Sleeping Pills

This article provides an overview of prescription sleeping pills, including their common types, uses and benefits, and side effects, as well information on long-term treatment of sleep issues.

Key Takeaways:

• Prescription sleeping pills are designed to help individuals with insomnia or other sleep issues. They have various effects, but primarily work by calming brain activity or promoting sedation.

• Most sleeping pills are prescribed for short-term use only, due to their risk of dependence or addiction. Furthermore, there are many possible side effects and dangers.

• Cognitive-behavioral therapy, sleep hygiene, and other strategies are generally preferred over sleeping pills for long-term treatment of sleep issues.

Understanding Prescription Sleeping Pills

Prescription sleeping pills are used for individuals who have sleep issues, such as trouble falling asleep, staying asleep, or with overall sleep quality. They are often used in short-term situations of sleep disruption, such as with stress or travel. ^[1]

Some individuals with significant sleep concerns may use prescription sleeping pills over the long-term, if the benefits outweigh the risks. They are generally not the first choice of treatment for longstanding sleep issues, but they may be implemented after other measures have not worked appropriately (e.g. sleep hygiene, therapy). ^[1]

How Do Sleeping Pills Work?

The exact mechanisms of sleeping pills differ depending on the specific drug involved. In general, sleeping pills work by slowing down brain activity and decreasing overall alertness. For example, some sleeping pills increase GABA, which is an inhibitory neurotransmitter that helps with anxiety, sleep onset, and general relaxation. Other sleeping pills may decrease histamine, which in turn lowers alertness and may cause drowsiness or sedation. ^[2]

Conditions Traditionally Treated with Sleeping Pills

Sleeping pills are traditionally used to treat individuals who have insomnia, which is characterized by difficulty falling and/or staying asleep, along with feeling unrefreshed after sleep. Some prescription sleeping pills are approved only for short-term use, while others can be prescribed for short or long-term use.

Specific types of insomnia that prescription sleeping pills are used for include:

• Sleep onset insomnia (difficulty falling asleep)

• Sleep maintenance insomnia (difficulty staying asleep)

• Combined sleep onset and sleep maintenance insomnia

• Short-term insomnia

Off-Label Uses

(Note: I did not find any info about off-label uses of sleeping pills).

Types of Prescribed Sleeping Pills

There are many types of sleeping pills, which fall into several different classes. Specific categories of sleeping pills are: ^{[1] [4] [5]}

• Antihistamines

• Barbiturates

• Benzodiazepines

• Nonbenzodiazepine benzodiazepine receptor agonists (Z-drugs)

• Melatonin receptor agonists

• Orexin receptor antagonists

Certain types of tricyclic antidepressants, antipsychotics, and second-generation antidepressants may also be used off-label for sleep issues. They typically aren’t the first recommended treatments. ^[5]

Antihistamines

Antihistamines block the production of histamine, which can lead to drowsiness and decreased alertness. There are over-the-counter antihistamines as well, but one commonly prescribed antihistamine is hydroxyzine.

Barbiturates

Barbiturates are depressants, meaning they slow down activity in the central nervous system (CNS). This can lead to faster sleep onset and reduced awakenings. However, they are not prescribed often due to their higher chance of side effects. ^{[4] [6]}

Examples of barbiturates used for sleep include: ^{[1] [4]}

• Amobarbital

• Phenobarbital

• Butabarbital

Benzodiazepines

Benzodiazepines increase the effects of GABA in the CNS, which leads to calming effects in the brain and body. They can reduce anxiety, promote physical relaxation, help individuals fall asleep faster, and stay asleep longer. ^[4]

Common benzodiazepines used for sleep include: ^{[4] [5]}

• Estazaolam

• Flurazepam

• Quazepam

• Temazepam

• Trizaolam

Nonbenzodiazepine Benzodiazepine Receptor Agonists (Z Drugs)

Nonbenzodiazepine benzodiazepine receptor agonists, also called “Z drugs) have similar actions as benzodiazepines, but were designed to be safer and have reduced side effects. They help individuals to fall asleep and stay asleep. ^{[4] [5]}

Common Z drugs include:

• Zolpidem

• Zaleplon

• Eszopliclone

Melatonin Receptor Agonists

Melatonin receptor agonists increase the effects of melatonin, which is an important hormone that regulates sleep-wake cycles, among other effects. They can be useful for insomnia and for sleep-wake disorders, such as Non-24.

The two main melatonin receptor agonists are ramelteon and tasimelteon. ^{[1] [5]}

Orexin Receptor Antagonists

Orexin receptor antagonists decrease the effects of orexin, which is a neurotransmitter that promotes wakefulness and alertness. Thus, these medications promote sleepiness and help individuals to fall and stay asleep. ^[5]

Specific orexin receptor antagonist medications include: ^{[1] [5]}

• Suvorexant

• Lemborexant

• Daridorexant

Over-the-Counter Sleeping Pills

There are many over-the-counter (OTC) sleeping pills available today. Many OTC sleeping pills contain antihistamines, such as diphenhydramine and doxylamine. Common drugs that use these ingredients are Unisom, Zzzquil, and Benadryl.

Another common ingredient found in OTC sleeping pills is melatonin. This may help with sleep-wake cycle regulation, especially in cases of shift work or jet lag. ^{[4] [5]}

Many OTC sleeping pills also use a variety of herbal ingredients, such as chamomile, hops, lavender, passionflower, and valerian. These herbs promote calming actions in the brain, such as increased GABA activity. However, they are unregulated, so each supplement’s safety and efficacy is not always clear. ^{[1] [3] [4]}

How are Sleeping Pills Prescribed?

Sleeping pills come in various forms, depending on the type of drug used. Common forms include capsules, tablets, and liquid. Some sleeping pills are available in specific duration forms too, such as immediate-release, extended-release, or controlled release. ^{[4] [6]}

Each prescription sleeping pill has a range of doses that are deemed safe and effective. Most often, your doctor will start you on the lowest effective dose, and work up from there if needed. This helps to minimize side effects.

When to Seek a Prescription

Most healthcare professionals do not start individuals on sleeping pills before other measures are implemented. This is because many other natural factors can be implemented to improve sleep, and they come with a lower risk of side effects. Examples include psychotherapy, exercise, sleep hygiene practices, maintaining a regular sleep/wake schedule, stress management, and minimizing alcohol and caffeine intake. ^{[1] [2]}

However, it may be relevant to seek a prescription if you’re experiencing significant sleep difficulties that have not responded to the above methods. This is particularly true if you’ve experienced sleep problems for several months or longer.

In addition, you may find sleeping pills beneficial in short-term situations characterized by high stress, such as after the death of a loved one or divorce. ^[3]

Common Side Effects of Sleeping Pill Medications

There are many possible side effects of sleeping pill medications. They vary from drug to drug, but common side effects include: ^{[3] [6]}

• Drowsiness

• “Hangover effect” the next day

• Drowsiness

• Trouble concentrating

• Dizziness

• Disorientation

• Nightmares

• Memory issues

• Agitation

• Headache

• Restlessness

• Tiredness

• Constipation

• Diarrhea

• Dry mouth

• Muscle weakness

• Heartburn

• Gas

• Nausea

• Worsened snoring and/or sleep apnea

Rare Side Effects

There are also several less common side effects of sleep medications. One of the most significant is parasomnia, which refers to abnormal movements and behaviors during sleep. These side effects are particularly known to be caused by Z drugs. They may cause you to sleepwalk, eat, take medications, talk, or even drive during sleep, without awareness of what’s actually going on. The next morning, you may have no recollection of what happened. ^{[3] [6] [7]}

Other rare side effects of sleeping pills include: ^[6]

• Low blood pressure

• Muscle spasms

• Sensitivity to sunlight

• Shaking

• Tic-like movements

• Allergic reactions

Are They Addictive?

Some sleeping pills have the potential for dependence and addiction, particularly benzodiazepines and nonbenzodiazepine benzodiazepine receptor agonists. This is why these, and most other sleeping pills, are prescribed for short-term use only. ^{[2] [3]}

Even for sleeping pills that aren’t considered addictive, long-term use can lead to physical dependence, in which you may be unable to fall asleep without the medication. Over time, your body may also require higher amounts of the drug to achieve the same benefits. Stopping the medication or decreasing the dose may lead to withdrawal symptoms, such as trouble sleeping, anxiety, headache, and mood changes. ^{[3] [6]}

Risks vs Benefits

Prescription pills can be very valuable and helpful in certain situations, but they also have several risks. Understanding the risks vs benefits of sleeping pills can provide insight into whether or not these medications are right for you. Listed below is a table outlining the main risks vs benefits of sleeping pills.

Who Shouldn’t Take Them

Prescription sleeping pills pose a greater risk towards certain individuals, particularly elderly adults, pregnant and nursing women, children, and individuals with certain medical conditions.

Elderly adults are more prone to side effects and should either avoid usage or take a lower dose. Of particular concern is the risk of falls and injuries. ^{[2] [3] [4]}

Sleeping pills may cause birth defects or other pregnancy-related complications and should be used very cautiously or not at all. Short-term use may be used for severe sleep issues. ^{[4] [6]}

There are no approved prescription sleeping pills for children. Parents should also generally avoid giving their child OTC sleeping pills and instead focus on improving sleep through behavior/lifestyle strategies. ^[3]

It’s always essential to speak with your doctor to determine which prescription sleeping pill, if any, is right for your individual needs and circumstances. They will help create the best treatment plan for you.

Long-Term Treatment for Sleep Issues

Sleeping pills are very rarely used as long-term sleep treatments, due to their risk of dependence and addiction, and side effects. Instead, the best way for most people to approach long-term treatment for sleep issues is to focus on certain behaviors, habits, and lifestyle changes that promote better sleep.

One of the primary ways this is achieved is through cognitive behavioral therapy for insomnia (CBT-I). CBT-I has been shown to be as effective as sleep medications, with no side effects, a much lower rate of relapse, and an ability to promote long-term sleep benefits. ^[8]

CBT-I involves the following components: ^{[2] [8]}

• Sleep hygiene: Focusing on specific factors and habits that are relevant to sleep quality. This includes:

• Avoiding alcohol, caffeine, nicotine, large meals, vigorous exercise and other known disruptors before bed

• Sleeping in a cool, quiet, and dark room (use eye mask, ear plugs, fan, temperature control, and other agents if/when needed)

• Shut off electronics and bright lights in the evening or at least an hour before bed

• Stimulus control: Ensuring that you only use your bed for sleeping, and only go to bed when you're sleepy. After 15 to 20 minutes without sleeping, get out of bed and do something lightly relaxing

• Sleep restriction: Restricts the time you spend in bed to improve sleep efficiency. Starts low and then gradually increases until you reach your optimal number of hours.

• Relaxation techniques: Deep breathing, progressive muscle relaxation, and other exercises to calm the mind and body

• Cognitive therapy: Focusing on specific thoughts that may be interfering with sleep, such as:

• Anxiety about not sleeping

• Belief that poor sleep ruins the next day

• Beliefs that one is unable to sleep no matter what

In addition to CBT-I, other forms of psychotherapy may be useful, especially if your sleep issues are due to stress, anxiety, or other mental health concerns.

Lastly, it’s important to get tested for any medical conditions that may be causing your sleep problems, especially if you’ve been having trouble sleeping for a long time. Possible medical conditions that can cause sleep issues include (but aren’t limited to): ^{[2] [4]}

• Primary sleep disorders:

• Obstructive sleep apnea

• Restless legs syndrome

• Circadian rhythm sleep-wake disorders

• Neurological disorders (e.g. Parkinson’s)

• Psychiatric disorders (e.g. depression, anxiety, schizophrenia)

• Cancer

• Chronic pain

• Arthritis

Final Thoughts

Prescription sleeping pills can be valuable treatments when used safely and appropriately, especially in the short-term. However, they have many possible side effects and come with a risk of dependence. Ultimately, it’s essential to talk with your doctor to determine the most appropriate treatment plan to help you sleep better, not just temporarily, but for the long-term.

Common Questions About Sleeping Pills

Listed below are common questions about prescription sleeping pills.

How long can you take sleeping pills for?

Most sleeping pills are designed to be used short-term, typically no more than 4 weeks. However, in some cases, the benefits of long-term use may outweigh the risks. Always talk with your doctor to see what’s best for you.

Which sleeping pills are most commonly prescribed?

The most commonly prescribed sleeping pills are nonbenzodiazepine benzodiazepine receptor agonists (Z drugs), such as zaleplon (Sonata®), zolpidem (Ambien®), and eszopiclone (Lunesta®).

Can they be dangerous?

Yes, sleeping pills can be dangerous. They can cause falls, drowsiness, dangerous sleep behaviors (e.g. sleepwalking), and may cause dependence or addiction.