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Sleep Aids: What You Need to Know

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It is 2:00 a.m. and you are staring at the ceiling. You check the clock every five minutes to calculate how much sleep you can squeeze in before the alarm jolts you awake. You have tried warm milk and relaxation tapes, yet you are still wide-awake. Should you take a sleeping pill?

If this sounds like your nightly routine, take heart. Insomnia affects millions of people, and sleep aids and other remedies claiming to solve the problem are plentiful. What is the best course of action and how do you know if sleeping pills or other sleep preparations are safe enough for regular use?

Talk to Your Doctor First

Before taking an over-the-counter sleep aid, talk to your doctor. These sleep aid medicines are not safe for everyone. Talking to your doctor may also help you find the triggers that keep you up at night and help you find a solution that works. Keep in mind that insomnia not only results in considerable nighttime distress for the insomnia sufferer, it is associated with next-day impairment, and may even have effects on health and mood.

What works for your neighbor may not work for you. Insomnia treatments may be short or long term, depending on your problem. It is important to know what options are available so you can minimize any effects on your sleeping patterns.

Over-the-Counter vs. Prescription Medication

Sleeping pills are available over-the-counter and by prescription. Use these tips when considering the use of sleep aids:

  • Take the medicine exactly as prescribed.
  • Try the medicine only after you have tried changing your behavior.
  • Use the lowest possible effective dose.
  • Do not automatically take a pill every night. Use the medicine only when you must have an uninterrupted night of sleep. Even then, it is a good idea to take sleeping pills only a few times per week at the most.
Over-the-Counter Sleep Aids

Many over-the-counter sleep aids contain antihistamines, while others contain the hormone melatonin .

Sleep aids containing antihistamines are common. They include medicines, such as Tylenol PM , Nytol , and Unisom , among others. Some people take a pure antihistamine drug, such as Benadryl , to help them fall asleep. The main problem with these remedies is known as the hangover effect. The next morning you may feel sluggish, sleepy, or have difficulty performing daily tasks.

Melatonin is a hormone that is secreted in the brain and helps our bodies regulate the sleep-wake cycle. Melatonin is sold as a dietary supplement, rather than as a medicine and is therefore not subject to regulation by the Food and Drug Administration for standards of potency and purity, so proceed with caution. There is some research that supports that melatonin may help treat jet lag. If you decide to try melatonin, talk to your doctor.

Prescription Medications

There are several prescription sleep aids available. Commonly prescribed classes of drugs include: benzodiazepines, nonbenzodiazepine, melatonin-receptor agonists, and antidepressants.

Sleep aids come with side effects and some may be associated with dependency with higher doses and longer treatment. Make sure that you use the medications as directed and monitor any problems you may be having with the medication.

Side effects

According to the National Sleep Foundation, many factors can influence potential side effects of prescription sleep aids, including:

  • Age
  • Dosage
  • The drug's half-life (the amount of time it takes for one-half of the drug to be lost through biological processes)
"Rebound Insomnia"

High doses of sleep medicines may result in what is known as rebound insomnia. This occurs when a person stops taking a sleep medicine and then experiences a few nights of insomnia that is more severe than what was originally experienced prior to treatment. Rebound insomnia generally occurs with medicines that have a short or intermediate half-life and can be avoided by slowly tapering the dose. Consult your physician prior to stopping or changing your dose.

Healthy Sleep Habits

The goal is to have healthy sleep habits, which may prevent the need for sleep aids. Here are some tips for a better nights sleep:

  • Keep a regular sleep schedule —Our sleep-wake cycles are regulated by a circadian clock in our brain and the body's need to balance sleep and wake times. It is beneficial to go to bed and get up at the same time each day to allow your body to get in sync with this natural pattern.
  • Avoid caffeine, nicotine, and alcoholCaffeine and nicotine are stimulants.Caffeine-containing products include coffee, tea, and chocolate. Half the amount of caffeine ingested will remain in the body on average from three to five hours, but some people are affected for up to 14 hours. Alcohol causes sleep disturbances throughout the night. While alcohol may help you relax and fall asleep, it can lead to a night of disrupted sleep as the night progresses.
  • Do not eat or drink too close to bedtime —It is best to avoid a heavy meal too close to bedtime. Spicy foods may cause heartburn , which leads to difficulty staying asleep. A light snack before bed may help you sleep better.
  • Exercise at the right time to promote sleep —Regular exercise is one of the most effective treatments for insomnia. However, exercising right before bedtime will make falling asleep difficult. Besides making you more alert, exercise causes a rise in body temperature, which can take approximately six hours to begin to drop. A cooler body temperature signals the body that it is time for sleep.
  • Use relaxing bedtime rituals —This may include taking a bath, reading a book, meditating, or listening to relaxing music. Use techniques that work best for you and your bed partner.
  • Create a sleep-promoting environment —The best sleep environment is a cool, quiet, and dark room. Be sure to check your room for noise or other distractions. Make sure that your mattress is comfortable and supportive.

Whether you decide to take medication or not, incorporate these sleep tips into your routine.

If you suffer from chronic insomnia, see your doctor. You may be experiencing a symptom of a larger problem, such as clinical depression or a sleep disorder. Your doctor will help you find the treatment plan or medicine that is best for you.

RESOURCES:

National Center on Sleep Disorders Research
http://www.nhlbi.nih.gov/about/ncsdr/index.htm

National Sleep Foundation
http://www.sleepfoundation.org/

CANADIAN RESOURCES:

Better Sleep Council Canada
http://www.bettersleep.ca/

The Canadian Sleep Society
http://www.css.to/

References:

Healthy Sleep Tips. National Sleep Foundation website. Available at: http://www.sleepfoundation.org/article/sleep-topics/healthy-sleep-tips. Accessed December 27, 2012.

Melatonin. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthlibrary/. Updated July 25, 2012. Accessed December 27, 2012.

Sack RL, Auckley D, Auger RR, et al. Circadian rhythm sleep disorders: Part I, basic principles, shift work and jet lag disorders. Sleep. 2007;30:1460-1483.

Sleep Aids and Insomnia. National Sleep Foundation website. Available at: http://www.sleepfoundation.org/article/sleep-related-problems/sleep-aids-and-insomnia. Accessed December 27, 2012.



Last reviewed December 2012 by Brian Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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