Sleep Aids for Insomnia

Sleep aids are medications, herbs, and supplements that can help alleviate insomnia and improve your sleep. Medications may be over-the-counter (OTC) or prescription.

Getting good sleep is important. Bouts of insomnia can have a major impact on your health and quality of life.

This article looks at various sleep aids, helpful lifestyle changes, and how to talk to your healthcare provider about prescription sleep medications.

Over-The-Counter Sleep Aids

OTC sleeping pills cause sleepiness as a side effect. They're a common choice for people who have trouble falling asleep.

Many of these products claim to provide immediate results. However, few can deliver on their promises.

Diphenhydramine

A lot of OTC sleep aids, especially those with "PM" in the brand name, contain the active ingredient diphenhydramine. Advil PM and ZzzQuil are two of many diphenhydramine products.

Diphenhydramine is the drug in Benadryl, an antihistamine. Typically used to treat allergies, diphenhydramine and other first-generation antihistamines can also cause sleepiness.

While it may help with the occasional sleepless night, the American Academy of Sleep Medicine does not recommend diphenhydramine as a treatment for chronic insomnia.

Diphenhydramine can cause serious side effects, including difficulty urinating and vision problems. If you experience either of these side effects, call your healthcare provider. 

Other side effects of diphenhydramine include:

  • Constipation
  • Dizziness 
  • Dry mouth, nose, and throat
  • Drowsiness
  • Excitement
  • Headache
  • Increased chest congestion
  • Loss of appetite
  • Muscle weakness
  • Nausea
  • Nervousness
  • Vomiting

Doxylamine

Doxylamine is an OTC sleep aid commonly sold as Unisom Sleep Tabs and many store-brand nighttime sleep aids.

An antihistamine, doxylamine causes sleepiness and is commonly used for short-term relief of insomnia. It is also used in combination nighttime cold medicines, such as Alka-Seltzer Plus Night Cold Formula, Tylenol Cold and Cough Nighttime, and NyQuil.

Doxylamine can cause serious side effects, including difficulty urinating and vision problems. If you experience either of these side effects, call your healthcare provider. 

Other side effects of doxylamine include:

  • Dry mouth, nose, and throat
  • Drowsiness
  • Excitement
  • Headache
  • Increased chest congestion
  • Nausea
  • Nervousness

Alcohol Isn't a Sleep Aid

While alcohol can make it easier to get to sleep, it also disrupts healthy sleep later in the night as your blood-alcohol levels drop. Experts don't recommend using alcohol as a sleep aid.

Prescription Sleep Aids

If you routinely have trouble falling asleep or staying asleep, talk to your healthcare provider about prescription sleep medications. Several classes of drugs are used for sleep.

Benzodiazepines

Benzodiazepines are anti-anxiety medications sometimes prescribed to treat insomnia. Like some sedative-hypnotics, they enhance the effects of gamma-aminobutyric acid (GABA).

They used to be widely prescribed for insomnia, but they've somewhat fallen out of favor due to dangerous side effects, including addiction, abuse, and overdose.

Benzodiazepines aren't recommended for long-term use. Those sometimes prescribed for sleep include:

  • Eurodin/ProSom (estazolam)
  • Halcion (triazolam)
  • Restoril (temazepam)

These drugs carry a risk of falls, delirium, and long-term memory problems. They may also cause daytime drowsiness, problems with thinking and memory, and rebound insomnia.

Other side effects of benzodiazepines may include:

  • Next-day grogginess ("hangover")
  • Dizziness or lightheadedness
  • Headache
  • Weakness
  • Dry mouth
  • Constipation
  • Nausea and vomiting
  • Aggression
  • Agitation or nervousness
  • Behavioral changes
  • Slow or uncoordinated movement
  • Stiff muscles
  • Leg pain
  • Tingling skin

Warning About Benzodiazepines

Do not abruptly stop taking benzodiazepines. It could cause seizures and other serious side effects. Ask your healthcare provider or pharmacist about how to wean off of these drugs.

Antidepressants

Antidepressants sometimes target brain chemicals in a way that slows the brain and helps with sleep.

  • Silenor (doxepin): This drug may modestly improve sleep. Side effects are nausea and dizziness.
  • Trazodone: This medication reduces the average amount of time it takes to fall asleep by 10 minutes and the average time spent awake in the night by eight minutes. It's widely used by older people.

Trazodone is linked with numerous side effects, including:

  • Nausea and vomiting
  • Diarrhea or constipation
  • Changes in weight or appetite
  • Tiredness or weakness
  • Nervousness
  • Dizziness or lightheadedness
  • Nightmares
  • Muscle pain
  • Dry mouth
  • Rash
  • Decreased sex drive
  • Problems with erection, ejaculation, and orgasm
  • Tremor
  • Stuffy nose
  • Itchy, red, or tired eyes

Melatonin-Receptor Agonists

Melatonin receptor agonists are prescription medications used to treat insomnia. These medications help to induce sleep and regulate the circadian rhythm, or internal body clock.

Melatonin-receptor agonists work to regulate the sleep-wake cycle by targeting specific melatonin receptors in the brain.  

Common melatonin-receptor agonists prescribed in the United States to treat insomnia include:

  • Hetlioz (tasimelteon)
  • Rozerem (ramelteon)

 Side effects of melatonin-receptor agonists vary by drug and can include:

  • Abnormal dreams
  • Abnormal thinking
  • Behavioral changes
  • Dizziness
  • Fatigue
  • Headaches
  • Nausea
  • Nightmares
  • Upper respiratory infections
  • Urinary tract infections

Warnings About Melatonin-Receptor Agonists

Melatonin-receptor agonists will impair your ability to drive, operate machinery, and perform activities that require alertness. After taking the medication, limit your activities to preparing for bed. People who shower before bed should wait to take this medication until after their shower. 

Rozerem can also cause severe adverse reactions, including anaphylaxis, amnesia, hallucinations, mania, and agitation.

Sedative-Hypnotics

Sedative-hypnotics are another class of prescription sleep aids. They work in various ways.

Several of them enhance the effects of GABA, which helps your brain and body relax. These drugs include:

  • Ambien (zolpidem): Reduces the average amount of time to fall asleep by five to 12 minutes; increases total sleep time by 29 minutes.
  • Intermezzo (zolpidem): Contains the same active ingredient as Ambien but is processed faster; allows it to be taken if you awaken in the middle of the night and can't get back to sleep.
  • Lunesta (eszopiclone): Reduces the average time to fall asleep by 14 minutes. It increases total sleep time by between 28 and 57 minutes.
  • Sonata (zaleplon): Reduces the average time to fall asleep by 10 minutes. May wear off within four hours, making it helpful for nighttime awakenings.

Other sedative-hypnotics target different brain chemicals and are associated with fewer side effects.

  • Belsomra (suvorexant): Blocks a wakefulness signal created by the chemical orexin. Reduces the average amount of time to fall asleep by eight minutes; reduces the average time spent awake during the night by 16 to 28 minutes.

Each sedative-hypnotic drug has its own list of side effects, but they also have many in common. Potential side effects include:

  • Sleepwalking, eating, driving, or other behaviors
  • Headache
  • Dizziness
  • Lightheadedness
  • Unsteady walking
  • Balance problems
  • Nausea
  • Constipation or diarrhea
  • Gas
  • Heartburn
  • Stomach pain
  • Changes in appetite
  • Tremor (uncontrollable shaking)
  • Pain, burning, or numbness in the limbs and extremities
  • Unusual dreams
  • Dry mouth or throat
  • Red eyes
  • Vision problems
  • Eye pain
  • Sensitivity to noise
  • Distorted sense of smell
  • Muscle aches, cramps, or joint pain
  • Heavy or painful menstrual periods
  • Decreased sexual desire
  • Breast enlargement in males

Be sure you're familiar with the side effects specific to the medication you're taking.

Dangerous Combinations

Never combine two or more kinds of sleeping pills without medical supervision. Do not take sleeping pills with alcohol. Both of these increase the risk of overdose, breathing problems, and death.

Herbal and Dietary Supplements

The following herbal and dietary supplements are natural sleep aids that are relatively safe for adults in moderate doses.

Melatonin

Melatonin is a brain chemical (neurotransmitter) that plays an important role in sleep and your 24-hour internal clock (circadian rhythm). It's especially helpful if your circadian rhythm is off.

Melatonin supplements are generally synthetic or made from animal sources. They're widely available in stores and online.

Melatonin doesn't start working for several hours, so don't take it right before bedtime. You may need to experiment with the timing to figure out what works best for you.

Side effects of melatonin include:

  • Agitation
  • Dizziness
  • Drowsiness
  • Headache
  • Increased urination or bedwetting in the evening

Valerian Root

Valerian root (Valeriana officinalis) is an herb that is used to promote sleep. Its active ingredient is valerenic acid, which has sedative effects.

Valerenic acid is thought to act similarly to benzodiazepines and other sleep medications. It affects GABA receptors to help calm and slow the brain. It also interacts with the neurotransmitter serotonin, which is also involved in the sleep-wake cycle.

Side effects of valerian root are typically mild and may include the following: 

  • Dizziness
  • Gastrointestinal (GI) discomfort
  • Headache
  • Itchy skin

Chamomile

Chamomile is a widely used herbal remedy for sleep. While often touted as a complementary medicine cure for insomnia, there is little evidence to support its use in treating clinical insomnia.

Research shows chamomile may help to improve sleep quality in people without clinical insomnia. If you have trouble sleeping from time to time, a cup of chamomile tea at bedtime may help.  

Side effects of chamomile are generally mild but not common and may include:

  • Allergic reactions
  • Dizziness
  • Nausea 

In rare cases, chamomile may cause a life-threatening allergic reaction known as anaphylaxis. People who are allergic to ragweed, daisies, chrysanthemums, and marigolds are more likely to experience an allergic reaction to chamomile. 

Kava

Kava (Piper methysticum) is an herbal remedy used to promote sleep. Research shows kava can help you fall asleep faster, stay asleep longer, and increase periods of deep sleep. 

The sleep-promoting qualities of kava are due to chemical components known as kavalactones, which also help to relieve anxiety. 

Kava is generally well tolerated with mild side effects that may include: 

  • Daytime drowsiness
  • Irregular heartbeat
  • Memory lapses
  • Mild dizziness
  • Nausea
  • Stomach discomfort
  • Tremors or shakiness 

Other Natural Sleep Remedies

Other herbs and nutrients are commonly recommended for better sleep, However, there is a lack of evidence to support their use for sleep in humans. Other purported natural sleep remedies include:

Talk to your healthcare provider before trying a natural sleep aid. If you take any prescription medications, check with your pharmacist before taking any supplements. Always make sure to follow the instructions on the label.

Things to Avoid

Treating insomnia isn't always about what you take. It may help to avoid caffeine, alcohol, and eating or exercising just before bed. These can all disrupt your sleep.

Non-Drug Tips for Better Sleep

Tips to Avoid Taking Sleeping Pills
Verywell / Brianna Gilmartin

Sleeping pills aren't right for everyone, and they can interact with other drugs. If you're pregnant, they may harm the developing fetus.

You may also be concerned about the potential for addiction. Or, you may dislike the side effects.

Fortunately, there are other ways to manage insomnia. You may find it helpful to simply change your sleep habits.

  • Start by keeping a regular bedtime and wake time. This will help reinforce your natural circadian rhythm.
  • Avoid naps during the day. They can reduce your body’s natural desire for sleep.
  • Reduce the time you spend awake in bed (called stimulus control). Use your bed only for sex and sleep. If you can't sleep, get up until you feel sleepy.

Other alternatives for treating insomnia include:

When to See a Healthcare Provider

You may not need treatment for an occasional bout of insomnia. But if it's a long-term or recurring problem that disrupts your life, you should see a healthcare provider.

Start by talking to your primary care doctor. If you need more specialized help, you may be referred to a sleep specialist.

Seek help at once if your insomnia makes you feel depressed or suicidal.

Obstructive sleep apnea (breathing pauses during sleep) is a common cause of long-term insomnia. When apnea wakes you up, you may have trouble getting back to sleep. This condition requires special treatment.

You may also benefit from sleep therapy. Cognitive behavioral therapy for insomnia (CBTI) is one example. You can learn about this from a book, an online course, a workshop, or a class. A professional therapist can also help you get started.

Summary

Insomnia affects nearly everyone at some point. For people who deal with the occasional sleepless night, OTC sleep aids diphenhydramine and doxylamine—antihistamines that cause drowsiness—can help. 

For chronic or clinical insomnia, prescription medications can help. Classes of prescriptions sleep aids include benzodiazepines (Halcion, Restoril), antidepressants (Silenor, Trazodone), melatonin-receptor agonists (Hetlioz, Rozerem), and sedative-hypnotics (like Ambien, Lunesta, Belsomra). 

Herbal and dietary supplements, like melatonin, valerian root, chamomile, and kava, may also help you fall asleep and stay asleep.  

If insomnia is keeping you up at night and OTC treatments aren’t helping, talk to your healthcare provider.

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Brandon Peters, M.D.

By Brandon Peters, MD
Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist.