Sleeping pills are medicines used to help people who have difficulty falling asleep, staying asleep, or getting enough restorative sleep. They include several different categories of prescription and over-the-counter medicines, and each type works differently in the body.
Insomnia can be short-term or ongoing and may be associated with stress, lifestyle factors, medical conditions, medications, substance use, or other sleep disorders. Because the underlying cause can vary, treatment should address the reason for the sleep problem rather than relying only on medication.
This sleeping pills guide explains the major types of sleep medicines, how they work, their potential benefits and side effects, important interactions, dependence concerns, and safer approaches to managing insomnia.
What Are Sleeping Pills?
Sleeping pills are medicines or sleep aids intended to help with sleep problems. Some are prescription medicines specifically approved for insomnia, while others are over-the-counter products that can cause drowsiness.
Prescription sleep medicines are sometimes called hypnotics or sedative-hypnotics. Depending on the medication, they may help reduce the time it takes to fall asleep, improve sleep maintenance, or address particular patterns of insomnia.
Over-the-counter sleep aids commonly contain antihistamines. Although these medicines can cause sleepiness, they are not necessarily appropriate for long-term management of insomnia.
According to MedlinePlus, some people may need sleep medicines for a limited period, while lifestyle changes, sleep habits, and behavioral approaches can play an important role in managing ongoing sleep problems.
What Is Insomnia?
Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or waking earlier than desired. It can occur occasionally or become persistent.
Common symptoms may include:
- Difficulty falling asleep
- Repeatedly waking during the night
- Waking too early
- Feeling unrefreshed after sleeping
- Daytime tiredness
- Difficulty concentrating
- Reduced alertness during the day
Insomnia may be related to stress, anxiety, changes in schedule, caffeine, alcohol, certain medicines, pain, other medical conditions, or sleep disorders such as sleep apnea.
Types of Sleeping Pills
There are several categories of medicines and products used to address sleep difficulties. The appropriate option depends on the type and cause of insomnia, medical history, other medicines, age, and individual risk factors.
1. Z-Drugs
Z-drugs are prescription sedative-hypnotic medicines commonly used for insomnia. Important examples include:
- Zolpidem
- Zaleplon
- Eszopiclone
These medicines work by reducing activity in the brain and can help promote sleep.
Zolpidem
Zolpidem is a prescription hypnotic used to treat certain forms of insomnia. Different formulations may be used for difficulty falling asleep, difficulty staying asleep, or both.
Zaleplon
Zaleplon is a short-acting prescription hypnotic generally used for difficulty falling asleep.
Eszopiclone
Eszopiclone is a prescription hypnotic used for insomnia and may help with both sleep initiation and sleep maintenance.
Z-Drug Safety
The FDA has issued a boxed warning for certain Z-drugs because of rare but serious complex sleep behaviors. These can include sleepwalking, sleep driving, preparing or eating food, or other activities performed while not fully awake.
These behaviors can result in serious injuries or, in rare cases, death. Anyone experiencing a complex sleep behavior after taking one of these medicines should stop taking the medicine and contact their healthcare professional immediately.
2. Benzodiazepine Sleeping Pills
Benzodiazepines are another class of prescription medicines that can be used for certain sleep disorders. Examples include:
- Temazepam
- Triazolam
- Estazolam
- Flurazepam
- Quazepam
Benzodiazepines increase the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that reduces activity in the central nervous system.
Depending on the medicine, they may help people fall asleep or remain asleep.
Risks of Benzodiazepine Sleep Medicines
Benzodiazepines can cause drowsiness, dizziness, impaired coordination, memory problems, and reduced alertness. Some can also lead to physical dependence and withdrawal symptoms.
Because of these risks, benzodiazepine sleep medicines should be used only according to a healthcare professional’s instructions.
3. Orexin Receptor Antagonists
Orexin receptor antagonists are prescription insomnia medicines that work by reducing the activity of orexin, a brain signaling system involved in wakefulness.
Examples include:
- Suvorexant
- Lemborexant
- Daridorexant
Rather than broadly slowing brain activity in the same way as some traditional sedatives, these medicines target orexin signaling involved in maintaining wakefulness.
Potential Side Effects
Possible effects can include drowsiness, fatigue, dizziness, and impaired alertness. Individual responses can vary, and patients should follow the prescribing information for their specific medicine.
4. Melatonin Receptor Agonists
Melatonin receptor agonists are prescription medicines that act on receptors involved in the body’s sleep-wake cycle.
Ramelteon
Ramelteon is a prescription medicine used for insomnia characterized primarily by difficulty falling asleep. It acts on melatonin receptors involved in regulating the sleep-wake cycle.
Ramelteon is different from over-the-counter melatonin supplements because it is a prescription medication with a specific formulation and mechanism of action.
5. Sedating Antidepressants
Some antidepressant medicines have sedating properties and may be prescribed in selected situations involving sleep problems.
Doxepin
Doxepin is available in a low-dose formulation specifically used for insomnia characterized by difficulty maintaining sleep.
Trazodone
Trazodone is an antidepressant that is sometimes prescribed off-label for sleep problems. Its use should be determined by a healthcare professional based on the patient’s individual circumstances.
A medicine that causes sleepiness is not automatically an appropriate treatment for insomnia.
6. Over-the-Counter Antihistamine Sleep Aids
Many OTC sleep aids contain antihistamines. Common ingredients include:
- Diphenhydramine
- Doxylamine
These medicines are commonly used for allergy symptoms but can cause drowsiness and are therefore included in some OTC sleep-aid products.
Potential side effects include:
- Drowsiness
- Dizziness
- Dry mouth
- Confusion
- Reduced alertness
- Memory problems
According to MedlinePlus, the body can become accustomed to the effects of some OTC antihistamine sleep aids relatively quickly, which may reduce their effectiveness over time.
7. Melatonin Supplements
Melatonin is a hormone naturally produced by the body that helps regulate the sleep-wake cycle. Melatonin supplements are available over the counter in the United States.
Some people use melatonin supplements for sleep-related concerns or situations involving changes to their normal sleep schedule, such as jet lag.
Melatonin supplements should not be confused with prescription medicines such as ramelteon. Supplements can also vary in formulation and quality.
Anyone taking prescription medicines or managing an underlying health condition should discuss supplement use with a healthcare professional.
Sleeping Pills Comparison
| Type | Examples | General Purpose | Important Considerations |
|---|---|---|---|
| Z-Drugs | Zolpidem, Zaleplon, Eszopiclone | Sleep initiation and/or maintenance depending on the medicine | Complex sleep behaviors, sedation, impairment and dependence concerns |
| Benzodiazepines | Temazepam, Triazolam and others | Sleep initiation and/or maintenance | Dependence, withdrawal, sedation and impaired coordination |
| Orexin Receptor Antagonists | Suvorexant, Lemborexant, Daridorexant | Reducing wakefulness and supporting sleep | Drowsiness and central nervous system effects |
| Melatonin Receptor Agonist | Ramelteon | Difficulty falling asleep | Acts on melatonin-related receptors |
| Sedating Antidepressants | Doxepin, Trazodone | Selected sleep-related problems | Use depends on the specific medicine and clinical situation |
| OTC Antihistamines | Diphenhydramine, Doxylamine | Short-term sleep-aid effects | Drowsiness, tolerance and other antihistamine-related effects |
| Melatonin Supplements | Melatonin | Sleep-wake rhythm support | Supplement formulations and individual responses vary |
How Do Sleeping Pills Work?
Sleeping medicines work through different biological pathways.
- Z-drugs: Affect GABA-related signaling in the brain to promote sleep.
- Benzodiazepines: Enhance GABA activity and reduce central nervous system activity.
- Orexin receptor antagonists: Block orexin signaling involved in wakefulness.
- Ramelteon: Acts on melatonin receptors involved in sleep-wake regulation.
- Doxepin: At low doses, affects histamine signaling and is used for sleep-maintenance insomnia.
- Antihistamines: Block histamine activity and can cause sedation.
- Melatonin: Influences biological signals involved in the sleep-wake cycle.
When Are Sleeping Pills Used?
Sleeping medicines may be considered when insomnia is interfering with daily life or when non-drug approaches have not provided sufficient improvement.
Before medication is selected, a healthcare professional may evaluate:
- The duration and pattern of insomnia
- Difficulty falling asleep versus staying asleep
- Other medical conditions
- Current medications and supplements
- Alcohol and substance use
- Potential sleep disorders
- Risk of medication dependence
- Potential next-day impairment
Insomnia caused by another medical condition, medication, substance, or sleep disorder may require treatment of the underlying cause.
Common Side Effects of Sleeping Pills
Side effects vary by medicine and by the individual taking it. Common or possible effects include:
- Drowsiness
- Dizziness
- Headache
- Fatigue
- Confusion
- Memory difficulties
- Problems with coordination
- Reduced alertness
- Balance problems
Some medicines may also cause dependence, withdrawal symptoms, unusual sleep behaviors, or other serious adverse effects.
Next-Day Drowsiness and Impairment
One important concern with sleep medicines is that their effects may continue after waking.
Some sleeping pills can impair alertness, coordination, concentration, or reaction time the following morning. This can be particularly important when driving, operating machinery, or performing tasks that require complete mental alertness.
The FDA advises patients to understand the potential next-day effects of insomnia medicines and to follow the medication’s specific instructions.
Sleeping Pills and Complex Sleep Behaviors
Some prescription insomnia medicines can rarely cause complex sleep behaviors.
These may include:
- Sleepwalking
- Sleep driving
- Preparing food while asleep
- Eating while not fully awake
- Making phone calls while asleep
- Other activities performed without full awareness
People may not remember these activities the following morning.
The FDA has issued a boxed warning concerning complex sleep behaviors associated with certain Z-drugs because serious injuries and deaths have been reported.
If a complex sleep behavior occurs after taking a Z-drug, the FDA recommends stopping the medicine and contacting a healthcare professional immediately.
Can Sleeping Pills Cause Dependence?
Some sleeping medicines can cause physical dependence or become habit-forming, particularly when used for extended periods or in ways other than prescribed.
Benzodiazepines are particularly associated with dependence and withdrawal risks. Certain other prescription sleep medicines can also cause dependence or withdrawal-related problems.
Stopping some sleep medicines suddenly can cause withdrawal symptoms or temporarily worsen sleep.
Anyone who regularly takes a prescription sleeping medicine should discuss discontinuation with their healthcare professional rather than stopping treatment abruptly.
Sleeping Pills and Alcohol
Alcohol can increase the sedative effects of many sleeping medicines.
Combining alcohol with sleep medicines may increase drowsiness, impaired coordination, confusion, and other potentially serious effects.
Patients should follow the specific medication instructions provided by their healthcare professional and should not assume that alcohol is safe to combine with a sleeping medicine.
Sleeping Pills and Other Medicines
Sleep medicines may interact with other substances that affect the central nervous system.
Examples can include:
- Other sleeping medicines
- Opioid pain medicines
- Benzodiazepines
- Muscle relaxants
- Sedating antihistamines
- Some antidepressants
- Other medicines that cause drowsiness
- Alcohol
Patients should provide their doctor or pharmacist with a complete list of prescription medicines, OTC medicines, vitamins, supplements, and other substances they use.
Prescription Sleeping Pills vs. OTC Sleep Aids
| Feature | Prescription Sleep Medicines | OTC Sleep Aids |
|---|---|---|
| Availability | Require a prescription | Available without a prescription for certain products |
| Examples | Zolpidem, Zaleplon, Eszopiclone, Ramelteon | Diphenhydramine, Doxylamine |
| Medical supervision | Generally required | Professional guidance may still be appropriate |
| Potential risks | Sedation, impairment, interactions and dependence depending on the medicine | Drowsiness, tolerance and antihistamine-related adverse effects |
Sleeping Pills for Short-Term vs. Long-Term Insomnia
Not all insomnia requires medication. Short-term sleep difficulties may improve when the underlying cause is addressed and sleep habits are improved.
For ongoing insomnia, healthcare professionals may evaluate medical conditions, medications, lifestyle factors, mental health concerns, and other sleep disorders before deciding whether medication is appropriate.
Behavioral approaches such as cognitive behavioral therapy for insomnia (CBT-I) are important components of insomnia management and may be used alone or alongside medication when appropriate.
Non-Medication Approaches for Better Sleep
Improving sleep habits can be an important part of managing insomnia.
- Maintain a consistent bedtime and wake-up schedule.
- Keep the bedroom dark, quiet, and comfortable.
- Limit caffeine, particularly later in the day.
- Avoid alcohol close to bedtime.
- Limit stimulating screen use before bed.
- Exercise regularly, but avoid strenuous exercise immediately before bedtime.
- Avoid large meals close to bedtime.
- Create a relaxing bedtime routine.
- Address medical conditions that may interfere with sleep.
Cognitive behavioral therapy for insomnia, commonly called CBT-I, can also help address behaviors and thought patterns associated with persistent insomnia.
How Is the Right Sleeping Medicine Selected?
There is no single sleeping pill that is appropriate for everyone.
A healthcare professional may consider:
- The specific pattern of insomnia
- How long sleep problems have been present
- Age
- Other medical conditions
- Current medications
- Potential drug interactions
- Risk of dependence or misuse
- Risk of next-day impairment
- Previous treatment history
The objective is to address the sleep problem while minimizing unnecessary medication-related risks.
Frequently Asked Questions About Sleeping Pills
What are sleeping pills?
Sleeping pills are medicines or sleep aids used to help with certain sleep difficulties, such as trouble falling asleep or staying asleep. They include prescription medicines and some OTC products.
What are the main types of sleeping pills?
Major categories include Z-drugs, benzodiazepines, orexin receptor antagonists, melatonin receptor agonists, selected sedating antidepressants, OTC antihistamines, and melatonin supplements.
Are sleeping pills safe?
Safety depends on the specific medicine, the individual taking it, other medications, underlying health conditions, and how the medicine is used. Sleeping medicines can cause drowsiness, impaired alertness, interactions, dependence, and other adverse effects.
Can sleeping pills become addictive?
Some sleeping medicines can become habit-forming or cause physical dependence. The risk varies between medicines and individuals, so prescription sleep medicines should be used exactly as directed.
Can I take sleeping pills with alcohol?
Alcohol can increase the sedative effects of many sleeping medicines and may increase the risk of adverse effects. Follow your healthcare professional’s instructions regarding alcohol.
Can sleeping pills cause daytime drowsiness?
Yes. Some sleep medicines can cause drowsiness or impaired alertness the following day, which may affect driving or other activities requiring concentration.
What are Z-drugs?
Z-drugs are prescription hypnotic medicines that include zolpidem, zaleplon, and eszopiclone. They are used for certain forms of insomnia but carry important safety warnings.
Can sleeping pills cause sleepwalking?
Some prescription Z-drugs have been associated with complex sleep behaviors such as sleepwalking and sleep driving. These reactions can be serious and require immediate medical attention.
Are OTC sleeping pills safe for long-term use?
OTC sleep aids commonly contain antihistamines, and their effectiveness may decrease as the body becomes accustomed to their effects. Long-term or persistent insomnia should be discussed with a healthcare professional.
What is the best treatment for insomnia?
Treatment depends on the cause and type of insomnia. Sleep-habit changes and behavioral approaches such as CBT-I can be important components of treatment, while medication may be considered in selected situations.
When should I talk to a doctor about insomnia?
Speak with a healthcare professional if sleep problems occur frequently, interfere with daytime activities, persist despite changes in sleep habits, or are accompanied by symptoms such as loud snoring, choking during sleep, excessive daytime sleepiness, or unusual nighttime behaviors.
Conclusion
Sleeping pills include several different categories, and each works through a different mechanism. Z-drugs, benzodiazepines, orexin receptor antagonists, melatonin-related medicines, selected antidepressants, antihistamines, and melatonin supplements all have different uses and safety considerations.
Sleep medicines can be useful for some people when appropriately selected and monitored, but they are not risk-free. Potential concerns include drowsiness, next-day impairment, drug interactions, dependence, withdrawal, and complex sleep behaviors with certain medicines.
For persistent insomnia, identifying and addressing the underlying cause is important. Improving sleep habits and considering evidence-based behavioral treatment such as CBT-I may also be part of an effective treatment plan.
Do not start, stop, increase, decrease, or combine sleeping medicines without appropriate guidance from a qualified healthcare professional.
Medical Disclaimer
This content is provided for informational and educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Sleeping medicines can cause side effects, drug interactions, dependence, withdrawal, impaired alertness, and other serious risks. Always consult a qualified healthcare professional before starting, changing, or stopping any medication or sleep supplement.
Medical Sources
- U.S. Food and Drug Administration (FDA) – Sleep Problems and Sleep Medicines
- U.S. Food and Drug Administration (FDA) – Taking Z-Drugs for Insomnia: Know the Risks
- MedlinePlus – Medicines for Sleep
- MedlinePlus – Insomnia
- MedlinePlus – Sleep Disorders
