What Medications to Take When You Cannot Sleep

Insomnia treatments include sleeping pills and CBTI therapy

Treatments for chronic insomnia include taking sleeping pills and prescription medications, but therapy may resolve difficulty sleeping
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Trouble falling or staying asleep can be greatly distressing. When it occurs chronically, this is called insomnia. If you find yourself having trouble getting to sleep, you may be seeking a solution in the form of sleeping pills. What sleeping pills and prescription medications can you take when you can’t sleep? Are there treatment options available at home?

When should you see a doctor? Learn about some of the treatments that might help you to finally get to sleep, including the role of insomnia therapy called CBTI.

A Word on Insomnia

Insomnia is the most common sleep disorder, affecting nearly everyone at some point in their lives. It may be short-lived and related to an identifiable stressor, in which case it is referred to as acute insomnia. Trouble sleeping the night before a big test is an example.

However, these difficulties might also become a chronic condition that can leave you greatly distressed. Chronic insomnia occurs at least 3 nights per week and lasts for at least 3 months. In either scenario, you may be interested in learning about ways to finally get to sleep, including the use of sleeping pills.

Home Remedies to Help You Sleep

Many people with insomnia hope for a quick fix. It would be ideal if you could do something, or simply take something, to help you get to sleep.

These desired options might range from sleeping pills you can take, foods you can eat, or beverages you can drink.

Both now and in the past, people have consumed a small amount of alcohol to aid sleep. These "nightcaps" (a reference to bygone headwear worn during sleep to minimize heat loss) are, for some people, a bedtime routine.

However, we now understand that alcohol is not an effective sleep aid. As a depressant of the brain, it might make you feel sleepy by increasing adenosine levels. However, the sleep that results is fragmented and disrupted. It suppresses REM sleep, characterized by vivid dreaming. The sleep that occurs is ultimately not refreshing and may lead to symptoms of sleep deprivation. In addition, alcohol use may contribute to an increased risk of obstructive sleep apnea due to relaxation of the airway muscles. Therefore, the use of alcoholic beverages to help with sleep is not recommended.

You might raid the kitchen looking for other things to help you sleep. Perhaps a glass of warm milk? What about a turkey sandwich, laden with the sleep-promoting chemical called tryptophan? Even a glass of soothing "sleepy time" tea may seem tempting.

You should be cautious if you choose to eat or drink something to help you sleep. Any products that contain the stimulant caffeine should, as a rule, be avoided. As such, abstain from coffee, caffeinated tea, chocolate, and energy drinks. In addition, other selections may be undesirable. You may not want to eat a large meal, spicy food, or tomato products as you might provoke nighttime heartburn.

Food consumption prompts the release of insulin, which may promote wakefulness.

There are foods that can be comforting, and this may put you in a more favorable mindset to sleep. In general, a bedtime snack is unlikely to ease you into a sound night’s rest, however. There are some foods that may be more effective. Certain foods, such as turkey, contain tryptophan. When you eat it, your body converts it to a neurotransmitter called serotonin. Higher levels of serotonin within your brain may, in turn, make you feel sleepy. There are also foods (such as tart cherries) that contain low doses of melatonin, a hormone that is important in the regulation of the timing of sleep called the circadian rhythm.

However, the melatonin contained within food is so little that you would have to consume a large portion of the food to see any effect.

In summary, the sleep-promoting effects of food and beverages are modest and unlikely to significantly improve your ability to sleep. Moreover, the use of alcohol or caffeine will have a disruptive effect on your sleep. You might also set yourself up for nighttime heartburn if you eat the wrong food too close to bedtime. As a result, you may need to turn to other options.

Over-the-Counter Sleeping Pills

Many people turn to sleeping pills to aid in the transition to sleep. If you can’t sleep, you might start by raiding your medicine cabinet or by visiting your local pharmacy shelf. Many products seek to provide immediate relief of difficulty sleeping, but unfortunately, few can deliver on their promises.

Over-the-counter sleeping pills typically induce sleepiness as a side effect. As an example, medications that contain a "PM" in the brand name often have diphenhydramine as an active ingredient. The same is true for the product sold as ZzzQuil. Benadryl (the generic name is diphenhydramine) is an antihistamine used to treat allergies and may cause sleepiness. These medications may be habit-forming, do not promote normal sleep, and are not recommended as treatments for persistent insomnia.

Another over-the-counter choice is the naturally occurring hormone called melatonin. This may be helpful if your insomnia is due to a misalignment of your circadian rhythm. It is important to follow the instructions on how to use melatonin. It should not be taken right at bedtime to treat a circadian issue, for instance, as the timing of its effect is delayed and it wouldn’t start working for several hours.

Prescription Sleeping Pills

If your insomnia persists despite trying over-the-counter medications, you may see your doctor and discuss prescription sleeping pills. There are two major classes of sleeping pills, those that are in the family of medicines called benzodiazepines and those that are not. The list of prescription pills includes:

  • Ambien (zolpidem)—The most widely prescribed sleeping pill, it is a benzodiazepine receptor agonist that works to enhance the effects of GABA within the brain. It reduces the average amount of time to fall asleep by 5 to 12 minutes and increases total sleep time by 29 minutes. It may be associated with transient memory loss and sleep-related behaviors.
  • Belsomra (suvorexant)—It blocks a signal for wakefulness created by the chemical in the brain called orexin (or hypocretin). It reduces the average amount of time to fall asleep by 8 minutes and reduces the average time spent awake in the night by 16 to 28 minutes.
  • Estazolam (ProSom)—It is a benzodiazepine medication that enhances GABA. There are higher rates of abuse and increased risk of falls, delirium, and long-term memory problems. The risk of overdose and withdrawal may also be higher.
  • Halcion (triazolam)—Like estazolam, it is a benzodiazepine medication. It carries the same potential for risks, and may not be the first choice for use as a sleep aid.
  • Intermezzo (zolpidem)—Similar to Ambien as it contains the same active ingredient, but with a shorter half-life, this medication can be taken in the middle of the night with an awakening.
  • Lunesta (eszopiclone)—Another medication that works as a benzodiazepine receptor agonist, it reduces the average time it takes to fall asleep by 14 minutes and increases total sleep time by 28 to 57 minutes. One unique side effect is a metallic (coppery) taste in the mouth.
  • Restoril (temazepam)—Also a benzodiazepine medication, it has the same risks of falls, delirium, long-term memory problems, and potential for overdose and withdrawal.
  • Rozerem (ramelteon)—This drug uniquely works to enhance the effects of melatonin, the brain's natural sleep hormone. It reduces the average amount of time to fall asleep by 9 minutes.
  • Silenor (doxepin)—An antidepressant, it may help to modestly improve sleep.
  • Sonata (zaleplon)—It reduces the average time it takes to fall asleep by 10 minutes. Unfortunately, it is metabolized quickly and may wear off within 4 hours. This may make it attractive for awakenings that occur in the night, however.
  • Trazodone—Another older antidepressant, it reduces the average amount of time it takes to fall asleep by 10 minutes and the average amount of time awake in the night by 8 minutes. It is widely used in older people, but has not been widely studied for potential side effects.

As you can tell, there are a large variety of options. Each sleeping pill has slightly different side effects and it might be useful in different scenarios. Sleeping pills should not be used in combination without medical supervision and they should never be used with alcohol. This increases the risk of overdose, breathing suppression, and death. In order to clarify what medication might be best for your situation, you should discuss these possibilities with your physician.

How to Avoid Sleeping Pills

For some people, using sleeping pills is not a favorable option. Some people take other medications that might interact with them. If you are pregnant, you would not want to take something that could potentially harm your baby. Others are concerned about the potential for addiction to or reliance upon sleeping pills. Moreover, some people don’t like the side effects of sleeping pills.

No matter the reason that you decide not to take a sleeping pill, fortunately, you have other options to manage your insomnia. If you don’t want to take anything to help you sleep, you can work on changing your sleep habits. Guidelines to improve sleep hygiene might make it easier to sleep. As part of this, you should keep a regular bedtime and wake time to help reinforce your natural circadian rhythm. You should avoid naps during the day as these might diminish your body’s natural desire for sleep (called the sleep drive). It is also important to minimize the time you spend awake in bed, a technique called stimulus control.

Moreover, there are alternatives to treat insomnia such as relaxation, biofeedback, and aromatherapy. You might see a psychologist and learn ways to manage your stress and the negative feelings that can be associated with insomnia. You can transition to sleep easier with the use of guided imagery, progressive muscle relaxation, and other treatments. In addition, the use of familiar and comforting scents with aromatherapy might help you ease into sleep.

When Should I See a Doctor?

Though you might seek to take something immediately to help you sleep when you have insomnia, there may not be any immediate relief. If your insomnia persists, you may need further help. If you can identify what is causing your insomnia, and you anticipate that it will resolve, you may decide to endure it. As an example, if you are studying for a test and you have trouble sleeping, this is likely to improve once the test passes.

Sometimes the problem of insomnia becomes a persistent or recurrent one. If the difficulty falling or staying asleep becomes disruptive to your life, you may wish to do something about it. If you find yourself feeling depressed or even suicidal because of your insomnia, then it is imperative that you seek help. You may start by speaking with your primary care physician about your concerns. If more sophisticated help is needed, you may be referred to a sleep specialist. Obstructive sleep apnea is a common cause of persistent insomnia, especially when associated with awakenings, and this may require its own treatment.

A Word From Verywell

Many people with insomnia can learn to sleep normally without the use of sleeping pills. In some cases, it is necessary to identify an underlying sleep disorder that may be contributing, such as sleep apnea. Many people will benefit from targeted changes as part of a cognitive behavioral therapy for insomnia (CBTI) program, delivered through a book, an online course, a workshop or class, or by meeting with a psychologist.

Even if insomnia lasts for decades, it can be resolved with guidance from an expert in sleep medicine. Reach out to get the help that you need—and don't hesitate to reach beyond the pills and prescription medications that are so often offered first as the way to improve insomnia.

Sources:

Patient Education: Insomnia Treatments (Beyond the Basics). UpToDate.

Sateia MJ et al. “Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline.” Journal of Clinical Sleep Medicine. 2017;13(2):307-349.

Sleep Disorders: In Depth. National Center for Complementary and Integrative Health.