By Alyson Powell Key
Many people with chronic insomnia turn to medications for relief. You have many options to choose from, including prescription and over-the-counter drugs.
It’s important to use these medications wisely, and under a doctor’s care. They’re not right for everyone. They may have side effects, and some can be addictive if you don’t use them properly. Most insomnia medications aren’t meant to be used for a long time.
But in some cases, they can be a good short-term solution to help you get some rest.
When you have insomnia, your first step should be to make an appointment with your doctor. They’ll ask about your sleep habits and may run tests to find out if another health issue is interfering with your sleep. They may advise you on good sleep habits, or refer you to another doctor to treat any medical conditions that may be contributing to your insomnia.
Before trying medicine, sleep experts suggest that you start with cognitive behavioral therapy for insomnia (CBT-I). There’s less chance of side effects or dependency. And you’ll learn strategies that can be helpful for longer.
CBT-I helps you spot thoughts and behaviors that make insomnia worse, and swap them for ones that encourage better sleep. It may teach you better sleep habits, relaxation techniques, and more.
“Research shows that CBT for insomnia is as effective as sleep medication in the short term and more effective in the long term, so you’re getting an overall more effective treatment that can be more sustained,” says Annie Miller, a behavioral sleep medicine therapist at DC Metro Sleep and Psychotherapy in Bethesda, MD.
But it takes time and effort for CBT-I to work. If insomnia is badly disrupting your daily life, or if you’re losing sleep because you’re going through a sad or stressful time, your doctor may decide that medication will help.
In choosing a sleep aid, your doctor will consider your health, age, other medical conditions, and other medications you’re taking. You may have to try more than one drug before finding one that works for you.
Your doctor should discuss your options before writing a prescription. A generic version could save you money. If you have health insurance, find out whether your provider covers insomnia medications and if there are restrictions on them.
Prescription drugs for insomnia include:
Like prescription drugs, over-the-counter sleep aids can interact with other medications. They may not be right for people with certain health conditions. So always check with your doctor before using one.
Common OTC sleep aids include:
Keep in mind that the FDA regulates both over-the-counter drugs and supplements less strictly than prescription medications.
Whether they’re over-the-counter or prescription, sleep aids can have unwanted side effects. Some of them include:
Before you start any sleep medication, make sure you know how to use it safely:
It’s important to be consistent with prescription sleep medication. If you skip a night or two, “it can be confusing for the brain,” Miller says. “We want there to be a consistent message for the brain so it isn’t only depending on medication at certain times.”
Prescription sleeping pills may not be safe if you’re pregnant or breastfeeding. Ask your doctor even before taking an OTC sleep aid.
Use caution if you have:
Not all sleep medicines are safe for people with those conditions, but your doctor may be able to prescribe one you can use.
Older people, particularly those over age 75, should be especially careful. Sleep aids may affect you more than they do younger adults, and they stay in your body longer. They can lead to confusion and memory troubles, which raise your risk of accidents and injuries. Even nonprescription sleep aids may have worse side effects for older people.
If you have a history of substance abuse, nondrug treatments for insomnia (such as therapy) are safest. Your doctor may give you the OK to use certain medications, like antidepressants or melatonin receptor agonists.
While sleeping pills may give you short-term relief from your insomnia, they don’t address its root cause, says one sleep expert.
“The treatment for insomnia is a reconstruction, a cognitive reordering of the way you think about sleep, not drugging yourself every night,” says Chris Winter, MD, a neurologist and sleep specialist in Charlottesville, VA.
In some cases, he thinks sleep aids can make insomnia worse. “They’re not helping the problem, they’re obscuring it,” he says.
Therapy, alone or together with medication, could help you get to the bottom of what’s keeping you awake.
Reviewed by Neha Pathak, MD on October 18, 2021
Photo Credit: Charles Wollertz
Annie Miller, behavioral sleep medicine therapist, DC Metro Sleep and Psychotherapy, Bethesda, MD.
Chris Winter, MD, neurologist and sleep specialist, Charlottesville Neurology and Sleep Medicine, Charlottesville, VA.
Mayo Clinic: “Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills,” “Prescription sleeping pills: What’s right for you?” “Sleep aids: Understand over-the-counter options.”
FDA: “Taking Z-drugs for Insomnia? Know the Risks.”
American Academy of Sleep Medicine Sleep Education: “Ten Safety Tips for Taking Sleeping Pills for Insomnia.”
Sleep Foundation: “Compare Sleep Aids,” “How To Use Sleep Medications Safely.”
Choosing Wisely: “Insomnia and Anxiety in Older People.”
Substance Abuse and Mental Health Services Administration: “Treating Sleep Problems of People in Recovery From Substance Use Disorders.”
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How to Safely Use Insomnia Medications – WebMD
By Alyson Powell Key