Sleeping Pills and Aids – What are they?
Sleep is an important neurological behavior and an essential component of good health. The number of hours and quality of sleep can have an important effect on overall well-being, learning and memory. Chronic lack of sleep can increase your risk of high blood pressure, obesity, heart disease, diabetes and stroke.1 But unfortunately, not everyone gets the sleep they require.1,2
According to estimates, approximately 50-70 million Americans have suffered from sleep disorders or sleep deprivation.4,5 Further, the National Sleep Foundation reports that 22% of Americans battle with life-disrupting insomnia every night.1 As the most commonly reported sleep disorder, insomnia is characterized by symptoms such as: difficulty falling asleep, interrupted or impaired sleep, early morning awakening or not feeling refreshed after sleep.3
Sleeping pills work to decrease the effects of anxiety, chronic pain or insomnia to help users fall asleep and remain asleep throughout the night. Sleep aids may work to calm signals in the brain, mimic natural hormones, use active ingredients with sedative properties or a mix of compounds to promote sleep. Sleep remedies fall into several categories such as prescription, over the counter medicine and natural or herbal medications.1
Looking for a better, more restorative sleep?
Below we’ll explore the science behind natural sleep aids, homeopathic remedies, over the counter sleeping aids and prescription sleep medications to help you achieve a better night’s sleep.
Natural Sleep Aids and Remedies
Thinking of buying a sleep aid? Click here for the latest buying guide.
Natural sleep aids serve as one of the most popular forms of Complementary and Alternative Medicine (CAM) because they are widely available, can be taken without a prescription and carry different risks or side effects than pharmaceutical drugs.6 A myriad of factors contribute to patients choosing natural sleep remedies, which may prove more beneficial to certain populations.
Data from the 2006 National Health Interview Survey indicates that the number one Complementary and Alternative Medicine (CAM) form of treatment is natural sleeping aids.6 Natural sleeping pills can be self-medicated, allowing a patient control over price and dosage. For many natural sleep remedies, a prescription is not required, which may be more accessible to patients with demanding work schedules or those who do not have insurance to cover costly prescriptions. Natural sleep aid can easily be purchased in supplement stores, supermarkets, pharmacies or offered by naturopaths.
Using an all natural sleep aid may also be a part of Traditional Chinese Medicine (TCM) or alternative health care system which may better align with patients’ lifestyle or values compared to Western medicine.
Individuals may also seek herbal sleep aids for long term use, as prescription sleep medication has its limitations. Currently, the recommended duration for taking a hypnotic drug, or prescribed sleep pill, is a maximum of four weeks. Over the counter sleep aids such as antihistamines, are not recommended to be taken for more than 10 days.6,7,8
For patients with chronic sleep disorders, chronic pain, insomnia or trouble falling asleep, symptoms may last longer than the recommended use of these sleep aids.6 Natural sedatives may not cause the same side effects or reactions, such as next day grogginess, commonly associated with prescribed sleeping pills. This may be desirable if you frequently operate heavy machinery or drive for long periods of time.
As one of the most consumed beverages in the world, emerging research indicates that teas may be useful herbal sleep aids in the fight against sleep disorders.2 While consuming tea has traditionally been thought of as a relaxing pass time, people have now begun to specifically seek tea that helps you sleep.
In a 2009 survey of nearly 1,000 North American adults, sleeping tea such as chamomile was reported as the most popular natural sleep aid used in the past year.6 This snapshot indicates the growing trend of using herbs for sleep in today’s society.
In clinical studies, researchers have discovered that certain teas contain Gamma-aminobutyric acid (GABA), an amino acid found in the central nervous system which when released, relaxes the body and blocks neurotransmitters. GABA concentrations have also been found in soybeans, rice and tea.9
In 2015, researchers examined the effect of black tea extract on mice for a 15-day period. The GABA black teas demonstrated statistically significant improvements on sleep duration. The tea wasn’t shown to decrease sleep latency in the mice, or time it took to fall asleep.9
Beyond GABA components, previous studies link the bioactive elements in green tea such as, tea polyphenols (micronutrients), catechins (antioxidants) and water-soluble polysaccharides (long chains of simple sugars) as contributing to a restful sleep.9
Homeopathy is an alternative system of medical practice which only uses small doses of medicine to treat illness or disease. As a comprehensive system, health care providers consider physical, psychological and emotional factors to prescribe remedies tailored to the individual.10 Patients looking for alternative methods to expensive prescriptions or over the counter drugs, may seek homeopathic sleep remedies to ease their restless nights.
Due to the holistic approach of homeopathy, combined with the uniqueness of each patient’s case limits the amount of double blind, placebo controlled studies. However, in 2010, researchers evaluated the efficacy of a simillimum homeopathic remedy on chronic insomnia.7 Simillimum prescriptions are unique to each patient and act to mimic the side effects of the illness, as homeopathic practitioners believe “like cures like.”10
Data derived from the four-week trial indicates a significant advancement in the number of hours slept in the simillimum group. Improvements were also noted in sleep impairment index (SII) scores and self-reported sleep diaries. No adverse reactions were reported by the participants.7
Prescription Sleep Medications
Lack of sleep can cause serious adverse effects on an individuals’ physical, emotional and psychological well-being. If sleep difficulties persist longer than two weeks, a prescription may be required to reset normal sleep cycles. Prescription sleep aids can be classified into four different groups, benzodiazepines, non-benzodiazepines, melatonin-receptor agonists and tricyclic antidepressants. Consulting with your health care provider can determine which may be most effective for you.
Benzodiazepines are the most commonly prescribed group of sleep medications and are classified as a depressant drug. These sedative drugs affect the nervous system and brain, particularly an amino acid known as gamma-aminobutyric acid (GABA) to temporarily suppress anxiety. This results in the user experiencing reduced muscle tension, calmness and increased drowsiness.1,6,11 Benzodiazepines are the strongest sleeping pills currently available, with the most common brands include: Xanax, Valium, Restoril, Rohypnol and Serapax.1,11
Non-benzodiazepines are a similar classification of prescription sleeping pills that also target the GABA chemical but leave the body faster than traditional benzodiazepines and are reported to have less side effects.1 Generally, these sleep drugs take a longer time to develop a tolerance, therefore reducing the potential risk of abuse or withdrawal symptoms. Research has noted that using non-benzodiazepines sleep medication causes reduced disruption of normal sleeping patterns and may be effective for more long-term treatments of insomnia.12 Common brands of non-benzodiazepines include: Lunesta, Sonata and Ambien.1
Melatonin-receptor agonists are an alternative form of prescribed sleeping medication designed to mimic the effects of a naturally produced hormone, melatonin. These sleeping pills are intended to quickly leave the body and not regarded as habit-forming. Currently, the only melatonin-receptor agonist available in pharmacies is ramelton (Rozerem).1
Tricyclic antidepressants are originally intended to ease neuropathic pain, tricyclic antidepressants may alternatively be prescribed as a sleeping medicine to help insomnia. Due to their antihistamine properties, sedation is a common side effect for most users. While limited studies address the efficacy or safety of this method, tricyclic antidepressants would be administered in lower doses than allotted for depression.8 Common brands include: Elavil, Silenor and Anafranil.34
Over the Counter Sleep Aids
Over the counter (OTC) sleeping pills are sedatives that are available without a prescription. In the United States, the use of a non prescription sleep aid is approved by the FDA to relieve temporary sleeping problems for up to two weeks. OTC sleep aids are non habit forming and do not carry the same risks as sedative-hypnotic sleeping pills.14
As with any drug, OTC sleep remedies still carry side effects and may not be suitable for everyone.14
The strongest over the counter sleep aid will vary from user to user and depend on your unique sleep issues or existing tolerances. Nearly all over the counter sleep supplements will contain the ingredient diphenhydramine, which causes drowsiness and the desire to sleep. Often OTC sleeping aids add a pain relieving ingredient such as ibuprofen, acetaminophen or naproxen to make these pills more effective for larger populations. Common brand names include Aleve PM, Tylenol PM or Motrin PM.13
Sleeping Pills and Adults
Most healthy adults require 7-8 hours of sleep a night.3 A lack of sleep can affect judgement, mood, ability to focus, learning new tasks and memory.2 Sleep aids for adults can come in various forms such as pills, liquids or chewable tablets.
As society seems to be moving quicker, the pace of life is seemingly speeding up. Increasing work demands, stress, number of hours spent in front of screens, certain health problems or a growing reliance on stimulants (caffeine or others), have all advanced the issue of sleep disorders. Many adults turn to sleep supplements or sleeping aid pills to calm daily stressors and achieve a restful sleep.
Data from the National health and Nutrition Survey from 2005-2010 examined the increasing trend of sleeping pill prescriptions. Findings indicate that over the past 30 years, the use of prescription sleep aids has increased steadily, across multiple adult age groups. 4% of U.S. adults over 20 have reported using a sleeping medication in the past month. Interestingly, women tended to use sleeping aids slightly more than men (5.0% vs. 3.1%) and non-Hispanic white adults were the most common group to use sleep aids.33
Liquid Sleep Aid
Liquid sleep aid can typically be found in drugstores and may be easier to take than the common pill form. These sleep remedies often contain diphenhydramine and are flavored to help improve the taste. Common brand names include Nyquil, Unisom and ZzzQuil.16
Sleep Aids for Children & Toddlers
Childhood insomnia has been reported to occur in as many as 10% of children, with higher frequency in children with emotional or physical disabilities. Main factors include problems getting to sleep and remaining asleep throughout the night.17,18
If your child is consistently struggling to fall asleep, remain asleep or dealing with nightmares, the first step is to evaluate their current sleeping conditions.
Ensure that their bedroom is a quiet and conformable space that gets dark enough to help induce sleep. Avoiding eating too close to bed time. Set consistent bed times and wake-up times to help establish routine and reset their wake-sleep cycle. Make sure your child is getting the recommended amount of sleep for their age.17
Avoid distractions before bed time; TV, video games cell phone or computer time can interfere or delay the natural release of melatonin, the sleep hormone. Promote reading before bed as an activity to help fall asleep.17
Introduce relaxation techniques before bed such as a bath, storytelling or playing soothing music. For older children, having a warm cup of chamomile tea before bed may help naturally reduce trouble falling asleep.17
If you’ve exhausted these options, talk to your health care professional about further steps. Sleeping medication for children should only be used as a last resort and be used under supervision.
In several studies exploring possible sleep aids for children, melatonin has demonstrated positive effects for resetting internal wake sleep cycles in children and adolescents.
In one clinical study, researchers evaluated the use of 3-6 mg of melatonin (based on body weight) in children age 6-12 with attention-deficit hyperactivity disorder (ADHD). The treatment group saw a mean improvement of sleep onset (time it took to fall asleep) by 44 minutes and advancement of total time asleep.19
It’s estimated up to 67% autistic children have difficulties with sleep. In one study, 5 mg of melatonin was given to autistic children aged 5-11 with reported sleeping difficulties. Data indicated that total time to fall asleep, number of awakenings and total sleep time all improved. All children continued using melatonin after the study by the request of their parents.20
Notably, these studies have been conducted on special populations, such as children with ADHD, autism and several other unique populations. In healthy children, the limited amount of evidence suggests melatonin may improve sleep onset and increase time asleep.21 Melatonin is only considered safe for short term use. No evidence is currently available for the use of melatonin in children under two years old.17
The recommended hours of sleep for a toddler (1-2 years old) is 11-14 hours each night. Many toddlers experience trouble going to sleep due to increased motor skills, social or cognitive abilities. A quickly growing imagination and increased autonomy have many parents searching for an effective sleep aid for toddlers. The best way to ease night time resistance is to maintain a consistent sleep schedule and bedtime routine. Creating and enforcing this pattern may help establish a regular sleeping pattern.22
Looking for natural sleep aids for toddlers?
Try adding a soothing essential oil such as lavender to their next bath. Giving your toddler a security aid such as a blanket or toy may help them, and you, get a better night’s sleep.22
Baby Sleep Aids
Sleep plays an important role in restoring energy, tissue growth and the release of important hormones responsible for development and growth. For newborn babies, the recommended amount of sleep is 14-17 hours. Infants 4-11 months old require 12-15 hours of sleep for every 24 hours.22
Playing with newborns, exposing them to light and noise during the day will help keep them awake. In the evening, dim lights, quiet and calm environments can act as a natural sleep aid for babies.22
To promote healthy sleep patterns early on, lay babies down to rest when they’re becoming drowsy, ideally not when they’re already asleep. This encourages babies and infants to become independent ‘self-soothers’ and develop the ability to put themselves back to sleep during the night.22
Sleeping Pills Side Effects
Similar to all medicines, sleeping pills can cause a variety of side effects depending on the medication, dosage and a range of physical or emotional factors in each user.24According to Dr. Daniel F. Kripke, professor of psychiatry at the University of California, San Diego,
Prescription, over the counter (OTC) and natural sleep aids all come with their own set of side effects and limitations. Long term use can lead to a drug tolerance, dependency, adverse side effects or increased risk of withdrawals after stopping use. Users with multiple prescriptions may have to be cautious about drug interactions.14
Previously reported side effects of sleeping pills include:14,24
- Next day grogginess
- Muscle aches
- Dry mouth
- Trouble concentrating
- Urinary retention
- Lack of motivation
- Increased appetite
- Loss of muscle and speech coordination
- Complex sleep-related behaviors: sleep-eating, sleep-walking, sleep-driving
Note: This is not an exhaustive list of all possible side effects users may experience when taking sleep medication. Always talk to your health care provider if you experience any abnormal side effects.
Strong sleeping pills, such as benzodiazepines tend to carry more serious or exaggerated side effects such as complex sleep-related behavior, or the ability for users to perform actions while being completely asleep. This side effect is more likely to occur when users take higher than the recommended dose advised by their doctors.
Users taking benzodiazepine may also display symptoms comparable to being intoxicated or hungover. Common signs include users appearing sluggish or experiencing mental confusion first thing in the morning. In select benzodiazepines such as Rohypnol, minor memory loss may occur throughout the duration of the drug therapy.24
Sleeping Pills and Alcohol – When combined with large doses of alcohol or other depressants, benzodiazepine can cause serious central nervous system depression, which may lead to impaired respiratory function or in serious cases, death. Users should not drink while taking prescribed sleeping medication.14
In over the counter (OTC) and natural sleeping pills, common ingredients include: magnesium, melatonin, valerian root or diphenhydramine. These ingredients all frequently make people feel drowsy and may promote sleep.
Magnesium for Sleep
Magnesium is one of the most abundant essential elements found in the human body. Involved in over 300 biochemical reactions, magnesium is crucial for energy metabolism and neurotransmitter synthesis, particularly in the role of sleep regulation.25 According to National Sleep Foundation, individuals 65 years or older are one and a half times more likely to struggle with insomnia than younger adults.1 As we age, levels of magnesium levels steadily decline, alluding that certain elements such as magnesium and sleep may be linked.25
In a double-blind, randomized study 46 elderly participants (60-75 years old) took a magnesium sleep aid daily for a total of 8 weeks. In the magnesium groups, statically significant improvements in sleep efficacy, time asleep, sleep latency (time it took to fall asleep) and levels of melatonin were reported. Results also indicated reduced early morning awakenings.25
Melatonin Sleep Aid
Melatonin is a naturally occurring neurohormone released into the bloodstream to increase tiredness and promote sleep. Internally, melatonin regulates our circadian rhythm or wake-sleep cycle. Levels naturally rise as it becomes dark outside, usually releasing around 9:00 pm.26
Produced in the pineal gland the secretion of melatonin is triggered by the cycle of daylight and darkness. Exposure to light and darkness plays a critical role in quality of human sleep. Bright lights such as sunlight or artificial indoor lighting can delay or inhibit the release of melatonin.26
In 1994, the U.S Dietary Supplement Health and Education Act permitted melatonin to be classified as a dietary supplement and not a regulated hormone because it occurs naturally in some food sources. This act allows melatonin to be widely available in supermarkets and pharmacies at varying doses.26
While several studies have examined the use of melatonin for sleep in normal and special populations, there are large variations between time administered, dosage and duration of the treatment.8,27 In a meta-analysis of 17 studies conducted from 1980 to December 2003, researchers recognized several wide spread effects of taking melatonin. Data indicates that taking a melatonin supplement significantly reduced onset sleep latency (time it takes to fall asleep) by an average of 4 minutes. It also increased sleep efficacy by 2.2% and total time asleep by 12.8 minutes.27
Taking melatonin as a sleep aid has been most effective in resetting our biological clock. Studies have noted that it’s particularly useful for individuals suffering from jet lag or who engage in shift work.26
Diphenhydramine Sleep Aid
Some individuals use the sleep aid ingredient diphenhydramine, commonly found in antihistamines to treat temporary sleep difficulties. These are over the counter (OTC) drugs that are intended to reduce allergy or cold symptoms, but have a desired side effect which causes drowsiness or fatigue. Examples of products with diphenhydramine include: Sleep-eze, Nytol, Benadryl and Sominex. Although diphenhydramine or as it’s alternatively referred to, diphenhydramine HCl sleep aid, (indicating the hydrochloride element of the ingredient) can be effective for inducing sleep, it often lasts for an extended period of time and may cause grogginess the next day.24
Valerian Root for Sleep
Used as a medicinal herb since ancient Greece, valerian is a perennial plant thought to aid nervous tension and reduce the effects of insomnia. As with many natural remedies, valerian root is composed of a variety of organic compounds that act synergistically. To date, it remains unknown which specific compound produces the sleep-inducing effects.29
In a clinical trial, valerian sleep aid was given to 128 subjects who reported trouble sleeping. After taking a dosage of 400 mg on non-consecutive nights, significant improvements were reported in sleep quality and sleep latency (time it takes to fall asleep); notably amongst participants who smoked, or were thought to be poor or irregular sleepers.30
Few adverse effects have been reported after taking valerian root, but minor side effects include sleepiness the following morning, headaches or dizziness.29
Trazodone Sleep Aid
Widely prescribed as a sleep aid, trazodone was formulated over 30 years ago as a generic antidepressant. Approved by the U.S. Food and Drug Administration in 1981, it’s been one of the most commonly prescribed drugs for insomnia due to its perceived safety, affordability and desired side effects such as drowsiness. While it’s rarely prescribed for depression today, few clinical trials have examined it’s use as a sedative when users do not have diagnosed depression. According to the American Academy of Sleep Medicine, trazodone should only be taken after other drugs dedicated to sleep aid have been tried without positive results.31
Sleep Aid Safety
With doctor supervision, a number of the above mentioned products can be safe sleep aids. Users seeking non addictive sleep aid may turn to OTC sleeping aids or natural alternatives, such as chamomile which are non-habit forming.14,6 Alternatively, melatonin or melatonin-receptor agonists which are also thought to be forms of non habit forming sleep aids.1
It should be noted that after as little as one week of using benzodiazepines, dependency could occur. This means you may require higher doses to achieve the same effect. Users should be aware of this before starting treatment. When stopping the use of benzodiazepine sleep aids, users may experience mild symptoms of withdrawal.
Withdrawal symptoms may include:24
- Poor appetite
- Disturbed sleep
- Muscle spasms
- Flu-like symptoms
Sleep Aids During Pregnancy
During pregnancy, a number of changes are occurring to both your body and your child’s. As the baby grows, it may be more uncomfortable to get a good night’s sleep.
While it may be tempting to take sleeping pills or natural sleep aids, according to the U.S. National Library of Medicine pregnant women should not take any sleep aids, this includes over the counter and natural medications. Supplement Analyst recommends that you always consult with your health care provider before taking any medication during pregnancy.32
Sleeping Pill Reviews
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