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Sleeping Pills: the Complete Guide

Sleeping pills are a very popular treatment for sleeping disorders.

However, there are so many options in the market to choose from. Some are pharmaceutical formulations; others are natural alternatives; each with its own advantages and disadvantages. As a consequence, it can be challenging to get a proper understanding of what our options are.

So today I’ve written this article in which I’ve gathered the most relevant options you have at your disposal, all available for consultation in one convenient place.

So let’s take a closer look at the three main categories of sleeping pills available on the market.

πŸ”Ž Do you want to learn about a specific type of sleeping pill? Click on the name and jump right into it:

1. Prescription Sleeping Pills
2. Over-The-Counter Sleeping Pills
3. Natural Sleeping Pills

1. Prescription Sleeping Pills

Prescription sleeping pills are pharmaceutical drugs that require a prescription from your doctor. Ideally, they will only be prescribed for a short duration, and as a last resort (only after other options have been tried, like having proper sleep hygiene, or implementing behavioral changes).

We can find a wide range of options under this category. The most common ones are:

1.1 Antidepressants

Antidepressants work by changing the chemical balance in your brain. As a result, your mood improves. Your sleep will also likely improve, in terms of quality and duration. This is why it’s not surprising antidepressants can sometimes be used to help those suffering from insomnia. However, they are typically not prescribed to treat it if you also don’t have a diagnosis of depression and/or anxiety.

πŸ‘ Pros:

  • It can treat co-existing depressive symptoms or anxiety along with sleep issues.

πŸ‘Ž Cons:

  • Higher risk of next-day performance impairment
  • Possible risk of dependency (While antidepressants are not typically regarded as having a risk of dependency, some challenge this notionx

πŸ’Š Medication Names and Brands:

  • Doxepin (Silenor)
  • Trazodone (Desyrel)
  • Mirtazapine (Remeron)
  • Note: it should be noted that other antidepressants like Zoloft can have the opposite effect and cause insomnia.

1.2 Benzodiazepines

You probably know these as “benzos”. They have a very powerful sedative and anti-anxiety effect. They work by acting on the GABA receptors in the brain. If you have indeed heard of benzos, then you probably are aware of their infamy β€” this is due to their capacity of causing dependence, and a potentially dangerous withdrawal process (in severe cases, where tapering occurs without medical supervision, it can even be fatal). For this reason, they are for short-term use only, under the guidance of a competent doctor who knows what they’re doing.

πŸ‘ Pros:

  • Effective in inducing sleep
  • It can also be used to treat anxiety.

πŸ‘Ž Cons:

  • Higher risk of dependence and tolerance development
  • Higher risk of withdrawal symptoms
  • Higher risk of next-day performance impairment
  • Higher chance of rebound insomnia after discontinuation.
  • Risk of fatal overdose when mixed with alcohol or opioidsx
  • Regular use is tied to a higher risk of death and cancerx

πŸ’Š Medication Names and Brands:

  • Diazepam (Valium)
  • Estazolam (Prosom)
  • Temazepam (Restoril)
  • Triazolam (Halcion)
  • Flurazepam (Dalmane)
  • Quazepam (Doral)
  • lorazepam (Ativan)

1.3 Non-Benzodiazepine Sedative-Hypnotics

To overcome the limitations and dangers of benzodiazepines, a type of sleeping pill known as sedative-hypnotics was created. These have fewer side effects and less risk of dependence. Regardless, the risk is still there, so, just like benzos, these are also meant for short-term use.

πŸ‘ Pros:

  • Effective in inducing sleep
  • Lower risk of next-day performance impairment compared to benzodiazepines
  • Lower risk of dependence compared to benzodiazepines

πŸ‘Ž Cons:

  • Risk of dependence and tolerance development
  • Risk of next-day performance impairment
  • Higher chance of inbound insomnia after discontinuation.
  • Risk of complex sleep-related behaviors.
  • Regular use is tied to a higher risk of death and cancerx

πŸ’Š Medication Names and Brands:

  • Eszopiclone (Lunesta)
  • Zolpidem (Ambien)
  • Zaleplon (Sonata)

1.4 Melatonin Receptor Agonists

These sleeping pills mimic the effects of melatonin but with a more consistent and potent effect.

πŸ‘ Pros:

  • No dependencex
  • No rebound insomnia after discontinuation
  • Usually, well tolerated
  • Not limited to short-term usex
  • Mild and infrequent side effects

πŸ‘Ž Cons:

  • It may be less potent than Benzodiazepines or Non-Benzodiazepine Sedative-Hypnotics
  • It is likely to interact with medications that affect liver enzymes, like fluvoxaminex
  • Specific side effects of this medicine may include decreased serum testosterone, increased prolactin, and complex sleep-related behaviors.

πŸ’Š Medication Names and Brands:

  • Ramelteon (Rozerem)
  • Tasimelteon (Hetlioz)

1.5 Orexin Receptor Antagonists

This is a newer class of sleeping pills that work by blocking the actions of orexin (a neurotransmitter involved in regulating wakefulness).

πŸ‘ Pros:

  • Shown to improve total sleep time, decreases in waking after sleep onset, and subjective sleep latencyx
  • No risk of dependencex
  • It targets a different mechanism than most other sleep aids, which can benefit those who haven’t responded to other treatments.
  • Limited next-day cognitive impairmentx

πŸ‘Ž Cons:

  • Since it’s a newer type of medication, its long-term effects are still being studied.
  • Higher cost.
  • Risk of complex sleep behaviors
  • Specific side-effects to this medication can include sleep paralysis, hypnagogic/hypnopompic hallucinations, and worsening of depression or suicidal ideation.

πŸ’Š Medication Names and Brands:

  • Suvorexant (Belsomra)
  • Lemborexant (Dayvigo)

1.6 Anti-Parkinsonian

For the more specific sleep disorder known as Restless Legs Syndrome, anti-Parkinsonian drugs can be used to reduce the symptoms, also resulting in improved sleep quality.

πŸ‘ Pros:

  • It targets dopamine receptors directly, one of the origins of Restless Legs Syndrome.

πŸ‘Ž Cons:

  • Over time, these medications can make Restless Legs Syndrome symptoms worse
  • Some individuals develop impulse control disorders (compulsive gambling, shopping, or eating).

πŸ’Š Medication Names and Brands:

  • Pramipexole (Mirapex)
  • Ropinirole (Requip)
  • Rotigotine (Neupro)
  • Gabapentin enacarbil (Horizant).

πŸ‘¨πŸ»β€βš•οΈ Pro-Tip: If you are looking for ways to get prescription sleeping pills online, you probably need to talk to a doctor who gives telemedicine consultations. If that’s the case, feel free to explore Sleep Atlas, our online sleep database, where you can find the right sleep professionals for your needs.

2. Over-the-Counter Sleeping Pills

An alternative to the prescription medication is the over-the-counter (OTC) sleep pills. These can be bought without a prescription.

2.1 Antihistamines

Antihistamines are usually used to treat allergies. However, since they work by blocking histamine (a neurotransmitter that promotes wakefulness), this can have a sedating effect.

πŸ‘ Pros:

  • It is readily available without a prescription
  • Effective in facilitating sleep for those suffering from occasional insomnia
  • Lower risk of dependency (although it still existsx)
  • Affordable

πŸ‘Ž Cons:

  • Tolerance building when used for long periods of time
  • Risk of next-day performance impairment
  • Long-term use of antihistamines has been linked to increased risk of Alzheimer’sx.

πŸ’Š Medication Names and Brands:

  • Diphenhydramine (Benadryl)
  • Doxylamine (Unisom)
  • Note: There are antihistamines like Hydroxyzine that are only available through prescription.

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3. Natural Sleeping Pills

Our final category is natural sleeping pills, which include dietary supplements. These tend to be seen as safer* alternatives, in the sense that they likely have fewer side effects. On the other hand, they are also typically less potent when it comes to sleep induction; and there’s usually less scientific solid evidence backing up their purported benefits.

*A word of caution regarding the safety, though: I should mention that the FDA does not regulate these natural supplements, so it’s not possible to know how safe or effective they really are. Any specific brand you buy may even contain potentially harmful ingredients, or interact with other medications.

3.1 Melatonin

Melatonin is a sleep-related hormone, produced by the pineal gland. It is this hormone that is mimicked by the Melatonin Receptor Agonists sleeping pills mentioned above. Compared to those, though, the regular melatonin supplement is less potent. Regardless, it is still a very popular natural sleeping supplement.

πŸ‘ Pros:

  • Naturally produced by the body
  • Evidence shows its effectiveness in overcoming jet lag or shift work
  • Generally safe when taken for a shorter duration

πŸ‘Ž Cons:

  • Risk of next-day performance impairmentx
  • There’s a chance it may interact with certain medications (e.g. anticoagulants and medications for diabetes).
  • Not recommended for long-term treatment of insomniax

3.2 Magnesium

Magnesium is a mineral that contributes to muscle relaxation and also helps regulate N-methyl-D-aspartate (NMDA) receptors in the brain, which are involved in sleepx

Magnesium deficiency can cause insomnia, restless legs syndrome, muscle cramps, and anxiety, so supplementing with it can be particularly helpful to those people.

πŸ‘ Pros:

  • Essential mineral

πŸ‘Ž Cons:

  • It can cause digestive issues when taken in excess.

3.3 Valerian Root

Valerian Root is one of the most popular sedative herbs, known since ancient history to induce sleep and reduce anxiety.

Similar to benzos and sedative-hypnotics, the valerian root interacts with GABA receptors in the brainx. This helps improve anxiety, mood, and sleep quality.

If taking it as a pill is not your ideal solution, you can drink it as tea.

πŸ‘ Pros:

  • Some studies have shown its benefits for anxiety and sleepx.

πŸ‘Ž Cons:

  • Some studies failed to reproduce its benefits.
  • Not recommended for long-term treatment of insomniax
  • Known side effects include headaches and upset stomach.
Q: Does valerian root cause dependency ❓

In most cases, valerian does not seem to cause dependency. However, it has been observed to cause some withdrawal symptoms in people who have been using it for a long time. To avoid such cases, long-term users who wish to stop should do it gradually.

3.4 Lavender

Lavender is a plant known for its calming effect.

Similar to the Valerian Root (and benzos and sedative-hypnotics) lavender also contains compounds that interact with GABA receptors in the brain, resulting in better mood and better sleep.

Lavender can be used as a sleeping pill, an essential oil, a pillow spray, a bath additive, or an inhaler, usually before bedtime.

πŸ‘ Pros:

  • Studies have shown that inhaling lavender essential oil can help with mild sleep issuesx.
  • Minimal risk when used topically or inhaled.

πŸ‘Ž Cons:

  • Taking it orally can cause constipation, headache, or increased appetite.
  • It’s currently being debated the possibility of it having estrogenic effectsx.

3.5 Passionflower

Passionflower is a vine that has also been used since ancient times as a sedative.

It is also another natural solution that contains compounds that interact with GABA receptors in the brainx , resulting in better mood and improved sleep.

Passionflower can be taken as a sleeping pill or tea, usually about an hour before bedtime.

πŸ‘ Pros:

  • Some studies have shown its benefits for sleep, mostly in micexy

πŸ‘Ž Cons:

  • Rare but known side effects include dizziness, confusion, or ataxiax
  • May interfere with other medication, like other sedatives, blood thinners, or MAO inhibitorsx

Safety and Considerations

A few words regarding sleeping pill safety:

Before Taking Sleeping Pills

  • Talk to your doctor
  • Discuss with him the benefits and risks of different types of sleeping pills as they apply to your specific case.
  • Always follow the instructions from your doctor.
  • Monitor your response to the sleeping pills and report any changes or concerns.
  • Keep in mind that it’s not safe to self-medicate. Even freely available supplements like magnesium could interfere with certain medications, so keep that in mind.
  • Beware of oversedation, which happens when a person becomes excessively sleepy or unresponsive due to taking too many pills or combining them with other substances that have sedative effects. In this state, individuals may lose their ability to think, act, or react. In extreme cases, this can lead to an overdose, coma, or death. People who have died from sleeping pills overdoses include Heath Ledger, Michael Jackson, and Anna Nicole Smith.
  • Prescription sleep aids for seniors might differ. For instance, seniors usually take higher amounts of medication, which increases the risk of drug interactions with sleeping pills.

FAQ: Answering Some Questions

Q: What About Barbiturates ❓

Barbiturates were commonly used in the past as anti-anxiety and sleeping pills. However, their popularity has declined since the 1970s, with less dangerous alternatives replacing them.

Barbiturates are known for their high potential for addiction and overdose risk. They have been responsible for the deaths of famous people like Marilyn Monroe, Judy Garland, Edie Sedgwick, and Inger Stevens.

Q: I’m Looking for Strong Natural Sleep Aids, Can you Help ❓

Your best shot is likely already mentioned in the Natural Sleeping Pills section above. Remember that expecting to find “strong” solutions in this category might not be very realistic. Natural sleep aids usually have a milder effect compared to prescription sleeping pills. However, the effects are not nothing! And if you couple it with some other sleep hygiene tips, you are likely to improve your sleep over time.

Q: Do Sleep Aids Cause Dementia ❓

As mentioned above, there is some suspicion that antihistamines can increase the risk of Alzheimer’s.

Q: Which Sleeping Pill is the Most Dangerous ❓

As a generic non-medical-advice answer (remember, different pills can have different effects on different people), Barbiturates used to be the most dangerous due to their higher risk of overdose.

Nowadays, Benzodiazepines are typically considered the most dangerous due to their higher risk of dependency and more complicated withdrawal process.

However, using both Benzodiazepines and Non-Benzodiazepine Sedative-Hypnotics has been linked to a higher risk of death and cancer.

Conclusion

Choosing the right sleeping pill can be difficult, especially when there are so many options available.

This is why it is essential not to make that decision alone, and to talk to your doctor about it. However, now that you have read this article, you can have a more informed discussion with them, allowing you to understand the benefits and risks of their recommendations. For instance, if your doctor recommends you take benzodiazepines, you might want to make sure exactly why that should be the case, and not some safer option.

Whatever type of sleeping pills you end up taking, it’s important to monitor your response to them and report any changes to your doctor.

Also, feel free to consult our other articles to see if you can find other alternatives that may help you with your sleeping problems as well.

Take care!
MN

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Micael L. Nobre

Sound Engineering for Sleep @ Drowzee Analytics

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