Sleep Medications
If you struggle with insomnia, understanding how sleep medications work can help you choose the safest option with your healthcare provider.
Sleep medications are drugs used to treat insomnia and other sleep problems. They help you fall asleep faster, stay asleep longer, or improve sleep quality when used correctly alongside overall sleep care.
Table of Contents | Jump Ahead
Z-Drugs (Ambien, Lunesta, Sonata)
Proper Use of Sleep Medications
When Sleep Medications Don't Work
Cognitive Behavioural Therapy for Insomnia (CBT-I)
What Are Sleep Medications?
Sleep medications affect brain chemicals and pathways that control sleep and wakefulness. They offer short-term relief but work best when combined with good sleep habits and by addressing the causes of sleep issues.
Key points about sleep medications:
- Different Types: Various types work through different methods to help sleep.
- Short-Term vs. Long-Term: Some are for brief treatment, others for longer use.
- Prescription and Over-the-Counter: Options include mild non-prescription aids and stronger prescription drugs.
- Individual Response: People respond differently to each medication.
Types of Sleep Medications
Prescription Sleep Aids
- Z-drugs: zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata) — used to help you fall asleep quickly.
- Benzodiazepines: temazepam (Restoril), lorazepam (Ativan) — reduce anxiety and promote sleep.
- Orexin receptor antagonists: suvorexant (Belsomra), lemborexant (Dayvigo) — block chemicals that keep you awake.
- Melatonin receptor agonists: ramelteon (Rozerem) — mimics melatonin, a natural sleep hormone.
Over-the-Counter Options
- Antihistamines: diphenhydramine (Benadryl), doxylamine (Unisom) — typically used for allergies but can cause drowsiness.
- Melatonin supplements: support the body's natural sleep cycle.
- Herbal supplements: valerian, chamomile, passionflower — traditional remedies for calming and aiding sleep.
Antidepressants for Sleep
- Certain sedating antidepressants like trazodone and mirtazapine are sometimes prescribed off-label to improve sleep.
What Sleep Medications Treat
Primary Sleep Disorders
- Insomnia: difficulty falling or staying asleep
- Sleep maintenance problems: waking up often at night
- Early morning awakening
- Shift work sleep disorder: trouble sleeping due to night or irregular work hours
Sleep Problems Related to Other Conditions
- Insomnia linked to anxiety or depression
- Sleep disturbances from chronic pain
- Sleep disruptions caused by medical diseases
Situational Sleep Problems
- Jet lag caused by travel across time zones
- Temporary insomnia from stress
- Adjusting to new sleep schedules
- Recovery from illness or surgery
How Sleep Medications Work
- Z-Drugs (Non-Benzodiazepine Hypnotics): These target specific GABA receptors in the brain that promote sleep. GABA (gamma-aminobutyric acid) is a key brain chemical that slows down nerve activity, helping the brain relax. Z-drugs like zolpidem (Ambien) work on particular GABA receptor sites to help sleep with fewer side effects than older drugs.
- Benzodiazepines: These boost GABA activity throughout the brain, which promotes relaxation and sleep. By enhancing GABA’s calming effect, benzodiazepines like temazepam (Restoril) reduce brain activity to help users fall asleep and stay asleep.
- Orexin Receptor Antagonists: These block orexin, a brain chemical that keeps people awake. By stopping orexin’s wakefulness signals, drugs like suvorexant (Belsomra) allow sleep to happen more easily.
- Melatonin-Based Medications: These mimic or support melatonin, a natural hormone that controls the body’s sleep-wake cycle. Ramelteon (Rozerem) works with the body's natural rhythms to promote feeling sleepy at the right time.
- Antihistamines: Typically used for allergies, these drugs block histamine receptors, and one side effect is drowsiness. This sedative effect helps people fall asleep but is less targeted than other sleep medications.
Benefits of Sleep Medications
- Faster Sleep Onset: Help people fall asleep quickly when going to bed.
- Improved Sleep Maintenance: Reduce waking up during the night and help stay asleep longer.
- Better Sleep Quality: Some improve the depth and restfulness of sleep.
- Reduced Sleep Anxiety: Knowing that help is available can ease worries about sleeping.
- Temporary Relief: Provide short-term aid while addressing the root causes of sleep problems.
Common Side Effects
Next-Day Effects- Drowsiness or grogginess
- Difficulty concentrating
- Memory problems
- Coordination issues
During Sleep
- Complex sleep behaviours (sleepwalking, sleep-eating)
- Vivid dreams or nightmares
- Sleep paralysis (rare)
Other Side Effects
- Dry mouth
- Dizziness
- Headaches
- Stomach upset
- Tolerance and dependence (with some medications)
Z-Drugs (Ambien, Lunesta, Sonata)
- Zolpidem (Ambien): A fast-acting medication that helps you fall asleep quickly. It comes in immediate-release and extended-release forms to suit different sleep needs.
- Eszopiclone (Lunesta): A longer-acting drug that helps both with falling asleep and staying asleep throughout the night.
- Zaleplon (Sonata): A very short-acting medication that can be taken during the night if you have at least four hours left to sleep.
Benefits:
These drugs are less likely to cause dependence compared to benzodiazepines and usually have fewer next-day effects like grogginess.
Risks:
They can cause unusual sleep behaviours such as sleepwalking or sleep-eating. Long-term use may still lead to tolerance, where the medication becomes less effective, requiring higher doses.
Benzodiazepines for Sleep
- Temazepam (Restoril): Approved specifically for treating insomnia, it helps with both falling asleep and staying asleep.
- Lorazepam (Ativan): Often used for sleep, especially if anxiety is also a problem.
Benefits:
These drugs are effective for treating both sleep issues and anxiety. They have been widely studied and used.
Risks:
They carry a higher risk of dependence, tolerance, and withdrawal symptoms. They also often cause more next-day sedation compared to other medications.
Newer Sleep Medications
- Suvorexant (Belsomra) and Lemborexant (Dayvigo): These block orexin receptors, which promote wakefulness. They may have fewer risks of abuse and side effects.
- Ramelteon (Rozerem): Works with melatonin receptors to regulate the sleep-wake cycle. It does not cause dependence or abuse.
Over-the-Counter Sleep Aids
- Diphenhydramine (Benadryl): An antihistamine that causes drowsiness; it is widely available but may cause next-day grogginess.
- Doxylamine (Unisom): Another antihistamine sleep aid, sometimes more effective than diphenhydramine for certain people.
- Melatonin: A natural hormone supplement that helps regulate the body’s sleep-wake cycle. Generally safe with few side effects.
- Herbal Supplements: Herbs like valerian and chamomile may have mild effects that promote sleep.
Starting Sleep Medications
- Medical Evaluation: Your doctor will review your sleep problems, medical history, and any current medications you are taking.
- Sleep Diary: Tracking your sleep patterns helps find the best treatment plan.
- Lowest Effective Dose: Treatment usually begins with the smallest dose that works.
- Short-Term Trial: Most sleep medications are prescribed for only a short period at first.
Proper Use of Sleep Medications
- Timing: Take sleep medicines only when you can dedicate 7 to 8 hours to uninterrupted sleep.
- Consistency: Use the medication at the same time every night for best results.
- Avoid Alcohol: Never mix sleep medications with alcohol, as this can be dangerous.
- Follow Instructions: Take the medication exactly as prescribed. Do not increase the dose without medical advice.
Risks and Concerns
- Dependence and Tolerance: Some sleep medications may cause physical dependence and become less effective over time.
- Complex Sleep Behaviours: Rarely, people may sleepwalk, drive, or eat while asleep.
- Memory Problems: Some drugs can affect memory during sleep.
- Falls and Injuries: There is an increased risk of falling, especially for older adults.
- Rebound Insomnia: Sleep problems might temporarily worsen after stopping some medications.
Special Populations
- Older Adults: More sensitive to side effects, with higher risks of falls and memory issues.
- Pregnancy and Breastfeeding: Safety data is limited, so treatment needs careful consideration.
- People with Sleep Apnea: Some sleep medicines may worsen breathing problems during sleep.
- Substance Use History: Benzodiazepines and Z-drugs might not be suitable for people with a history of addiction.
Drug Interactions
- Other Sedating Medications: Combining sleep drugs with other medicines that cause drowsiness can be dangerous.
- Antidepressants: Some antidepressants may increase sedation or other side effects when taken with sleep medications.
- Pain Medications: Using opioids (strong painkillers) with sleep medications can dangerously slow breathing.
- Supplements: Even herbal supplements might interact with prescription sleep medicines, increasing side effects.
When Sleep Medications Don't Work
- Underlying Sleep Disorders: Conditions like sleep apnea or restless leg syndrome may need specific treatments beyond sleep medication.
- Poor Sleep Hygiene: Improving sleep environment and habits is vital for medications to work well.
- Medication Switching: Trying different types of sleep medications if the first one is ineffective.
- Combination Approaches: Using medications together with cognitive behavioural therapy for insomnia (CBT-I) can improve results.
Stopping Sleep Medications
- Medical Supervision: Always work with your doctor to stop sleep medications safely.
- Gradual Tapering: Slowly reducing the dose helps prevent withdrawal symptoms and rebound insomnia (temporary worsening of sleep).
- Sleep Hygiene Focus: Maintaining good sleep habits is important before and during stopping medication.
- Alternative Strategies: Using other sleep improvement methods before stopping the medication supports a smooth transition.
Cognitive Behavioural Therapy for Insomnia (CBT-I)
- First-Line Treatment: CBT-I is often recommended as the first treatment for chronic insomnia.
- Long-Term Benefits: Provides lasting improvement without medication side effects or dependence risks.
- Combination with Medication: Can be used alongside sleep medications for enhanced effectiveness.
- Skills for Life: Teaches permanent strategies for managing sleep problems.
Sleep Hygiene and Lifestyle
- Sleep Environment: Cool, dark, quiet bedroom optimised for sleep.
- Regular Schedule: Consistent bedtime and wake time, even on weekends.
- Pre-Sleep Routine: Relaxing activities before bed signal to your body it's time to sleep.
- Avoid Stimulants: Limit caffeine, nicotine, and screens before bedtime.
- Exercise and Diet: Regular physical activity and avoiding large meals before bed.
Questions to Ask Your Doctor
About the Medication- How long should I take this medication?
- What side effects should I expect?
- Is it safe to drive the next day?
- What should I do if it stops working?
About Treatment Plan
- Should I also try therapy for insomnia?
- What lifestyle changes would help?
- How will we know if it's working?
- What's the plan for eventually stopping the medication?
Cost and Insurance
- Generic Options: Many sleep medications are available in less expensive generic forms.
- Insurance Coverage: Most insurance plans cover prescription sleep medications, though some may require prior authorisation.
- Over-the-Counter Costs: Non-prescription options are generally less expensive but may be less effective.
- Sleep Study Coverage: Insurance may cover sleep studies to diagnose underlying sleep disorders.
Myths About Sleep Medications
- "They're Always Addictive" While some carry dependence risk, many newer medications have lower abuse potential.
- "Natural Means Safe" Even herbal supplements can have side effects and interactions.
- "You Should Just Tough It Out" Chronic insomnia is a medical condition that often benefits from treatment.
- "They'll Stop Working Eventually" While tolerance can occur, many people use sleep medications effectively long-term.
When to Seek Help
- Chronic Insomnia: If sleep problems last more than a few weeks, it is important to get a professional assessment.
- Daytime Impairment: Seek help if sleep difficulties affect your ability to function during the day, such as feeling very tired or unable to concentrate.
- Safety Concerns: If drowsiness impacts crucial activities like driving or operating machinery, consult a healthcare provider.
- Underlying Conditions: When sleep problems might be linked to other health or mental conditions, professional evaluation is necessary.
Related Terms
- Sleep Disorders - Conditions treated with sleep medications
- Insomnia - Primary condition addressed by sleep medications
- Sleep and Mental Health - Connection between sleep and psychological well-being
References
U.S. Food and Drug Administration. (2023). Sleep Disorder (Sedative-Hypnotic) Drug Information. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/sleep-disorder-sedative-hypnotic-drug-information
Mayo Clinic. (2022). Prescription sleeping pills: What's right for you?. https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/sleeping-pills/art-20043959
PMC/NCBI. (2024). Pharmacological Treatment of Insomnia. https://pmc.ncbi.nlm.nih.gov/articles/PMC4634348/
Stanford Health Care. (2024). Treating Insomnia with Medications. https://stanfordhealthcare.org/medical-conditions/sleep/insomnia/treatments/treating-insomnia-with-medications.html
U.S. Food and Drug Administration. (2023). Drug Trials Snapshots: QUVIVIQ. https://www.fda.gov/drugs/drug-approvals-and-databases/drug-trials-snapshots-quviviq
This information is for educational purposes only and is not a substitute for professional medical advice. Always consult with a qualified healthcare provider before starting, stopping, or changing any medication regimen.
Important:
TherapyRoute does not provide medical advice. All content is for informational purposes and cannot replace consulting a healthcare professional. If you face an emergency, please contact a local emergency service. For immediate emotional support, consider contacting a local helpline.
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