Katarzyna Bialasiewicz | Dreamstime
Over-the-counter and prescription sleeping pills might seem like an easy fix for your insomnia. After all, who wouldn’t want to get a better night’s sleep just by taking a pill?
Trouble is, many sleep medications may cause unwanted side effects, especially in older adults. So, many sleep experts encourage judicious use of these medications, while advocating greater use of non-pharmacological alternatives.
Instead of relying on sleeping pills, learn some strategies that can help you sleep better. If you have insomnia, talk to your physician about using sleep aids wisely, and explore non-drug treatments that can help you “get your ZZZs.”
When used properly, sleeping pills are generally safe; however, they may be problematic for certain patients, especially older users, who tend to be more sensitive to the medications. If you’re older, chances are your metabolism has slowed down, allowing sleep medications to accumulate in your system. If you have to get up in the middle of the night, you might stumble and fall, due to the sedating effects of the medication. Some patients experience morning grogginess, decreased reaction times, or impaired driving abilities that linger into the next day.
In fact, the U.S. Substance Abuse and Mental Health Services Administration reported in August 2014 that the number of emergency department visits involving one sleep aid, zolpidem (Ambien), nearly doubled from 2005-2006 to 2009-2010.
In rare cases, sleep aids may cause unusual nighttime behaviors, such as walking, eating, or driving while asleep. And, particularly with long-term use, some people may develop a physical or psychological dependence on the drugs.
Improve Your Sleep Hygiene
Consider these recommendations to improve your sleep hygiene and combat insomnia;
- Get exposure to bright light in the morning, and avoid bright lights at night.
- Find ways to unwind—reading, taking a warm bath, listening to soft music—before you go to bed.
- Keep your bedroom dark, and remove pets or any sources of noise that could disrupt your sleep.
- Turn off the television and computer at least two hours before bedtime, and don’t eat or exercise at least four hours before bedtime.
- Use your bedroom only for sleep or sex. Leave the bedroom if you can’t fall asleep within 15 to 20 minutes.
- Minimize your caffeine intake, and avoid caffeinated beverages or alcohol after 2 p.m.
- Limit daytime napping to an hour or less.
- Put your clock out of sight. Fixating on the clock will just make things worse.
- Ask your doctor if the medications you take are making you sleepy or keeping you awake.
Options for Sleeping Pills
Several types of prescription sleeping pills are available. Widely used sleep aids such as zolpidem and escopiclone (Lunesta®) work by slowing brain activity to promote sleep. A newer option—suvorexant (Belsomra), approved in 2014 by the U.S. Food and Drug Administration—alters the action of chemicals that keep you awake, essentially shutting off your awake switch. Studies have found that suvorexant users are unlikely to develop physical or psychological dependence, but like other sleep medications, the drug may cause daytime sleepiness, foggy thinking, or unusual sleep behaviors.
The choice of sleep aid depends largely on the nature of your insomnia. Some medications, such as triazolam (Halcion) and zaleplon (Sonata), only help you fall asleep, while drugs such as escopiclone, suvorexant, and extended-release zolpidem help you fall asleep and stay asleep.
If pain or restless legs syndrome (RLS) is causing insomnia, your doctor might recommend a medication like gabapentin (Horizant), pramipexole (Mirapex), or ropinirole (Requip), all of which can improve symptoms and also help you sleep. Similarly, if your insomnia is accompanied by depression, antidepressants such as mirtazapine (Remeron) and trazodone (Oleptro) may be prescribed. Be sure to speak with your doctor about what’s causing your insomnia. Treating an underlying problem might be all you need to improve your sleep.
A non-prescription option is supplements of the hormone melatonin, which may be especially helpful for insomnia associated with problems with the sleep/wake cycle and shifting sleep times, such as jet lag. However, the supplements should be taken about four to six hours before bedtime in order to be effective.
Many sleep experts recommend against using over-the-counter sleeping pills containing diphenhydramine or doxylamine, found in products like Benadryl, Nyquil, and Unisom. Tell your doctor if you use any over-the-counter sleep aids. And, avoid consuming alcohol with any prescription or non-prescription sleeping pills, or imbibing to help you fall asleep. Alcohol can help induce sleep, but it also causes fragmented sleep, which can lead to drowsiness the next day.
Better Sleep Without a Pill
Sleeping pills may provide short-term relief of insomnia, but for more permanent improvements, many experts recommend cognitive behavioral therapy for insomnia (CBT-I).
CBT-I teaches you skills to improve your sleep, such as ways to manage stress or avoid negative thoughts or fears that keep you awake. You’ll learn relaxation techniques or decrease the time you spend in bed, which may help make you more sleepy. Among other things, CBT-I teaches you about the importance of sleep hygiene (see chart for some sleep hygiene tips).
Research suggests that people who take part in CBT-I, with or without a sleep aid, do better over the long term than those who rely on sleeping pills alone.
To find a sleep specialist near you, visit these online sources: