When you have trouble sleeping, it can significantly burden your life. Whether you have insomnia or just intermittent sleep deficiencies, it can lead to less energy, inability to focus, and difficulty completing everyday tasks. That’s when it’s important to look into sleep aids to help you get a more restful night’s sleep.
Just because these products are natural, that does not mean they are effective or safe. Patients should talk to their doctors before using natural sleeping aids.
Prescription drugs for insomnia, such as sedatives and benzodiazepines, carry risks for dependence or misuse.
Benzodiazepines are not recommended as a long-term treatment for insomnia.
Figuring out what type of sleep aid to use, whether it’s more natural remedies or prescription sleeping pills, will depend on a range of factors. Sometimes, a simple change of habits or developing a bedtime routine is enough to solve the problem. However, you may need medication or other interventions if a medical issue causes sleep deficiency. Let’s take a closer look at natural sleeping aids and sleeping pills to discover which solution you should discuss with your doctor.
Insomnia is a common sleep disorder that causes difficulty falling asleep, difficulty staying asleep, and poor sleep quality. Insomnia can cause complications such as weight gain, stress, and depression.
This sleep disorder can be managed using non-drug treatments (behavioral therapy), natural sleeping aids, over-the-counter (OTC) medications, and prescription medications. Many people may benefit from a combination of drug and non-drug methods. Before treatment, it is recommended to address the underlying problem that may be contributing to insomnia.
Cognitive behavioral therapy
Cognitive behavioral therapy-insomnia (CBT-I) is preferred for treating insomnia. CBT is a psychological treatment that helps patients manage their problems by changing their behaviors and mindset.
Change lifestyle habits (e.g., keep the bedroom dark, avoid daytime naps, avoid caffeine in the afternoon or evening).
- Maintain a consistent sleep schedule even on the weekends.
- Remove bedroom stimuli (such as television, radio, digital entertainment).
- Establish a relaxing nighttime routine to wind down, such as reading or meditating.
- Avoid exercising or eating heavy meals before sleep.
Natural sleeping aids
Several natural sleeping aids can help ease insomnia and promote sleep. Natural sleeping aids include dietary supplements that may not be regulated by the U.S. Food Drug Administration (FDA) or subjected to the same level of FDA evaluation as prescription medications. Just because these products are natural, that does not mean they are effective or safe. It’s best to talk to your doctor before using natural sleeping aids.
CBD is derived from cannabis and is thought to help promote sleep, reduce anxiety, and minimize pain. Cannabis products are not approved by the FDA for the treatment of insomnia. Before using CBD, you should speak to your physician about the correct dosage and different routes of administration.
Chamomile is an herb derived from the chamomile flower. Chamomile tea can help promote sleep and relaxation. Chamomile is generally regarded as a safe and natural sleeping aid that rarely causes side effects and has limited drug interactions. Chamomile is also available as dietary supplements, oils, and skincare products.
Lavender is an herb used to improve sleep and promote relaxation. Lavender sleep products include lavender oil, tea, supplements, and others.
Melatonin is a hormone that helps regulate the circadian rhythm and promotes sleep. It is also available as a dietary supplement. Adults may use 3-5 milligrams (mg) of melatonin before bedtime to help with sleep.
Tryptophan is the precursor to serotonin, a hormone involved in mood and sleep. Tryptophan can be found in foods such as cheese, milk, and fish. It’s also available as a dietary supplement.
Valerian root is an herb thought to help relieve insomnia and anxiety. Valerian root products include dietary supplements and tea.
Over-the-counter (OTC) medications
Over-the-counter (OTC) antihistamines are commonly used to treat short-term insomnia.
- Diphenhydramine (Benadryl).
- Doxylamine (Unisom SleepTabs).
Antihistamines have unpleasant side effects such as difficulty urinating, dry eyes, dry mouth, and drowsiness. It is not recommended for people with glaucoma (increased eye pressure) or benign prostatic hyperplasia (BPH) to use antihistamines as antihistamines may worsen these conditions.
Benzodiazepines (BZDs) are a class of prescription drugs. Doctors typically prescribe them short-term for anxiety or insomnia. BZDs are Schedule IV controlled substances (CIV), which means they are strictly regulated due to their risks for dependence and misuse.
- Alprazolam (Xanax).
- Diazepam (Valium).
- Lorazepam (Ativan).
- Quazepam (Doral).
- Temazepam (Restoril).
- Triazolam (Halcion).
BZDs are not recommended for insomnia treatment in people with a history of substance abuse. The FDA requires a boxed warning on all BZDs due to their risks of misuse, addiction, and withdrawal. Side effects of BZDs may include drowsiness, dizziness, cognitive impairment, and unusual behaviors during sleep.
Hypnotics, also called sedatives or “Z-drugs,” are typically preferred over benzodiazepines in peoplepatients requiring long-term insomnia drug treatment. Hypnotics are CIV substances and require a prescription drugs to be dispensed. All CIV substances may cause physical and psychological dependence, tolerance, abuse, and addiction.
- Eszopiclone (Lunesta).
- Zaleplon (Sonata).
- Zolpidem (Ambien, Edluar).
Hypnotics have a boxed warning due to the risk of complex sleep behaviors. Complex sleep behaviors are unusual behaviors that occur during sleep that you may not remember doing. Examples of reported behaviors include sleep-walking, sleep-driving, having sex, and making phone calls. These drugs also carry serious warnings due to increased risks of CNS depression (slowed brain and nerve function), mood changes, respiratory depression (slow, shallow breathing), and potential for dependence and subsequent withdrawal. Common side effects of hypnotic use include dizziness and drowsiness.
Orexin receptor antagonists
Orexin receptor antagonists (ORAs) are a group of prescription drugs that work by blocking the orexin signaling system. Orexin is a brain chemical thought to promote wakefulness.
- Suvorexant (Belsomra).
- Lemborexant (Dayvigo).
- Daridorexant (Quviviq).
ORAs are CIV medications used to treat insomnia. These drugs are not advised for use in people with narcolepsy. Warnings include behavioral changes, suicidal thoughts, sleep paralysis, hallucinations, and increased risk for complex sleep behaviors. Side effects of ORAs may include drowsiness, dizziness, and abnormal dreams.
Melatonin receptor agonists
Melatonin receptor agonists are a group of prescription drugs that promote sleep via regulation of the body’s circadian rhythm. These drugs are not controlled substances and do not carry risks for addiction.
- Ramelteon (Rozerem).
- Tasimelteon (Hetlioz).
Melatonin receptor agonists interact with the antidepressant drug, fluvoxamine (Luvox). Common side effects include drowsiness and dizziness.
In some cases, certain antidepressants may be prescribed to treat insomnia. These treatment options may be particularly beneficial in people with concurrent insomnia and depression.
- Doxepin (Silenor), a tricyclic antidepressant (TCA).
- Trazodone, a serotonin modulator.
Antidepressants work by affecting the activity of chemical messengers in the brain such as norepinephrine and serotonin. These chemicals are involved in regulating many brain functions including mood and sleep.
All antidepressants carry a boxed warning for increased risk of suicidal behavior in children and young adults. This risk is higher within the first few months of use and when there is a dose change. People using monoamine oxidase inhibitors (MAOIs) should not take. Side effects of doxepin and trazodone may include dizziness, drowsiness, headache, dry mouth, nausea, blurred vision, and constipation.
To determine which sleeping aid is right for you, whether it be natural sleeping aids or prescription sleeping pills, it is important to speak to your physician regarding your medical history and current medication use.
- Sleep Medicine Reviews. The Role of Sleep Hygiene in Promoting Public Health: A Review of Empirical Evidence.
- Sleep Medicine Reviews. Herbal medicine for insomnia: A systematic review and meta-analysis.
- PLoS One. Meta-Analysis: Melatonin for the Treatment of Primary Sleep Disorders.
- American Family Physician. Treatment of Chronic Insomnia in Adults: ACP Guideline.
- Journal of evidence-based integrative medicine. Valerian Root in Treating Sleep Problems and Associated Disorders-A Systematic Review and Meta-Analysis.