5 Alternatives to Ambien You May Find Helpful for Sleep

If you've ever taken medicine to help you sleep, you're probably in one of two camps. Either it worked well and provided much-needed relief—or it was a waste of money, caused a slew of side effects, and left you wondering what better options were out there.

The FDA has approved a handful of sleep aids for various conditions, including choices such as Neupro, Hetlioz, and Silenor. Here are some potential treatments that could soon help you rest easier—and suggestions for what to do in the meantime.

Hetlioz

Two clinical trials found that Hetlioz (generic: tasimelteon) helped subjects increase nighttime sleep and decrease daytime sleep duration. It was initially approved by the FDA in January 2014 for non-24-hour sleep-wake disorder in blind individuals, with additional changes in dosage and administration approved in December 2020.

The drug, called a melatonin analogue, works by targeting melatonin receptors in the brain. Melatonin is the naturally occurring hormone that helps regulate the body's sleep-wake patterns. Unlike existing benzodiazepine-hypnotic sleep medications, melatonin analogues have shown no tendency toward addiction or dependence, according to a May 2012 Journal of Pineal Research article.

Circadin/Melatonin

Circadin, a drug developed in Israel, may help people 55 and older get much-needed sleep, as melatonin levels in their brains decrease as a consequence of aging. By slowly releasing small amounts of melatonin over time—rather than one immediate dose, as is typically the case with over-the-counter melatonin—the drug has been shown to help people sleep through the night without sacrificing next-day alertness.

However, Circadin has not been approved for use in the United States as of May 2022. It is similar to melatonin, and the FDA considers melatonin as a dietary supplement, so it does not regulate the use of melatonin as strictly, according to the National Center for Complementary and Integrative Health (NCCIH).

Of note, Lisa Shives, MD, president and medical director of Northshore Sleep Medicine in Evanston, Ill., and spokesperson for the American Academy of Sleep Medicine, explained that taking over-the-counter melatonin "one or two hours before your new adjusted bedtime" for two to four days before an east-bound flight can help your body transition. (East-bound flights are typically tougher on sleep schedules than west-bound flights.) Upon arrival at your destination, you would take melatonin at your desired bedtime, and then upon your return home, you'd take it again at your regular bedtime to help readjust.

Horizant

If you've been diagnosed with restless legs syndrome (RLS), which is classified as a sleep disorder, Horizant could help. Horizant (generic: gabapentin enacarbil, formerly known as Solzira), has been shown to be effective in the treatment of RLS and was approved in April 2011. Unlike previous dopamine agonist RLS medications, Horizant's active ingredient is gabapentin—an anticonvulsant drug currently approved to treat epilepsy and also commonly prescribed off-label to relieve hot flashes. (It's also commonly used to treat migraines and chronic pain.)

Neupro

Neupro might be another option to try for RLS. The medicated skin patch Neupro (generic: rotigotine transdermal system), which was approved in Europe for the treatment of Parkinson's disease, was shown to help relieve RLS symptoms in a July 2008 study. It was also approved in the United States in 2007 and reapproved for its changes in April 2012.

Neupro contains the dopamine agonist rotigotine and is designed to be applied once a day to offer 24-hour support for moderate to extreme RLS. Although the rotigotine patch was previously available in the United States for the treatment of early-stage Parkinson's disease symptoms, it was pulled off the market in April 2008, due to problems with its delivery system.

Silenor

In higher doses, the drug Silenor (generic: doxepin) is used to treat depression and anxiety—but at doses as small as 3 to 6 milligrams, it has been shown to help those with insomnia too, according to a May 2022 US Pharmacist article. The drug's sedative abilities improved the total sleep time of those involved in a clinical trial.

Other Considerations for Sleep Treatment Alternatives

The first thing Dr. Shives recommended is a thorough examination to determine the cause of the sleeplessness, whether it's insomnia or an underlying problem like sleep apnea.

Taking sleep medications or supplements may serve as a complement to other treatments for sleep. For insomnia, Dr. Shives recommended patients try cognitive behavioral therapy along with low doses of prescription nonbenzodiazepines, such as Ambien, Lunesta, or Sonata, which have been shown to cause relatively low incidences of grogginess and next-day alertness problems.

"There have been lots of clinical studies showing that cognitive behavioral therapy does better in the long run for people with chronic insomnia," Dr. Shives said. "But it can be hard to find CBT physicians, they're not always covered by insurance, and it takes at least four to eight sessions before it begins to work. For those patients who are willing to try CBT, sometimes they need short-term medication as well."

Dr. Shives also noted that it was common in the past for people to take over-the-counter antihistamines for their sedating properties, though she did not recommend this remedy. "If an antihistamine doesn't say it's non-drowsy, it will make you drowsy," Dr. Shives explained. "But we should always be careful when using antihistamines because they may have the opposite effect and make older patients feel wide awake."

Finally, although there is a variety of medical treatments to help people sleep better, that doesn't mean that they will always be the best options. "The brain is a complicated setup with approximately 17 different neurotransmitters involved in the sleep-wake cycle and, as soon as we fully understand all of them, drugs will present better solutions for sleep disorders," Dr. Shives said.

The fact that these treatments have shown promising results is encouraging, but there's no guarantee that they'll solve your specific sleep problems. Talk to your healthcare provider about healthy habits, relaxation techniques, and—if you decide to try them—sleep aids that can help you get your z's.