Nearly a third of adults worldwide claim to sometimes have trouble falling asleep or staying asleep. If you are one of them, you may have tried sleeping medications to find temporary relief.
In the United States, there is a growing category of prescription pills, such as suvorexant (sold under the name Belsomra) and ramelteon (Rozerem), specifically approved for sleep. Doctors can also prescribe drugs such as the antidepressant mirtazapine (Remeron) for off-label use for insomnia. Over-the-counter antihistamines, such as diphenhydramine (Benadryl) or doxylamine (Unisom), can also function as sedatives.
“We are truly in the golden age” of insomnia drugs, said David Neubauer, a sleep specialist at Johns Hopkins Hospital. Doctors can suggest different treatments depending on the type of sleep problem you have: if your mind is racing or if you wake up several times in the middle of the night.
However, all sleep aids carry risks, such as daytime drowsiness, and some can even be addictive. That’s why experts recommend limiting their use.
“The ideal use for these medications is only as needed, so I would say two or three times a week, limited to a short period,” said Alcibiades Rodriguez, a sleep medicine expert at NYU Langone Medical Center.
When should you take sleeping pills?
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There are situations where judicious use of sleep aids can be helpful, such as during a two or three-week episode of insomnia due to a specific event. A doctor may also recommend sleeping pills as a last resort if restful sleep has not been achieved after trying lifestyle changes, such as avoiding screens at night, and specifically designed cognitive behavioral therapy tactics for sleep.
Before starting to take sleeping pills, you should always consult a healthcare professional to plan how long you will take them. If you still need them after a month, talk to a doctor to determine if another treatment or medication would work better or to see if you have any underlying conditions that contribute to poor sleep and cannot be treated with any sleep aid.
According to Neubauer, the cause of your insomnia will determine what works for you. Rozerem works by stimulating the brain’s melatonin receptor to help maintain a normal sleep cycle. If you have trouble falling asleep, doctors sometimes prescribe a class of drugs called benzodiazepines, which can reduce anxiety and induce drowsiness. These include alprazolam (Xanax) and clonazepam (Klonopin). There are also non-benzodiazepine drugs, such as zolpidem (Ambien) and eszopiclone (Lunesta), that can produce similar effects.
How bad is it to take sleeping pills every night?
The effects of over-the-counter antihistamines on sleep have not been well studied, and the American Academy of Sleep Medicine recommends avoiding their use for treating insomnia. Many can linger in your system and cause daytime drowsiness and falls. Long-term use can carry risks of memory problems, confusion, and constipation, which may be more pronounced in older adults. Some studies have suggested that prolonged use of antihistamines is associated with an increased risk of dementia, although the link is not definitive.
Although they are not considered sleeping pills, many people also take supplements to combat insomnia, such as the hormone melatonin. According to experts, it is important to consider that many supplements have not been rigorously tested for efficacy and may not contain the amount of melatonin indicated on their labels… or may not contain any at all.
Prescription sleeping pills have their own side effects, from dizziness and headaches to gastrointestinal problems. They should also not be mixed with certain drugs and substances, such as alcohol, opioids, and antidepressants. Doing so can further depress the central nervous system and slow down breathing, which can be dangerous, explained Neubauer. Additionally, prescribed sleep aids can cause sleepwalking or greatly impair driving ability.
Over time, the body can become accustomed to these pills, which is why people often end up needing higher doses to achieve the same effect, Rodriguez stated. With some of these drugs, especially benzodiazepines, this dependence can escalate to addiction. That’s why it is often difficult to stop taking medication, and the reason why many people take them for years.
How to stop taking them?
You should adopt a slow and strategic method, commented Jade Wu, a sleep psychologist at Duke University, who is also an advisor for the sleep wellness company Hatch. In some people, abruptly discontinuing the use of sleeping medication after more than a month of use can trigger withdrawal symptoms, such as increased anxiety, restlessness, or rebound insomnia, where sleep is disrupted again. Most experts recommend gradually reducing the dose over several weeks or months with the help of a doctor.
Cognitive-behavioral therapy for insomnia (CBT-I) can also address the underlying causes of insomnia by focusing on modifying behaviors and thought patterns that contribute to sleep problems. Studies have shown that CBT-I can be a more lasting alternative to medication.
It is also essential to establish good bedtime habits, such as sleeping in a dark room and avoiding screens, which can help with rebound insomnia.
“There may be some tough nights here and there, but that’s normal,” Wu said. “Trust that you’re not actually relapsing.”