February 24, 2022
Restlessness… non-stop thoughts whizzing through your mind? Feeling hyper-alert and anxious as sleep continues to escape you? If you find yourself wondering whether sleeping pills work and if they are right for you, you’re not alone. Improving sleep is a core concern for the 50-70 million Americans who struggle with sleep disorders each year (1). Another ⅓ fail to get the recommended 7-8 hours of sleep each night, leaving many of us looking for long-term solutions (2).
But how do you know if sleeping pills are right for you? Your first step is to determine if your sleep struggles are just a few one-off events, or whether you have a chronic sleep disorder.
How Do I Know If I Have a Sleeping Disorder?
Sleeping disorders go beyond a few nights of rough sleep. There are over 90 different sleep disorders (1) marked by consistent difficulty falling asleep, trouble staying asleep, and abnormal movements, behaviors, and sensations. Sleep disorders are associated with states of hyperarousal that can have many root causes, from daily stress to lifestyle (irregular sleep schedule, technology before bed, caffeine or alcohol) to mental health.
Research has found that sleep loss (<7 hours/night) incurs a range of short-term symptoms and side effects, including (1):
- Daytime fatigue and low energy
- Poor mood and irritability
- Anxiety symptoms
- Depressed mood
- Digestive issues
- Difficulty concentrating
- Reduced coordination
- Anxiety about sleeping (further creates a complex cycle that prevents you from falling asleep the next night)
- Increased risk of accidents*
This risk of accidents doesn’t just refer to sending a text to the wrong person or forgetting your keys somewhere. The Center for Disease Control found that over 6,000 car accidents each year in the U.S. happen because of drowsy driving (3).
In the long-term, research suggests sleep loss can contribute to (1):
- High blood pressure (hypertension)
- Cardiovascular disease
With so many long-ranging impacts of sleep loss, both in the present moment and for our long-term health, it’s understandable why sleeping medication prescriptions and supplement sales have skyrocketed in recent years. (Melatonin sales in the U.S. increased by a stunning 42.6% from 2019 to 2020 !)
How Do Sleeping Pills Work?
Sleeping pills work by increasing the feeling of drowsiness, which can help override excitatory mental activity that keeps us in a state of hyperarousal and alertness.
More specifically, the most common prescription sleep medications belonging to the benzodiazepine and Z-drug families (discussed below) work similarly to alcohol by increasing levels of GABAA, a neurotransmitter in the brain associated with calm. Increasing GABAA levels helps slow down the central nervous system, defusing those feelings of restlessness and alertness that contribute to chronic insomnia and other sleep problems.
How Fast Do Sleeping Pills Work?
The speed of how fast sleeping pills work depends on the drug and individual factors. For instance, the UK’s National Health Service reports that the Z-drug Zolpidem takes roughly one hour for its effects to be felt (6). Ultimately, the effects of most sleeping pills are felt in about an hour. Interestingly though, a comprehensive review of 13 studies showed that Z-drugs actually only helped people fall asleep about 22 minutes faster (7) than a placebo.
What Are The Risks of Taking Sleeping Pills?
It’s important to note that while sleeping pills help us feel drowsy, they don’t actually solve the root cause of our sleep problems. The sedating effect that makes them so popular as a solution to sleep disorders actually works more like a band-aid. Additionally, sleeping pills are not effective for all sleep disorders, such as sleep apnea and narcolepsy. For this reason, sleeping pills are intended for short-term use, not as a long-term solution.
Taking prescription sleeping pills can also increase the risk of dependence, addiction, withdrawal symptoms, and dangerous drug interactions if people adjust doses or combine with other substances, namely central nervous system depressants.
In severe cases, sleeping pills may prompt complex sleep behaviors like sleepwalking, sleep eating, and sleep-driving. If you’re experiencing any of these symptoms, it’s advisable to talk with your care provider.
Types of Pharmaceutical Sleeping Pills
Benzodiazepine Sedative Hypnotic Medications
Benzodiazepines are one of the oldest classes of prescription sleep medications. Benzos are traditionally prescribed for anxiety, seizures, and spasms, but because of their drowsiness-causing side effects, are also prescribed for sleep disorders. Benzodiazepines have a higher risk of dependence and addiction, and withdrawal after discontinued use. Some examples of Benzodiazepines are Quazepam (Brand name: Doral), Temazepam (Brand name: Restoril) and Triazolam (Brand name: Halcion).
Z-Drugs (non-benzodiazepine sedative hypnotic medications)
Z-drugs work similarly in the brain as benzodiazepines, helping to calm excitatory activity that keeps you from falling asleep and staying asleep. Unlike benzos, Z-drugs specifically target sleep problems and were created as a safer alternative to benzos (although that claim has recently come into question (5). Some examples of Z-Drugs are Zolpidem (Band names: Ambien, Edluar, Intermezzo, Zolpimist), Zolpidem Extended-Release (Brand name: Ambien CR), and Eszopiclone (Brand name: Lunesta).
While not officially approved for chronic insomnia and sleep problems, certain antidepressants that induce sleepiness may be prescribed off-label for their anti-anxiety and sedating effects. Some examples of Antidepressants are Doxepin (Brand name: Silenor) and Trazodone (Brand name: Oleptro, Desyrel).
One of the newest prescription sleep medications on the market, melatonin receptor agonists, is called Ramelton (Brand name: Rozerem). It works by mimicking melatonin, a sleep-regulating hormone responsible for regulating your circadian rhythm and creating that drowsy wind-down feeling you get before bed. Taking melatonin supplements may help you with your nighttime wind-down process but they might not be as effective in helping you stay asleep.
Over-the-Counter Sleep Aids
Most OTC sleep aids induce drowsiness through antihistamines, which you may recognize in your allergy medications. You might have seen Doxylamine (Brand name: Nighttime Sleep Aid, Unisom) and Diphenhydramine (Brand name: Sominex, Nytol) on your pharmacy’s shelves. Some OTC medications may combine their central component of antihistamines with alcohol (NyQuil) or acetaminophen (Tylenol PM). OTC sleep aids can pack a powerful punch and have been known to leave many feeling groggy far into the next day when too much is taken.
More “natural” supplements like valerian and melatonin have been widely used to treat sleep problems, although more research is needed to understand the exact mechanism of action. Because supplements are unregulated, it’s advisable to talk to your doctor before beginning a new routine. Supplements that have been used to treat sleep problems include:
A note on melatonin: when it comes to melatonin, less is more, says Johns Hopkins sleep expert Luis F. Buenaver, Ph.D., C.B.S.M. . Try taking 1-3 mg about two hours before bed to see the best results.
Non-Pharmaceutical Sleep Aid Alternatives
Whether you’re an older adult looking to offset some of the potential risks of sleeping pills or want to address your insomnia more holistically and comprehensively, there are plenty of paths you can explore.
Muse’s Digital Sleeping Pill
Ever heard of digital sleeping pills? It’s okay if you haven’t. We at Muse have been hard at work developing a cutting-edge approach to insomnia relief that – unlike traditional sleeping pills – helps you attain a natural sleep state for a truly nourishing good night’s sleep.
So what exactly is a digital sleeping pill, you ask? When you fall asleep your brain activity changes. The digital sleeping pill comes in the form of a plush neurofeedback-based intelligent EEG headband that detects these changes and supplies relaxing soundscapes or stories to match your mental state, and gently fades out to cue your mind that it’s time for sleep. If you wake in the night, we use the same technology to automatically guide you back to sleep again.
The Digital Sleeping Pill Collection consists of gentle ambient noises, nature soundscapes, and sleep stories like Alice in Wonderland, Rainstorm Relaxation, and Wood Cabin Fire.
The bonus: Muse’s Digital Sleeping Pill helps you approach your sleep quality with none of those pesky side effects of traditional sleeping pills, and works on a deeper level, by supporting a natural sleep state for a truly restorative good night’s sleep.
Hack your circadian rhythm
As mentioned, melatonin is produced in the body naturally and is responsible for regulating your circadian rhythm. It’s triggered by light and suppressed by high levels of cortisol. That means you should limit screen time before bed and anything else hyper-stimulating, like caffeine, tv, or exercise (but some light stretching wouldn’t hurt!).
Develop a consistent, relaxing evening routine.
Find a relaxing routine and stick to it each night. This helps reduce your cortisol levels and conditions your mind to let go and relax before you finally slip into bed. This routine should include anything that relaxes you, from a warm bath to hot tea to listening to calming music.
Progressive muscle relaxation
This technique is aimed at relieving tension and is very simple to do. As you breathe in, tense a part of your body for about 5-10 seconds. As you breathe out, let the tension ebb from your body for about 10-20 seconds.
Focusing on your breath may help quiet your mind. Aim for deep, steady abdominal breathing as you inhale for a count of eight, hold for a count of eight, then breathe out for another count of eight.
CBT is a therapeutic technique widely used to help people become aware of their patterns of thought, so they can develop more intentional thoughts, habits, and actions that lead to better experiences. This can be particularly helpful for addressing anxiety in insomnia.
After reviewing the research, The Sleep Foundation found that meditation had a positive effect on chronic insomnia and led to fewer sleep disturbances for older adults (7). There are many types of meditation, from guided meditations to open-monitoring meditations to mantra meditations, so explore different styles to see what feels right for you.
Because insomnia often relates to the overactive mind, brain training (learning to attune yourself to different mental states) offers exciting potential for addressing sleep troubles. Brain training tools like neurofeedback can help us learn to patiently guide our attention back to a neutral place, often strengthening our ability to focus. This could help you more easily let go of non-stop thoughts and cultivate a neutral mental space as you fall asleep.
So, Do Sleeping Pills Work for Insomnia?
Yes and no. In the short-term, sleeping pills can help us get some much-needed shut-eye. But in the long run, they don’t do much to address the root causes of insomnia. Like we mentioned above, sleeping pills work more as a band-aid solution, helping us to calm our states of hyperarousal without addressing what’s causing that hyper-alert and tense state to begin with.