FYI: They should really be a last resort for treating insomnia.

By Leah Groth
Updated August 11, 2020
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If you regularly find yourself tossing and turning in bed, unable to fall asleep—especially right now—you're not alone. Insomnia is one of the most common sleep problems, according to the Office on Women's Health (OWH)—and women bear the brunt of sleep issues, with one in four women reporting that they experience trouble falling asleep, staying asleep, or both.

While the occasional sleepless night isn't necessarily something to worry about, chronic insomnia (characterized by not being able to sleep, waking up too early, or feeling unrested after sleep at least three nights a week for three consecutive months) can do some serious damage to your heath and quality of life. For many, long-term insomnia can result in productivity issues at work or school, or even health issues down the line, including depression, heart disease, and stroke, per the OWH.

It's for this reason many people who suffer from sleeplessness turn to sleep aids or sleeping pills to hopefully get a full eight hours each night—but how safe are these medications? Here's what you need to know about sleeping pills if you're considering them, and what steps you should take with your doctor before seeking a prescription.

What are sleeping pills, and how do they work?

Sleeping pills—technically known as sleep disorder or sedative-hypnotic drug products—are medications used to induce and/or maintain sleep, according to the US Food & Drug Administration, and they can be prescribed or bought over the counter to treat insomnia. "Sleeping pills make you drowsy, and as such promote sleep,” Christine Won, MD, associate professor of pulmonary medicine at Yale School of Medicine and medical director at Yale Centers for Sleep Medicine, tells Health. “They are used to initiate sleep, as well as to maintain sleep.” In general, sleeping pills are most effective in acute insomnia (lasting less than 3 months) and are generally not so good at treating chronic or long-lasting insomnia (lasting more than 3 months) she adds. 

Because there are quite a few options for specific kinds of sleeping pills—the FDA lists 19 on their website—some sleeping pills serve different specific purposes, Janet Hilbert, MD, assistant professor at Yale School of Medicine and medical director at Yale Noninvasive Ventilation Program and Adult Sleep Medicine Program, tells Health. "Sleeping pills work in different ways and have different side effect profiles," she says. "Some work better for problems falling asleep, while some are better for difficulty staying asleep."

According to Dr. Won, sleeping pills can be classified in three different ways:

  • Hypnotics or GABA agonists: These target and activate the GABA receptors in the brain, which promote sleepiness, she says. Medications in this class include Ambien, Lunesta, and Sonata.
  • Melatonin receptor agonists: These target and activate the melatonins receptors, says Dr. Won. Medications in this class include Rozerem
  • Orexin receptor antagonists: The newest class of sleeping pills, orexin receptor antagonists inhibit orexin, a neurotransmitter in the brain that promotes wakefulness. Medications in this class include Belsomra and Dayvigo.

But those are just the medications specifically indicated for insomnia—medications with other initial purposes may also be prescribed to treat sleeplessness. "There are other medications that are commonly prescribed to treat insomnia, even though their main indication is a different medical disorder," says Dr. Won. That's because the side effects of those medications often includes severe drowsiness, she says. Those include benzodiazepines (Xanax, Klonopin), antidepressants (Trazodone), and antipsychotics (Seroquel). The FDA also lists over-the-counter drugs like Benadryl and Unisom as treatments for insomnia due antihistamines, which also cause drowsiness.

Who should—and shouldn't—take sleeping pills?

One sleepless night does not warrant a sleeping pill prescription, and even those who suffer from acute insomnia may be better off exploring other options. “Sleeping pills are not the only treatment for insomnia, nor are they necessarily required,” Dr. Hilbert says. Additionally, trouble sleeping may be due to other sleep disorders (like sleep apnea or restless legs syndrome), other medical or psychiatric disorders, medications taken for other problems, or poor sleep habits—and it's important to seek medical help to get a handle on any undiagnosed conditions. “In many cases, treatment of the underlying condition, stopping a medication, or improving sleep habits may be all that is needed,” she says.

Dr. Won adds that the evidence for the effectiveness of sleeping pills in the long run is generally poor. “The mainstay and most effective treatment for chronic insomnia is cognitive behavioral therapy for insomnia (CBTi)," she says. "Even in head to head comparisons of medications versus CBTi, CBTi does better in the long run. However, if a thorough medical evaluation doesn't show another underlying cause of sleeplessness, and CBTI isn't available or successful, that's a situation in which someone may benefit from sleeping pills, says Dr. Hilbert. 

How to use sleeping pills safely

If you think you might be a candidate for sleeping pills, the first step is speaking with your primary care doctor. “She/he may review your health history, the medications you are taking, and your sleep habits and make further recommendations from there,” says Dr. Hilbert. After that, you may be referred to a sleep center for a consultation with a sleep specialist (which may include taking part in a sleep study), or to a clinical psychologist for CBTi. "Your healthcare team may review the options for sleeping pills and help you determine potential benefits and risks in your situation," says Dr. Hilbert.

If you're eventually approved for and prescribed sleeping pills, it's important to use them exactly as directed. The Cleveland Clinic also recommends allowing yourself to devote a full eight hours to sleep after taking the pills—any less, and you can risk feeling extra groggy the next day. And when first trying out sleeping pills, it's best to clear your schedule for the next day (or at least make sure not to plan anything too important) so you can see how your body reacts to the medication.

You'll also want to avoid long-term use of the sleeping medication—they're not supposed to be used that way, anyway. "Sleeping pills by themselves rarely work on a long term basis for treating insomnia," says Dr. Won. "The best way to assure sleeping pills work is to take it during times you have a regular sleep schedule, good sleep habits, and effective relaxation. If these are not in place, it is unlikely any sleeping pill will work."

It's smart, too, to be aware of the risks that can come with sleeping pill usage. According to Dr. Hilbert, the main side effects include dizziness, lightheadedness, dry mouth, and morning grogginess, in addition to "worrisome interactions" with other medications. There are also concerns about increased falls and memory difficulties. “Sleepwalking and other more complicated sleep behaviors (sleep eating, sleep driving) have also been reported with some medications.”

As long as you've been cleared by your doctor to take sleeping pills—and you're in contact with them about your experience on the medication, short-term use of sleep aids is fine, but remember that "sleeping pills are really just a [bandage]," says Dr. Won. Underlying issues—like an untreated sleep disorder, disruptive sleep environment, depression or anxiety, or an irregular sleep schedule--must eventually be addressed for long-lasting relief. 

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