Do Sleeping Pills Work? Are They Right For You?

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. 

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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):

• Obesity
• Diabetes
• Stroke
• 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 [4]!)

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).

Antidepressants

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).

Melatonin-Receptor Agonist 

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.

Supplements

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:

• Melatonin
• Valerian
• Chamomile

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. [8]. 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.