It is 2:00 a.m. and you are staring at the ceiling. You check the clock every 5 minutes to calculate how much sleep you can squeeze in before the alarm jolts you awake. You have tried warm milk and relaxation tapes, yet you are still wide-awake. You wonder whether you should take a sleeping pill.
If this sounds like your nightly routine, you are not alone. Insomnia affects millions of people, and sleep aids and other remedies claiming to solve the problem are plentiful. It's difficult to know the best course of action and whether sleeping pills or other preparations are safe enough for regular use.
Talk to Your Doctor First
Some sleep aids are not safe for everyone. Before taking an over-the-counter sleep aid, talk to your doctor. Talking to your doctor may also help you find the triggers that keep you up at night and help you find a solution that works. Keep in mind that insomnia not only results in considerable nighttime distress for the insomnia sufferer, it is associated with next-day impairment, and may even have effects on health and mood.
What works for your neighbor may not work for you. Insomnia treatments may be short or long term, depending on your problem. It is important to know what options are available so you can minimize any effects on your sleeping patterns.
Sleeping pills are available over-the-counter and by prescription. Use these tips when considering the use of sleep aids:
- Take the medication exactly as prescribed.
- Try the medication only after you have tried changing your behavior.
- Use the lowest possible effective dose.
- Do not automatically take a pill every night. Use the medication only when you must have an uninterrupted night of sleep. Even then, it is a good idea to take sleeping pills only a few times per week at the most.
Over-the-Counter Sleep Aids
Many over-the-counter sleep aids contain antihistamines, while others contain the hormone melatonin.
Sleep aids containing antihistamines are common. They include medications, such as Tylenol PM, Nytol, and Unisom, among others. Some people take a pure antihistamine drug, such as Benadryl, to help them fall asleep. The main problem with these remedies is known as the hangover effect. The next morning you may feel sluggish, sleepy, or have difficulty performing daily tasks. In some people, antihistimines have the opposite effect, which keeps them awake.
Melatonin is a hormone that is secreted in the brain and helps our bodies regulate the sleep-wake cycle. Melatonin is sold as a dietary supplement, rather than as a medication and is therefore not subject to regulation by the Food and Drug Administration for standards of potency and purity, so proceed with caution. There is some research that supports that melatonin may help treat jet lag. If you decide to try melatonin, talk to your doctor.
There are several prescription sleep aids available. Prescribed medications include hypnotic sedatives (benzodiazepines) that are used to treat depression, anxiety, or seizure disorder. Other medications include nonbenzodiazepine hypnotics, melatonin receptor agonists, or other types of antidepressants that have sedative effects.
Sleep aids come with side effects and some may be associated with dependency with higher doses and longer treatment. Make sure that you use the medications as directed and monitor any problems you may be having with the medication.
According to the National Sleep Foundation, many factors can influence potential side effects of prescription sleep aids, including:
- How your body uses and responds to the drug
- How long the drug stays in your body
Side effects may include:
- Excessive sleepiness
- Complex sleep-related behaviors, such as sleep-driving
- Memory problems
- Allergic reaction, such as facial swelling or anaphylaxis
High doses of sleep medications may result in what is known as rebound insomnia. This occurs when a person stops taking a sleep medication and then experiences a few nights of insomnia that is more severe than what was originally experienced prior to treatment. Rebound insomnia generally occurs with medications that have a short or intermediate half-life (how long it takes for half the drug to be eliminated from your body) and can be avoided by slowly tapering the dose. Consult with your doctor prior to stopping or changing your dose.
Healthy Sleep Habits
The goal is to have healthy sleep habits, which may prevent the need for sleep aids. Here are some tips for a better night's sleep:
- Keep a regular sleep schedule —Our sleep-wake cycles are regulated by a circadian clock in our brain and the body's need to balance sleep and wake times. It is beneficial to go to bed and get up at the same time each day to allow your body to get in sync with this natural pattern.
- Avoid caffeine, nicotine, and alcohol —Caffeine and nicotine are stimulants. Caffeine-containing products include coffee, tea, and chocolate. Half the amount of caffeine ingested will remain in the body on average from 3-5 hours, but some people are affected for up to 14 hours. Alcohol causes sleep disturbances throughout the night. While alcohol may help you relax and fall asleep, it can lead to a night of disrupted sleep as the night progresses.
- Do not eat or drink too close to bedtime —It is best to avoid a heavy meal too close to bedtime. Spicy foods may cause heartburn, which leads to difficulty staying asleep. A light snack before bed may help you sleep better.
- Exercise at the right time to promote sleep —Regular exercise is one of the most effective treatments for insomnia. However, exercising right before bedtime will make falling asleep difficult. Besides making you more alert, exercise causes a rise in body temperature, which can take approximately 6 hours to begin to drop. A cooler body temperature signals the body that it is time for sleep.
- Use relaxing bedtime rituals —This may include taking a bath, reading a book, meditating, or listening to relaxing music. Use techniques that work best for you and your bed partner.
- Create a sleep-promoting environment —The best sleep environment is a cool, quiet, and dark room. Be sure to check your room for noise or other distractions. Make sure that your mattress is comfortable and supportive.
Whether you decide to take medication or not, incorporate these sleep tips into your routine.
If you suffer from chronic insomnia, see your doctor. You may be experiencing a symptom of a larger problem, such as clinical depression or a sleep disorder. Your doctor will help you find the treatment plan or medication that is best for you.
National Center on Sleep Disorders Research
National Sleep Foundation
Better Sleep Council Canada
Healthy sleep tips. National Sleep Foundation website. Available at: http://sleepfoundation.org/sleep-tools-tips/healthy-sleep-tips. Accessed October 25, 2016.
Melatonin. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/biomedical-libraries/natural-alternative-treatments. Updated August 2013. Accessed October 25, 2016.
Sack RL, Auckley D, et al. Circadian rhythm sleep disorders: Part I, basic principles, shift work and jet lag disorders. Sleep. 2007;30:1460-1483.
Side effects of sleep drugs. US Food and Drug Administration website. Available at: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm107757.htm. Updated April 11, 2016. Accessed November 28, 2016.
Safe use of sleep aids. National Sleep Foundation website. Available at: https://sleepfoundation.org/insomnia/content/safe-use-sleep-aids. Accessed October 25, 2016.
Last reviewed October 2016 by Michael Woods, MD Last Updated: 11/28/2016