Sleep Aids for Insomnia

Prescription and OTC sleep medications that can help you get to sleep

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, which is an antihistamine. While it's typically used to treat allergies, it can also cause sleepiness.

There's little evidence that this drug can help you sleep, though. The American Academy of Sleep Medicine doesn't recommend it as a treatment for insomnia.

Melatonin

Melatonin is a brain chemical (neurotransmitter) that plays an important role in sleep and your 24-hour internal clock (circadian rhythm). They're 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 you don't want to take it right before bedtime. You may need to experiment with the timing to figure out what works best for you.

Natural Sleep Aids

Some natural sleep aids, in low doses, may be considered relatively safe for adults. These include:

Talk to your healthcare provider before trying a natural sleep aid. Always make sure to follow the instructions on the label.

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.

Sedative-Hypnotics

Most prescription sleep aids are sedative-hypnotics. They work in various ways.

Several of them enhance the effects of a neurotransmitter called gamma-aminobutyric acid (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 in the night by between 16 and 28 minutes.
  • Rozerem (ramelteon): Enhances the effects of melatonin. Reduces the average amount of time to fall asleep by nine minutes.

Sedative-Hypnotic Side Effects

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.

Antidepressants

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

  • Silenor (doxepin): May modestly improve sleep. Side effects are nausea and dizziness.
  • Trazodone: Reduces the average amount of time it takes to fall asleep by 10 minutes; reduces the average time spent awake in the night by eight minutes. Widely used in older people.

Trazodone Side Effects

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

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.

Benzodiazepines for Sleep

Benzodiazepines are anti-anxiety medications sometimes prescribed to treat insomnia. Like some sedative-hypnotics, they enhance the effects of 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. They may also cause:

  • Daytime drowsiness
  • Problems with thinking and memory
  • Rebound insomnia

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

These drugs carry a risk of falls, delirium, and long-term memory problems.

Benzodiazepine Side Effects

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

Don't 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.

Foods as Sleep Aids

Some people have luck with certain foods or beverages that may promote sleep. However, not all of them work. And, just as with medications, they can cause side effects.

Herbal Teas

Herbal teas are a popular home remedy for insomnia. Some evidence suggests they can help you sleep.

Certain herbs like valerian and passionflower have been shown to improve sleep quality. This means they may help you sleep more deeply. They may not help you fall asleep faster, though. 

Be careful when choosing tea as a sleep remedy. Make sure they're herbal teas, which don't contain caffeine.

Foods to Help You Sleep

You may have heard that a glass of warm milk or a turkey sandwich could help you sleep. These generally have very little scientific backing.

Some foods, like warm milk, can be comforting. They may put you in the right mindset for sleep. A few studies have shown that milk or a mixture of milk and honey can help you sleep.

Certain foods, like turkey, contain tryptophan. Your body converts tryptophan to a neurotransmitter called serotonin. Your brain uses serotonin to make melatonin, so increasing serotonin levels may promote sleep.

Some evidence suggests tryptophan supplements can improve sleep. However, you probably don't get enough tryptophan from food for it to have this effect. (Post-Thanksgiving dinner fatigue is more likely related to digesting a large meal.)

Some foods, including tart cherries, contain low doses of melatonin. Again, though, they probably don't give you enough to have any measurable effect.

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 things can all disrupt your sleep.

How to Avoid Sleeping Pills

Tips to Avoid Taking Sleeping Pills
Verywell / Brianna Gilmartin

Sleeping pills aren't right for everyone. They can interact with other drugs. If you're pregnant, they may harm your unborn baby.

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 Should You 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 about it.

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. Many OTC sleep aids and natural remedies are available, but few of them are proven to work.

Warm milk and herbal tea may help. Other foods said to promote sleep tend to be much less effective. Some substances like alcohol can actually disrupt your sleep.

Prescription sleeping pills are another option. Be aware that some can have dangerous side effects. They may also be addictive.

If you would prefer to avoid sleeping pills, changing your sleep habits can help. Therapy may be useful, too. You may also be able to get help from a sleep specialist.

A Word From Verywell

Many people with insomnia can learn to sleep normally without sleeping pills. In some cases, an underlying sleep disorder like sleep apnea may be contributing to your insomnia. These disorders need to be identified.

Even if you've had insomnia for decades, an expert in sleep medicine may be able to help you resolve it. Reach out to get the help you need. Don't hesitate to look beyond the pills and prescription medications that are so often offered first as a way to improve insomnia.

Frequently Asked Questions

  • How common is insomnia?

    Insomnia is very common. Among American adults:

    • 30% have some symptoms of insomnia
    • 10% have symptoms severe enough to cause daytime problems
    • Less than 10% have chronic insomnia
  • What causes insomnia?

    Insomnia can be caused by several things, including:

    • Stress
    • Depression, mental health problems, or emotional distress
    • Chronic pain or illness
    • Shift work
    • Long-distance travel
    • An inactive lifestyle
    • Hormone fluctuations
    • Medication
    • Other sleep disorders, such as sleep apnea
  • What happens if chronic insomnia goes untreated?

    Lack of sleep or poor-quality sleep can eventually lead to other problems, including:

    • Weight gain and obesity
    • Diabetes and impaired glucose tolerance
    • Heart disease and high blood pressure
    • Concentration problems
    • Mood disorders (e.g., depression, anxiety)
    • Driving accidents
    • Increased risk of falls and other injuries
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By Brandon Peters, MD
Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist.