Fight Insomnia: Natural Sleeping Aids vs. Sleeping Pills

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.

Key takeaways:
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    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.
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    Schedule IV-controlled substances (CIV) require a prescription to be dispensed.
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    Benzodiazepines should not be used long-term.

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

Insomnia is a common sleep disorder in which patients have 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 treated through non-drug treatments (behavioral therapy), natural sleeping aids, over-the-counter (OTC) medications, and prescription medications. The most effective insomnia treatment can include a combination of these 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.

CBT-I recommendations:

  • Change lifestyle habits (keep the bedroom dark, avoid daytime naps, avoid caffeine in the afternoon/evening, etc.)
  • Maintain a routine sleep schedule.
  • Remove bedroom stimuli (television, radio, entertainment, etc.)
  • Establish a nighttime routine (reading, meditation, etc.)
  • Avoid exercising/eating heavy meals before sleep.

Natural sleeping aids

Several natural sleeping aids help treat 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 other sleep medications. 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.

Cannabidiol (CBD)

CBD is derived from cannabis and can help promote sleep, reduce anxiety, and minimize pain. There are only a few cannabis products that are approved by the FDA. Before using CBD, patients should speak to their physician about the correct dosage and different routes of administration.

Chamomile tea

Chamomile is an herb derived from the chamomile flower. Chamomile tea can help promote sleep and relaxation. Chamomile is 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

Lavender is an herb used to improve sleep and promote relaxation. Lavender sleep products include lavender oil, tea, supplements, etc.

Melatonin

Melatonin is a hormone that helps regulate the circadian rhythm and promotes sleep. Adults may use 3-5mg of melatonin nightly to help treat insomnia.

Tryptophan

Tryptophan is the precursor to serotonin and can help improve sleep. Tryptophan can be found in supplements and foods such as cheese, milk, fish, etc.

Valerian root

Valerian root is an herb used to treat insomnia and anxiety. Valerian products include dietary supplements and tea.

Others (glycine, magnesium, passion flower, tart cherry juice, etc.)

Over-the-counter (OTC) medications

Antihistamines

  • Diphenhydramine (Benadryl)
  • Doxylamine (Unisom SleepTabs)

Over-the-counter (OTC) first-generation antihistamines are commonly used by patients to treat insomnia. Patients should not use antihistamines as a long-term insomnia treatment.

Antihistamines have anticholinergic side effects such as difficulty urinating, dry eyes/mouth, and drowsiness. It is not recommended for patients with glaucoma or benign prostatic hyperplasia (BPH) to use antihistamines as antihistamines may worsen these conditions.

Prescription medications

Hypnotics

  • Eszopiclone (Lunesta)
  • Zaleplon (Sonata)
  • Zolpidem/Ambien/Edluar/Intermezzo

Hypnotics are preferred over benzodiazepines in patients requiring long-term insomnia drug treatment.

Hypnotics CIV substances and require a prescription to be dispensed. All CIV substances may cause physical and psychological dependence, tolerance, abuse, and addiction.

Hypnotics have a black-boxed warning for complex sleep behaviors (sleep-walking, sleep-driving, etc.). There is a warning for increased risk of CNS depression, mood changes, respiratory depression, withdrawal symptoms, and potential for abuse/dependence. Patients with complex sleep behaviors may not use hypnotics. Side effects of hypnotic use include dizziness, drowsiness, and complex sleep behaviors.

Orexin receptor antagonists

  • Suvorexant (Belsomra)

Orexin receptor antagonists block the orexin signaling system; therefore, orexin will be unable to promote wakefulness.

Suvorexant/Belsomra is a CIV medication used to treat insomnia. Patients with narcolepsy may not use Suvorexant. Warnings with Suvorexant use include behavioral changes, suicidal ideation, sleep paralysis, hallucinations, and increased risk for complex sleep behaviors. Side effects of Suvorexant use include sedation, dizziness, and abnormal dreams.

Melatonin receptor agonists

  • Ramelteon (Rozerem)
  • Tasimelteon (Hetlioz)

Melatonin receptor agonists promote sleep and regulation of the circadian rhythm.

Patients may not use melatonin receptor agonists with fluvoxamine/Luvox. Melatonin receptor agonist side effects include drowsiness and dizziness. Melatonin receptor agonists require a prescription for dispensing.

Tricyclic antidepressant

  • Doxepin (Silenor)

Tricyclic antidepressants (TCA) work by inhibiting neurotransmitter (norepinephrine and serotonin) reuptake.

Doxepin (Silenor) is an FDA-approved TCA for insomnia treatment. There is a blocked-boxed warning for increased suicidal behavior in children and young adults within the first few months of use and when there is a dose change. Patients using monoamine oxidase inhibitors (MAOIs) may not use Doxepin. Side effects of Silenor use may include dizziness, drowsiness, and anticholinergic effects.

Silenor requires a prescription to be dispensed.

Benzodiazepines

  • Estazolam
  • Lorazepam (Ativan)*
  • Flurazepam
  • Quazepam (Doral)
  • Temazepam (Restoril)*
  • Triazolam (Halcion)

*Lorazepam and temazepam are the preferred BZDs for elderly patients.

Benzodiazepines (BZDs) may only be used for the short-term treatment of insomnia. BZDs are CIV drugs and require a prescription.

BZDs are not recommended for insomnia treatment in patients with a current/history of substance abuse or elderly patients. There is a black-boxed warning for increased abuse, addiction, and withdrawal risk. Side effects of BZD use include drowsiness, dizziness, cognitive impairment, and complex sleep behaviors.

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.