Some basic principles of taking sleep aids safely include: