The Truth About Sleeping Pills: A Doctor Explains

If you often struggle to get some shut-eye, you're not alone — many Americans suffer from insomnia on a regular basis.

And a significant percentage of them are now routine users of sleeping pills as a result. In fact, at least one in eight adults who have trouble sleeping use sedative medications, according to the CDC. And the number of prescriptions for nonbenzodiazepine sedative hypnotics — a category of sleep drug — increased 30-fold between 1994 and 2007.

But is it safe to be taking these sleeping pills?

To answer the question, it's important to know the differences between the various options. After all, sleep aids include a spectrum of different pharmaceuticals — from over-the-counter solutions like melatonin supplements and Benadryl (diphenhydramine), to anxiety meds like Xanax (alprazolam), to prescription-only drugs specific to sleep, such as Ambien (zolpidem).

Here's what I tell my patients about each option:

Melatonin supplements

Melatonin is a hormone produced by a tiny gland in your brain that helps regulate sleep and wake cycles. It's produced prior to the onset of darkness, and it can be purchased over the counter in supplement form as a sleep aid.

Most people have positive experiences with melatonin. And research on this substance to treat seasonal depression is encouraging since irregularities of this hormone have been associated with seasonal affective disorder.

Verdict: In general, melatonin is safe and non-addictive, but you might not find it as effective as other sleep aids.

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Over-the-counter drugs

Did you know that one of the most common over-the-counter sleep aids is the same substance used to treat allergies?

The active ingredient in Benadryl — diphenhydramine — is actually a very potent sleep aid (in addition to combating allergies). That's because histamine, the substance that diphenhydramine acts against in allergies, is also a neurotransmitter that heightens your level of alertness in the brain. So as a result, you often become drowsy.

Verdict: In general, diphenhydramine is not habit-forming and is relatively safe.

Anxiolytic drugs

There's another class of drugs commonly used to help you fall asleep called benzodiazepines, which includes medications like Xanax and Valium (diazepam).

These drugs are actually mostly used for their anxiolytic, or calming, properties, and drowsiness is a side effect. But given their potency, this side effect can be quite effective at inducing sleep. Still, I don't recommend using them for this purpose.

Verdict: These drugs aren't for sleep and should only be used when prescribed for the appropriate reason by your medical provider. Benzodiazepines can be very habit-forming, especially the shorter-acting varieties like Xanax, and withdrawal can actually be dangerous.

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Prescription pills

Finally, there are the prescription sleep aids. Ambien (zolpidem), Lunesta (escopiclone) and Sonata (zalpelon) are some of the most common of this variety of drugs and are used specifically to treat insomnia.

The particular drug is typically chosen by your prescriber, who gears it toward your sleep pattern.

For instance, Ambien is very effective but tends to be shorter-acting. So for those who wake up during the night, Ambien CR (longer-acting) or another drug might be a better choice.

Lunesta is long-acting, so if you don't often have seven to eight hours to sleep, it might not be the best choice. Sonata is one of the newer drugs that is very short-acting, so if you have only a few hours to dedicate to sleep, it might be a better choice for you. However, if you wake up during the night regularly, it's probably not right for you.

Another type, Remeron, works differently from the others and targets the sleep-wake cycle. It's non-habit-forming for those who are worried about addiction.

With the exception of Remeron, the rest of these drugs can be habit-forming to some degree, and while the risk is not as significant as the risk with benzodiazepines, it should still be a concern for both you and your health care provider.

The verdict: In general, these drugs are useful — but they are best and most efficiently used as an adjunct to natural methods that help induce a good night's sleep, such as sleep-inducing lighting devices, and an environment and routine that encourages rest.

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