Globally drugs are commonly used as sleeping aids. This $3.8 billion market is estimated to grow to $5.7 billion in 2025 in which insomnia treatment sleeping aids will be $4 billion of that market.
One out of 3 adults suffer from insomnia and in 35%, insomnia runs in the family.
Sleep deprived workers cost the US industry about $150 million each year because of lack of productivity, negative actions, and absenteeism.
Insomnia should be Treated
This comprehensive guide will give you all the information about sleeping aid pills: over the counter (OTC) versus prescribed sleeping aids; required dosage; types of sleeping pills; and how to safely use sleeping pills.
An Introduction To Sleeping Pills
More than 8.5 million Americans use prescription sleeping pills to help them sleep. Sleeping pills are the general term people use when referring to prescribed sleeping aids or over the counter (OTC) sleeping aids. Sleeping pills are also called sedatives or sleeping drugs.
A sedative hypnotic drug is a group of drugs that make you sleepy or helps you to relax. Hypnotics help you sleep and sedatives help you relax while awake. Many sleeping aids are sedative and hypnotic.
Sleeping pills work in two basic ways:
Studies have shown that sleeping pills help fight all types of insomnia, but it doesn’t always work as well as you may think. Sleeping pills are not the alternative to natural sleep. When you sleep, your brain and body restore and renew the body cells and mind. The brain is very active during sleep. In contrast, sleeping aids are sedatives that decrease the brain activity. However, if you don’t sleep, the brain and body can’t recuperate at all.
Insomnia symptoms occur in 33-50% of adults.
About 25% of Americans use some form of sleep aid or medication for insomnia.
What is insomnia?
Insomnia is a sleeping disorder where a person has difficulty in falling asleep, staying asleep, or quality of sleep is lacking despite enough hours sleeping. This leads to excessive sleepiness during the day.
Insomnia isn’t measured by the number of hours you sleep, it’s measured by the quality of your sleep.
3 Kinds of Insomniacs
There are 3 kinds of insomniacs based on what time during the night they can’t sleep.
Chronic or Acute Insomnia
How frequent you suffer from insomnia determines if it is acute or chronic.
Chronic insomnia is recurring. You have difficulty with sleeping most nights of the week and the symptoms last longer than a month. The cause may be some medical conditions like depression. Chronic insomnia is also caused by chronic stress and discomfort or pain at night.
With acute insomnia, sleeplessness is intermittent or sporadic. The common causes are often related to stress; illness; environmental factors like light, noise, and temperatures; certain medication for allergies, colds, asthma, blood pressure, and depression; and change in sleep schedule due to jet lag or shift work.
Acute insomnia is treated with sleeping aids whereas chronic insomniacs respond poorly to sleeping pills.
Who is prone to suffer from insomnia?
Insomnia is a global health issue that occurs in all countries, countries, ethnicity, and age. However, there are certain groups of people that are more prone to develop insomnia.
Sleeping Aids Treatment
The basic goal of treating insomnia is to ensure that the person’s sleep quality improves. Sleeping aids help combat insomnia.
Insomnia effects the person’s ability to function during the day. Lack of sleep influences the daytime alertness, energy, emotions, cognitive functions, and overall quality of life. When insomnia is treated, these daytime adverse effects are also indirectly treated.
Different Types Of Sleeping Pills
Although most sleeping pills are sedative hypnotic drugs, all sleeping pills are not the same. Sleeping pills differ in how fast it enters the bloodstream, the dosage required, side-effects, type of insomnia used for, and the average half-life.
The average half-life is the time the sleeping aid takes to leave the body. The half-life of sleeping pills varies from 6 hours to 20 hours. The hangover effect is a typical symptom of having the sleeping pill still in your system. A too short half-life will help you fall asleep but then you wake up after a few hours and can’t fall asleep again.
Most patients who suffer from depression or anxiety, suffer from insomnia too. The sedating effect of antidepressants helps with sleeplessness.
Antidepressants aren’t as addictive as other sleeping pills. However, antidepressants cause drowsiness during the day.
In contrast to other sleep aid pills, antidepressants can be prescribed for longer than 2 weeks. Although commonly prescribed for insomnia, the FDA doesn’t approve taking lower dosage antidepressants to combat insomnia.
In the 1970s benzodiazepines replaced the highly addictive barbiturates. Although not as dangerous, benzodiazepines hypnotics are addictive and strong sedative sleeping aids.
The side effects of most benzodiazepines are:
- Diazepam and Nitrazepam are prescribed for short-term insomnia. Diazepam may cause irritability and headaches as additional side-effects.
- Estazolam has an intermediate half-life and is commonly prescribed for insomnia. Irritability and headache are other side-effects associated with Estazolam.
- Flurazepam and Loprazolam have a long half-life that causes the inability to focus and excessive drowsiness during the day. Flurazepam and Loprazolam are prescribed for extreme insomnia cases. Headaches and blurred vision may occur with Loprazolam and the inability to stand or walk is another side-effect of Flurazepam.
- Temazepam is prescribed for sleep-maintenance insomniacs. Temazepam relaxes muscles and reduces anxiety. Additional side-effects are blurred vision and headaches.
- Alprazolam and Flunitrazepam are highly addictive sleeping aids and are rarely prescribed.
The key is how long the sleeping pills remain in your body. The most common benzodiazepines are:
Non-Benzodiazepines or Z-drugs
Z-drugs are less addictive than a benzodiazepine. Although the half- life is shorter to decrease side effects, studies have shown the long term negative effects are the same as benzodiazepines.
Z-drugs also work on the GABA receptors. Where benzodiazepines have a wide target area, z-drugs are limited to receptors that encourage sleep.
Daytime drowsiness is a common side-effect of all z-drugs.
Melatonin Receptor Antagonist
Ramelteon targets the melatonin receptors instead of the GABA receptors. The supraschiasmatic nucleus (SCN) or your biological clock, establish the circadian cycles that determine your waking and sleeping time in a 24-hour cycle. Melatonin inhibits the body clock.
Ramelteon copies the workings of melatonin. Studies have shown this sleeping aid pill shortens the time you fall asleep and increases the sleep duration.
Ramelteon is often used for the elderly whose biological clocks change with age and become less receptive to environmental signals.
Ramelton is not addictive and effectively treats insomnia. Dizziness and daytime drowsiness are the only side-effects.
Over-The-Counter or Prescription Medication?
Generally, doctors will explore non-prescription sleeping aids before they prescribe sleeping pills. The main reason is that prescription sleeping aids may be addictive whereas the OTC sleeping aids are not.
Benzodiazepine, the main active ingredient in most prescribed sleeping pills is known for its side effects and prone to becoming addictive. The active ingredient in OTC is antihistamine that causes drowsiness.
The FDA approved only 3 active ingredients for over the counter (OTC) sleeping aids. In 1978 antihistamine doxylamine succinate was the first active ingredient to be approved. Diphenhydramine HICI and diphenhydramine citrate were approved in 1982.
OTC sleeping aid pills are the milder sleeping drugs with fewer side effects than the prescribed medicines. Common side effects that may occur are:
Drugs that treat allergy are commonly taken for mild cases of insomnia.
Insomnia is often a side-effect of pain. Pain relievers do not cause daytime drowsiness but help with falling asleep. Non-steroidal inflammatory pills also help reduces the pain and cause sleep.
Sleeping pills shouldn’t be taken longer than 4-5 weeks. Usually, the doctor will prescribe a sleeping aid for about 10 days and then re-evaluate the situation.
Due to the addictive tendencies and side effects, it is recommended to start with the lowest prescribed dosage. This includes OTC sleeping aids.
Always take the prescribed dosage, never self-medicate.
30 Minutes or Less
Prescription sleeping pills are fast acting. Therefore, take the sleeping pills with a glass of water when you’re in bed. Generally, sleeping pills are taken 20-30 minutes before you want to sleep. Due to its quick action, stay in bed 10-15 minutes after you’ve taken the sleeping pill.
Although a milder sleeping drug, OTC sleeping aids should be taken before bedtime.
- They are taking the sleeping pills longer than they should. The recommended time is 7-10 days.
- They are taking more than they should. Sleeping pill dosages are specifically prescribed for the specific individual taking into consideration age, gender, insomnia type, and other medical disorders.
- They are taking the sleeping pills with supplements, beverages or drugs that create harmful combinations.
Women Versus Men
The FDA recommended dosage for women are lower than for men. Women metabolize sleeping pills slower and therefore the effect lasts longer. The recommended dosage is 5 mg.
Elderly Versus Younger.
The same sleeping pill effects people differently. In the elderly, the average half-life is longer than in younger people.
Benzodiazepines and z-drugs are not recommended for the elderly. If prescribed, it is the elderly person starts at half the recommended dosage.
Due to the way it works and the few side effects, Ramelteon is preferred for the elderly.
The Risk Of Addiction
Consumer Report survey indicated that 50% of Americans who use sleeping aids are using it incorrectly.
If taken over a period, your body becomes accustomed to the dosage. With the higher tolerance level, an increased dosage is needed for the sleeping pills to have the same effect. After a while, the body becomes tolerant of that dosage too and you find the sleeping aid is not helping. Too high dosage may cause death because your breathing stops.
After prolonged use of sleeping aids, don’t stop abruptly. Anxiety, muscle cramps, and nausea are common withdrawal symptoms. Consult your doctor for a weaning off a program that prevents or minimizes withdrawal symptoms.
Sleeping pills are highly addictive. Studies show that 25% of people who take sleeping aids for longer than 3 months become addictive. Prevent the risk of addiction and break the cycle after a period of 2 weeks.
Although some sleeping aids are not physically addictive, it is psychologically addictive.
SAMHSA (Substance Abuse and Mental Health Services Administration) reports that a common addictive misuse is the combination of alcohol and sleeping pills. Accidents while driving under the influence of alcohol and sleeping pills endangers not only the driver’s life but passengers, pedestrians, family, and friends.
The Drawbacks of Sleep Medications
Sleeping pills have unpleasant side-effects that may be dangerous. Through the years the FDA has decreased dosage recommendations of sleeping pills because of the dangerous adverse effects.
The 10 most common side effects of sleeping pills are:
A feeling of lightheadedness or dizziness may cause you to lose your balance and fall. This is particularly dangerous for the elderly who can easily fall and break a hip.
#2 Fast Working
Sleeping pills work fast. If you’re not in bed when you take the pills, you may be caught unaware. This may lead to making wrong decisions and doing things you have no recollection the next day.
#3 Gastrointestinal Problems
Sleeping pills may cause diarrhea and nausea. This, in turn, affects your mineral levels in your body.
#4 Erratic Behavior and Memory Loss
You may take part in activities that you have no recollection of the next day: sleepwalking, driving while not awake, having a conversation, having sex, and leaving the house. Triazolam may cause sleepwalking and memory loss.
A Washington University of study showed a correlation between prolonged usage of sleeping pills and dementia in people 65-year-old and older.
#5 Performance Level
If the sleeping tablet hasn’t worked out of your system, it affects your performance level during the day. This may lead to making mistakes at work, poor decisions, and irrational behavior.
With the long half-life of some sleeping pills, you may find it difficult to wake up the next morning. Too strong a dose may cause you to sleep so deeply that you don’t hear the alarm clock. When you do awake, you feel groggy and tired.
#7 Prolonged Drowsiness
Despite taking the prescribed dosage, sleeping aids can cause prolonged drowsiness the next day.
According to the National Highway Traffic Safety Administration, each year in the US alone, 100,000 car accidents with 1,500 deaths are caused by drowsiness.
#8 Allergic Reaction
Like any medication, people can be allergic to the sleeping aid. It may be the active ingredient, the coating, the dyes or the binders that cause an allergic reaction. Blurred vision, chest pain, breathing difficulty, itching, throat constriction, hives, nausea, and swollen eyes are all symptoms of possible allergy. Stop using the medication immediately and consult a physician.
#9 Tolerance and Overdose
The danger of taking sleeping pills longer than 2 weeks is your body becomes accustomed to the drug. The tolerance level increases and you need a higher dosage for the same effect.
When taking a higher dosage than recommended, may lead to overdose. Common symptoms of overdose are drowsiness with shallow breathing, slow heartbeat. Overdose may induce a coma.
#10 Cancer Risk
A study in the British Medical Journal found that the risk of cancer increased with 35% in people who took sleeping pills than those who didn’t.
Sleeping Soundly and Safely
When you do need to take a sleeping aid take these suggested precautions to ensure a safe and good night’s sleep.
8 Hours Sleep
If you don’t sleep long enough while taking sleeping pills you will wake up feeling tired. The sleeping pill may work fast to help you fall asleep and stay asleep, but it also stays in your system for a while. An 8-hour sleep is recommended for most sleeping aids to work out of your system.
Avoid Alcohol and Drugs
Alcohol and certain drugs work on the same GABA receptors as sleeping pills. When you mix sleeping pills with alcohol or other drugs, the effects are enhanced. Your breathing and heart rate may slow down to such an extent that it becomes dangerous. The effects last longer as well; you’ll wake up sluggish and still drowsy.
Grapefruit and grapefruit juice increases the absorption of sleeping aids in the blood and prolongs the half-life of the drug. This means you can over sedate yourself if you eat grapefruit while taking sleeping pills.
Prolonged drowsiness is a common side-effect. If you feel drowsy, don’t drive.
Start with the lowest dosage until you know how the sleeping pill affects you. Slowly increase to the dosage you need to combat insomnia. Keep in mind that women, the elderly, and when taking other medication, the effect of sleeping aids are enhanced. Be safe and take a lower dosage.
Always read the package insert before you take the sleeping pill. Take not of possible side effects and the safety precautions in taking the sleeping pill.
If you’ve tried improving your sleeping pattern naturally and it doesn’t help, seek help. Untreated insomnia may lead to other health issues such as depression, heart diseases, or injuries.
Always consult a doctor for a treatment plan for insomnia. He will prescribe the correct medication for your age, health issues, and type of insomnia.
Be aware of the possible side effects of the specific OTC or prescribed sleeping aid. When you notice any side effects consult with your doctor.
Sleeping pills are aids to help you for a short time. Don’t take the pills longer than necessary or the required prescription time. If taken too long, you may become addicted to the sleeping pill.
One of the adverse effects of stop taking the sleeping pills without a weaning off period is that initial insomnia will re-occur. Wean yourself off by taking smaller dosages over a period.
Improve Sleep Without Medication
If you’re not keen on consulting a doctor or taking sleeping aids, then try these simple steps that will help improve your sleep. If insomnia persists, consult a doctor, even before you decide to purchase an OTC drug.
- Routine Wakeup. Get up the same time every day irrespective of what time you went to bed or fell asleep.
- Bedtime. Wait until you’re sleepy before you go to bed.
- Pre-sleep Rituals. Replace bad sleeping rituals with pre-sleep rituals that are relaxing like: a warm bath, reading, or a bedtime snack.
- Relaxation Techniques. Breathing exercises and muscle relaxation decreases the anxiety levels of not being able to sleep. Relaxation techniques help you control your heart rate, slowdowns anxious breathing improves your mood, and works against muscle tension.
- Exercise Timing. Exercise regularly It is best to exercise mildly 2-3 hours before bedtime and to keep vigorous exercise for late afternoon.
- Exercise Daily. Studies have shown that exercise combats insomnia and improves sleep quality. Six randomized trials showed that older people who exercised regularly slept better and took less sleeping aids. A study, in 2013 found a direct correlation between exercise and sleep. Women who exercised for 20-30 minutes daily for 4 months or longer, suffered less from insomnia than those who didn’t exercise regularly. The positive results were due to consistent exercise over a period.
- Avoid Caffeine. According to a study published in the Journal of Clinical Sleep Medicine, you should stop drinking coffee, colas and other caffeine foods and beverages 6 hours before bedtime. Coffee causes insomnia. If you fall asleep despite the coffee, the caffeine affects the quality and duration of your sleep and you wake up tired.
- Stop Smoking. If you don’t want to stop smoking, then don’t smoke in your bedroom. Smoking stimulates sleeplessness and it may cause snoring. Snoring causes sleep disruptiveness and prevent deep sleep.
- Alcoholic Beverages. Alcohol may cause you to fall asleep, but it interferes with the sleep quality.
- Don’t Worry. Schedule a time during the day to find solutions to the problems that may cause you to worry.
- No Technology. The light from the television, your laptop, tablet, and cellphone give the brain the impression that it’s daytime. Therefore, it produces less melatonin which results in difficulty falling asleep. If you can’t sleep, don’t watch television in the room. Go to another room to read or watch television. Then you’ll associate your bedroom with sleeping.
- Avoid Saturated Fats. Fatty foods late at night cause indigestion and heartburn that keeps you awake. Avoid eating saturated fatty foods at night.
- Sleep Journal. Record your sleeping patterns for a few weeks. Diagnosing insomnia is easier than determining the cause. A sleep journal will indicate if environmental factors or pre-sleep rituals play a role in the reason for your insomnia.
- Quiet and Dark. A noisy or light will prevent you from sleeping. Blot out all light in the bedroom. Close the curtains and remove any flickering lights and noise.
Treating Chronic Insomnia with CBT
Most sleeping aid pills when prescribed for longer than 2 weeks become addictive. American College of Physicians recommends CBT as the treatment for chronic insomnia. CBT is a cognitive behavioral therapy that combats chronic insomnia.
The brain works with patterns and associations. When you lie awake in bed and can’t sleep night after night, the brain starts associating the bed with being awake instead of asleep. In other words, you may feel sleepy but the moment you go to bed, you’re suddenly wide awake.
CBT trains the brain to react differently. To break this cycle of associating the bed with being awake, take the following steps:
When the cycle is broken, create new behavioral patterns. Wait until you’re sleepy before you go to bed at night. Gradually go to bed earlier and earlier until you are sleeping about 8 hours each night.
Herbs and Hormones
The small pineal gland produces the hormone melatonin. Melatonin production decreases from the age of 40. The production of melatonin correlates directly with the amount of light in your environment. During daytime, production is decreased to keep you alert. When its dark, melatonin production is increased, and you become drowsy and sleepy.
Melatonin supplements are produced naturally from extracts taken from sheep pineal glands and synthetically.
Melatonin is the most common sleeping aid supplement for sleep-onset and sleep-maintenance insomnia. Melatonin is not as effective for chronic insomnia.
Consult a doctor when taking melatonin. If the dosage is too high, you will inhibit the production of melatonin by the pineal gland.
Headaches, nightmares, and mild depression are known side effects of melatonin. This normally occurs when the too high dosage is taken.
Since babies have an abundant supply of hormones, melatonin should not be given to babies. Melatonin supplements are not recommended for:
Valerian Root (Valerian officinales)
Valerian root is a flowering plant that has sedative properties. The dried root is recommended for sleep-onset insomniacs and sleep-maintenance insomniacs.
Valerian root is available in capsule form. The recommended dosage is 4 capsules 1 hour before bedtime. For sleep-maintenance insomnia, take another 4 capsules when you wake up during the night and can’t fall asleep again.
To prevent your body becoming tolerant to valerian root, change to another herbal supplement after 3 weeks. After a few weeks, you can use valerian root again.
For Early-Morning- Awakening Insomniacs
Ashwagandha and magnolia bark are herb supplements early-morning-awakening insomniacs can take.
Both supplements reduce cortisol levels and therefore relaxes the body and mind.
Italian studies show that magnolia bark combined with magnesium decreases anxiety levels and improves sleep. A study published in The Indian Journal of Psychological Medicine reported that ashwagandha reduced chronic stress and insomnia.
Insomnia can be caused by a simple thing as having a 2-3-hour afternoon nap or a too soft or hard mattress. By following simple steps mentioned above, you can eliminate the obvious reasons for insomnia.
If insomnia persists, consult a doctor. Lack of sleep influences how your body cells grow, restore and recuperate. Insomnia also affects your quality of life.
Despite the side effects of sleeping pills, there is a need for sleeping aids if taken correctly. Herb and hormone supplements are alternatives to prescribed and OTC sleep aids.
Be cautious and never take sleeping pills without a doctor’s prescription, including OTC sleep medication.
Disclaimer: Our content does not constitute a medical consultation. We recommend you see a certified medical professional for diagnosis and treatment.