Best Sleep Aids: Prescription vs. Over-the-Counter

What is Insomnia?

Insomnia is a condition in which a person finds it difficult to fall asleep or stay asleep. It is the most common sleep disorder and affects millions of Americans. The Centers for Disease Control and Prevention (CDC) says almost 15% of American adults report experiencing insomnia in the past 30 days. One study estimated that an employee with insomnia loses about eight days of work performance each year; this adds up to $63 billion in lost work performance due to insomnia.

The severity and frequency of insomnia symptoms vary from person to person. For some, it is a temporary situational problem. For others, insomnia can be a chronic issue that warrants proper medical attention. Lack of healthy sleep can lead to a range of physical and mental health problems.

Sleep Aids: Natural vs Over-The-Counter vs Prescription

Are you having trouble sleeping at night? Have you tried tips for sleep hygiene without much improvement? A sleep aid might be the answer for you. There is a range of options available, including natural remedies and herbal products, over-the-counter sleep aids, and prescription medications that help you fall asleep and stay asleep.

Prescription drugs are usually the most effective sleep aids but can cause serious side effects and may be addictive. Over-the-counter sleep aids work well for occasional short-term insomnia but are not a long-term solution for sleep problems.

Natural sleep aids (herbal products and dietary supplements) are not regulated by the U.S. Food and Drug Administration (FDA). Unlike other types of sleep aids, dietary supplements have less evidence regarding their efficacy and safety. But similar to over-the-counter medicines and prescription drugs, herbal products can also interact with other medications. Drug interactions can increase the risk of serious side effects. Older adults are at a higher risk of side effects compared to younger people from all kinds of sleep aids.

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What To Consider When Choosing a Sleep Aid?

Many have asked, which is better: prescription drugs, over-the-counter sleep medications, or natural herbs? The good news is there are several options for each type. To decide which sleep medication will work best for you, you should have a good understanding of your general medical history, in addition to the specific cause of your sleep disorder, if any. Your primary care physician or pharmacist are a good source of guidance if you are unsure or have additional questions.

Please talk to your doctor or pharmacist for evidence-based medical advice before taking an OTC sleep aid or herbal supplements, especially if you are currently taking any over-the-counter or prescription medication.

Top Herbal or Natural Sleep Aids

Below are some over-the-counter (OTC) supplements and herbal products that could help you get a good night's sleep. However, remember to always consult your doctor before taking any OTC products, including natural or herbal sleep aids.

The word “natural” can cause a false sense of safety, while, in fact, almost every single OTC product and herbal supplement can potentially interact with other medications (both prescriptions and OTC drugs), leading to undesirable adverse effects that can be very harmful in many cases.

In addition to drug interactions, herbal supplements may not be safe for people with certain health conditions. Therefore, you should always discuss with your doctor before taking any new OTC products or herbal supplements to prevent health complications.

Lastly, as with any medication, if you are pregnant or nursing, it's essential to always consult your gynecologist before starting a new medication. Their professional advice is crucial to ensure the safety of both you and your baby.

Magnesium

Magnesium is an essential mineral that may help you sleep better. Natural sources of magnesium include leafy green vegetables, whole grains, dairy products, soy, and nuts. Taking a magnesium supplement, at doses up to 350 mg daily, also aids sleep according to some studies.

Valerian Root

Some studies have found that taking dietary supplements containing valerian root (Valeriana officinalis) can help you fall asleep faster and enjoy better sleep. You can take valerian root up to 3 times a day, with the last dose taken 1-2 hours before bedtime.

L-Theanine

L-theanine is an amino acid found in tea, especially loose tea leaves and green tea. Taking L-theanine before bedtime can help people who have trouble falling asleep. Research suggests L-theanine benefits both sleep duration and sleep quality by increasing the effects of gamma-aminobutyric acid (GABA), a naturally occurring brain chemical that has a calming effect.

L-tryptophan

L-tryptophan is an amino acid that the body uses to make melatonin, a sleep-inducing hormone. Studies have shown that taking L-tryptophan supplements may reduce sleep latency (the time taken to fall asleep) in people with mild insomnia. The results are less promising in people with normal sleep patterns and in those with severe insomnia or other serious mental health problems.

Chamomile

Chamomile (Matricaria chamomilla) is a mild sedative and tranquilizer that can help with sleep. It contains apigenin, a flavonoid that binds to benzodiazepine receptors in the brain, which are also targeted by prescription drugs used to treat insomnia and anxiety. Studies have shown that chamomile can improve sleep quality and help people with insomnia function better during the day.

Passionflower

Passionflower (Passiflora incarnata) is a herb that aids sleep, including increasing total sleep time in people with insomnia. Studies suggest passionflower increases GABA levels in the brain. GABA is a natural chemical that makes you feel more relaxed.

Lemon Balm

Research suggests that lemon balm (Melissa officinalis) is a calming herb that has anxiety-reducing and sleep-promoting effects. One study found 8 out of 10 people who took a combination of valerian root and lemon balm reported sleeping much better compared to those in the placebo group.

Kava Kava

Kava kava (Piper methysticum) is a herb that is commonly consumed in the Pacific Islands. A paste made from the roots of the plant is used in ceremonial drinks. Kava kava is believed to induce relaxation and calmness, and studies suggest it may be helpful in the treatment of insomnia and anxiety. However, there are safety concerns, including a risk of liver damage.

Lavender

A relaxing bedtime routine with a warm bath and lavender essential oil aromatherapy can help you gently fall asleep. You can also apply a few drops to your temples or spray lavender pillow mist on your bed linen.

Combination Natural Remedies for Sleep

There are a range of natural sleep aids available on the market that contain a combination of sleep-promoting herbs, for example, melatonin, chamomile, and lavender (ZzzQuil).

Cannabidiol

Cannabidiol (CBD) is becoming increasingly popular as a sleep-inducing substance. However, more research is needed before scientists can say whether cannabidiol (CBD), which is a derivative of cannabis, is safe and effective for improving sleep quality.

Top Over-The-Counter Sleep Aids

Melatonin

Melatonin is a hormone that is naturally produced by the human brain. This hormone regulates the body’s natural sleep-wake cycle or circadian rhythm. Melatonin sends signals from the brain to the body that it’s time to sleep.

There isn’t much scientific evidence about the safety of long-term melatonin use. However, melatonin is effective in treating short-term insomnia. This hormone can also help reset the sleep cycle in people with jet lag and in night-shift workers who have problems regulating their sleep cycle. It is not habit-forming like some other sleep aids.

Melatonin is available over-the-counter without a prescription; however, a prolonged-release formulation of melatonin called Circadin is a prescription medication.

Diphenhydramine

Diphenhydramine is the generic drug for the brand name Benadryl. It is an antihistamine and is an ingredient in many cold, flu, and allergy medications. If you see a product label that says “PM,” it likely contains diphenhydramine. While diphenhydramine can help with sleep, it can also cause daytime drowsiness, grogginess, and reduced alertness the next day.

Side effects of diphenhydramine-containing products may include drowsiness, dizziness, constipation, blurred vision, and dry mouth. Examples of diphenhydramine-containing products include:

Doxylamine Succinate

Doxylamine succinate, similar to diphenhydramine, is an antihistamine that can help you fall asleep and stay asleep. It has a similar side effect profile. Examples of doxylamine products include:

Tip: You can get discounts on over-the-counter sleep aids with a signed prescription from your doctor.

Top Prescription Sleep Aids

Benzodiazepine Sedative Hypnotics

Benzodiazepines are a group of sleeping pills that are effective for short-term use (less than four weeks) to treat insomnia. Long-term use of these prescription sleeping pills is generally not recommended due to the risk of serious side effects.

Benzodiazepines are Schedule IV (4) controlled substances because of their potential for physical dependence, misuse, withdrawal, and addiction. You can build up a tolerance to these drugs, meaning, you might need higher doses over time to get the same effects.

Besides the risk of dependence, benzodiazepines must be used with extreme caution for the treatment of insomnia since they can cause lingering sleepiness and dizziness the following day (hangover effect). You should have a whole night (7 to 8 hours) of sleep planned if you want to take this type of sleep medication.

Examples of benzodiazepines prescribed as sleep medications are listed below, with their brand names in parentheses:

Lorazepam (Ativan)
Temazepam (Restoril)
Estazolam (ProSom)
Triazolam (Halcion)
Flurazepam (Dalmane)
Quazepam (Doral)

Non-Benzodiazepine Hypnotic Sedatives

Most people have heard of “Ambien” as a sleep aid. Ambien is the brand name of the generic drug Zolpidem, a non-benzodiazepine sedative-hypnotic drug (also called Z-drugs).

Unlike benzodiazepines, Ambien (active ingredient: zolpidem) does not cause dependence or withdrawal. Therefore, zolpidem (Ambien) can be used to treat insomnia long-term in people who have trouble falling asleep or staying asleep. However, this drug class can cause side effects such as sleepwalking, sleep-driving, or engaging in other activities while not fully awake, which can potentially lead to serious injuries.

Discover what medications to avoid when taking zolpidem tartrate or Ambien.

Examples of non-benzodiazepine sleep aids are:

Zolpidem (Ambien) – oral tablet
Zolpidem extended release (Ambien CR)
Zolpidem sublingual tablet (Intermezzo, Edluar)
Zolpidem oral spray (Zolpimist)
Zaleplon (Sonata)
Eszopiclone (Lunesta)

Find out “How Much Ambien Can I Take Safely?”

Melatonin Receptor Agonists

Melatonin supplements are widely available over-the-counter (OTC). However, melatonin receptor agonists such as ramelteon (Rozerem) are prescription drugs for sleep problems.

In terms of pharmacologic treatment for insomnia, ramelteon is considered the first line of therapy because it does not cause physical dependence or abuse. Also, unlike some other hypnotic sleep aids, it does not typically cause morning sedation (daytime drowsiness).

Effectiveness and Safety

Which Sleep Aid Is Most Effective?

There is no single sleep aid that is most effective. Different sleep aids work best for different people based on individual needs and specific circumstances.

For example, an OTC sleep aid such as a melatonin supplement may be the best choice if you have jet lag and want to regulate your sleep-wake cycle.

On the other hand, you may need to take a prescription sleeping pill such as zolpidem (Ambien) if you have more severe or chronic insomnia.

Your healthcare provider can help you choose the best sleep aid from the various prescription and over-the-counter options available.

Which Type of Drug Is The Most Effective as a Sleep Aid?

Benzodiazepines and non-benzodiazepine sedative-hypnotics (called Z-drugs) are the strongest and most effective sleep aids available. The effectiveness of individual sleep medicines will vary from person to person. Always consult your doctor for medical advice.

Are Natural Sleep Aids Safe?

Natural sleep aids are safe for most healthy adults, but it’s best to check with your health care provider before taking any sleep-inducing herbal remedies. Some of these herbs can have drug interactions with your other medications.

Also, keep in mind that many commercially available herbal sleep aids contain multiple ingredients. While these may work better than a single-ingredient OTC sleep aid, they also carry a higher risk of side effects.

Are OTC Sleep Medications Safe?

OTC sleep medications are safe for short-term use by most healthy adults. Always consult your doctor before taking any OTC sleep aids or dietary supplements.

Diphenhydramine and doxylamine are available by themselves or as active ingredients in OTC cough and cold products such as Tylenol PM, Mucinex Nighttime Colds & Flu, Nyquil, and Robitussin Nighttime Cough DM. Reading the product label thoroughly is essential to ensure you're not taking more than the recommended dose. You should talk to your pharmacist if you have questions about dosage or general OTC products.

Tips for Better Sleep

Natural Strategies For Sleep

A balanced, healthy diet can support overall health.
Regular moderate exercise can help to induce sleep and improve sleep quality if you have a sedentary lifestyle.
Relaxation techniques such as mindfulness, meditation, deep breathing exercises, progressive muscle relaxation, yoga, and tai-chi can reduce stress and anxiety, which are common causes of poor sleep.
Psychotherapy (talk therapy), such as cognitive behavioral therapy (CBT), can help you learn coping skills to manage stress and anxiety.

Sleep Routine Adjustments

Maintain a regular sleep schedule, which means going to bed and getting up at the same time every day, including holidays and weekends.
Make sure your bedroom is cool, dark, and quiet.
Avoid use of electronics for 1-2 hours before bedtime. The blue light from screens can interfere with the body’s natural circadian rhythm (wake-sleep cycle).
Avoid caffeine and alcohol for several hours before bedtime.

When To Use A Sleep Aid

A non-pharmacological (no drug) approach is always the first line of therapy for insomnia. Before initiating any sleep aid, ensure that you practice good sleep habits (see above). If improving sleep habits does not help, you can consider taking a sleep aid for the short term.

If you find yourself taking sleep aids on most nights to treat insomnia or your insomnia lasts two weeks or longer, always consult your doctor. It’s important to be medically reviewed and find out what is causing your sleep troubles and treat the root cause. For example, you may have serious health conditions such as sleep apnea that should be properly diagnosed and treated by an expert in Sleep Medicine.

Frequently Asked Questions

What Is The Best Sleeping Pill That Is Not Addictive?

OTC sleep aids such as melatonin are not addictive. Among prescription sleeping pills, non-benzodiazepine hypnotic sedatives such as zolpidem (Ambien) and melatonin receptor agonists such as ramelteon (Rozerem) do not cause dependence.

What Is The Best Safe Sleep Drug?

Melatonin 1 to 5 milligrams (mg) is considered one of the safest sleep aids to take. This OTC sleep aid has few side effects and is not habit-forming. Prescription sleep aids such as ramelteon (Rozerem) are also a safe, non-habit-forming option. Keep in mind that the safety of sleep drugs is highly individualized based on your health status and current medications. You should discuss options with your healthcare provider to determine the best option for you.

Which Sleep Aid Is The Best For Me?

Struggling with sleep disorders can be frustrating. However, keep in mind that there is no one-size-fits-all sleep aid that will work for everyone. Meaning, the best sleep aid is the one that is tailored to your individual needs. This includes getting to the root cause of your insomnia and other factors such as your age, sex, and other health conditions.

Many medications can make you sleepy, but safety is the most important factor when it comes to taking sleeping pills. You should take sleeping pills only at the recommended dose and dosing frequency. In addition, plan to have a whole night of sleep if you take a hypnotic sedative. Also, sleep aids should not be mixed with alcohol or other sedatives.

Your doctor can guide you on both pharmacological (drug) and non-pharmacological (non-drug) treatment approaches for insomnia. A short course of sleep aids may be prescribed and is generally safe for most healthy adults if taken as directed. However, considering the variety of sleep aid products on the market and their potential side effects, it is safest to talk to your doctor about your sleeping problems so you can decide together on the best course of treatment for you.