What you need to know about sleeping pills

About one-third of adults worldwide say they sometimes have trouble falling or staying asleep. If you are one of them, you may have tried sleeping pills to find some temporary peace.

There is a growing list of prescription drugs, including suvorexant (Belsomra) and ramelteon (Rozerem), which are specifically approved for sleep. Doctors may also prescribe off-label medications to treat insomnia, such as the antidepressant mirtazapine (Remeron). Over-the-counter antihistamines such as diphenhydramine (Benadryl) or doxylamine (Unisom) can also double as sedatives.

We are truly in the golden age of insomnia medications, says Dr. David Neubauer, a sleep expert at Johns Hopkins University School of Medicine. Your doctor can recommend different treatments based on the type of sleep problem you have—whether your thoughts are racing or you wake up multiple times in the middle of the night.

But all sleeping pills carry risks, such as daytime drowsiness, and some can even be addictive. That’s why experts say it’s best to limit how much you rely on them.

The ideal use of these medications is to use them only when needed, so I recommend using them two to three times a week, but only for short periods of time, says Dr. Alcibiades Rodriguez, a sleep medicine specialist at NYU Langone Health.

Judicious use of sleeping pills may be helpful in certain situations, such as during a two- or three-week period of insomnia triggered by a specific event. Your doctor may also recommend taking sleeping pills as a last resort if you’re still having trouble getting a restful sleep after trying lifestyle changes, such as avoiding screens at night and using cognitive behavioral therapy strategies designed for sleep.

You should always talk to your healthcare provider before starting to take sleeping medications so that you can make a plan for when you will take them. If you still need them after a month, talk to your doctor to determine if another treatment or medication might work better, or to see if you have a condition that causes poor sleep that isn’t resolved by any sleeping pills.

What works for you depends on the reason for your insomnia, Dr. Neubauer says. Rozerem works by stimulating melatonin receptors in the brain, helping you maintain a normal sleep cycle. Doctors sometimes prescribe benzodiazepines, which can both reduce anxiety and make you drowsy when you have trouble falling asleep. These include alprazolam (Xanax) and clonazepam (Klonopin). There are also non-benzodiazepine drugs, such as zolpidem (Ambien) and eszopiclone (Lunesta), that can produce similar effects.

The effects of over-the-counter antihistamines on sleep have not been well studied, and the American Academy of Sleep Medicine recommends against their use to treat insomnia. Many can linger in your system and cause drowsiness and falls during the day. Long-term use may carry risks of memory problems, confusion, and constipation, which may be more pronounced in older adults. Some studies suggest that long-term use of antihistamines is associated with an increased risk of dementia, although this association is not clear-cut.

Although they are not considered sleeping pills, many people also take supplements like melatonin to treat insomnia. Experts say it’s important to note that many supplements have not been rigorously tested for effectiveness and may not contain the melatonin content listed on the label or any melatonin at all.

Prescription drugs come with their own side effects, ranging from dizziness and headaches to gastrointestinal problems. You also shouldn’t mix them with certain drugs and substances, including alcohol, opioids, and antidepressants. Doing so can further depress the central nervous system and cause breathing to slow, which can be dangerous, Dr. Neubauer says. Prescription sleeping pills may trigger sleepwalking or cause severe driving impairment.

Over time, the body gets used to these drugs, so people often need higher doses to achieve the same effects, Dr. Rodriguez said. For some of these drugs, especially benzodiazepines, this dependence can escalate into addiction. This is why it’s so hard for people to quit sleeping pills, and why many people stay on prescription drugs for years.

You need a slow and strategic approach, says Jade Wu, Ph.D., a sleep psychologist at Duke University and consultant to sleep health company Hatch. For some people, suddenly stopping after using sleeping pills for more than a month can trigger withdrawal symptoms, which may include high levels of anxiety, irritability, or rebound insomnia, meaning your sleep is disrupted again. Most experts recommend gradually reducing the dose over several weeks or months with your doctor’s help.

Cognitive behavioral therapy for insomnia can also address the causes of insomnia, focusing on changing behaviors and thinking patterns that contribute to sleep problems. Research suggests that CBT-I may offer a longer-lasting alternative to medications.

It’s also important to develop good bedtime habits, such as sleeping in a dark room and avoiding screens, to help mitigate rebound insomnia.

Dr. Wu says there may be some rocky nights, but that’s okay. Believe that you are not actually going backwards.

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