Approximately 4% of American adults take prescription sleeping pills, and somewhere between 3-11% report using over-the-counter (OTC) sleep aid pills. Sleeping pills, including OTC and  “natural” alternatives, are associated with risk of dependency, addiction and other health consequences.

What Do Sleeping Pills Do?

Sleeping pills either help someone fall asleep more quickly or by help them stay asleep throughout the night. This is why they are used to treat insomnia. Sleeping pills are commonly used in other situations as well.

It is generally not recommended to take sleeping pills for short flights or daytime flights. Taking sleeping aids before long, overnight flights also poses risks. Ambien, in particular, has become infamous for causing embarrassing sleepwalking episodes (as was documented by “Betty” in “Confessions of a Fed-Up Flight Attendant: Attack of the Ambien Zombies”). However, if you want to take a sleeping aid for an overnight flight, it is highly recommended that you test the drug ahead of time so you understand how it will affect you. Also, if you take sleeping aids before a flight it is strongly recommended that you avoid alcohol on the flight. Melatonin, another popular sleep supplement, is used by travelers to help ease jet lag. Melatonin regulates the sleep-wake cycle, so supplementing melatonin can help you modify the cycle.

Benzodiazepines are the most common prescription anti-anxiety drug. Both benzodiazepines and z-drugs (the most common prescription sleeping pill) enhance the efficacy of a neurotransmitter called GABA, resulting in sedation. Benzodiazepines and, to a lesser extent, z-drugs pose a risk for developing dependency and addiction issues and they should be taken with caution.

Anxiety and depression often coexist, and z-drugs and benzodiazepines can help with anxious depression. However, prescription sleeping pills should not be taken by people who suffer from major depressive disorders. Z-drugs and benzodiazepines can both make depression worse, and they are associated with increased incidence of suicidal ideation and completion even among people who have not been diagnosed with depressive disorders.

Many people with diabetes suffer from sleep disturbances due to sleep apnea, diabetic neuropathy, hormonal dysregulation, or other causes. Sleeping pills can have dangerous consequences for diabetes patients. For example, high doses of benzodiazepines can cause respiratory depression. In a patient with sleep apnea, this could be lethal. If you are diabetic, speak with your doctor before using any OTC or prescription sleep aids.

Types of Sleeping Pills

Most prescription sleeping pills (including z-drugs and benzodiazepines) work by enhancing the effects of a brain chemical called GABA. GABA is a neurotransmitter that quiets brain excitability. This is why some prescription sleeping pills (notably benzodiazepines) are often prescribed as anti-anxiety drugs.

The most common sleeping pills purchased without a prescription are melatonin, antihistamines and valerian root. The ways that OTC sleeping pills work vary, and in some cases, the mechanism of action is unclear.

Over the Counter Sleeping Pills

OTC sleeping pills are available without a prescription, and anecdotal reports suggest that many of them are quite useful. However, most of them are relatively untested in controlled research trials.

  • Melatonin

    Melatonin is a natural hormone that is secreted by the pineal gland and regulates circadian rhythm (the sleep-wake cycle). OTC melatonin supplements can help reduce insomnia. Although melatonin is not associated with tolerance, some people report that they become psychologically dependent on melatonin for sleep.

  • Sedating antihistamines

    Diphenhydramine (brand names include Zzzquil, Benadryl, Sominex, Unisom SleepGels) and doxylamine (brand names include Unisom SleepTabs and Sleep Aid) are antihistamines that are generally used to treat allergies, but they also induce drowsiness. However, tolerance can develop quickly with regular use and they are associated with side effects like dry mouth and dizziness. In general, sedating antihistamines should not be used regularly as sleep aids.

  • Valerian

    Valerian root (specifically Valeriana officinalis) is often considered to be a natural sleeping pill, but data supporting its efficacy is inconclusive. In addition, valerian’s mechanism of action remains unclear.

Before taking any OTC sleeping pills, it is highly recommended that you talk to your doctor. All OTC drugs have the potential to interact with other drugs you take or make existing health concerns worse. In addition, some data exists suggesting that regular use of OTC sleep aids may increase the risk of stroke in middle-aged and older individuals with no prior history of stroke.

Prescription Sleeping Pills

In general, FDA-approved prescription sleeping medications are either z-drugs or benzodiazepines. Here is a list of the most common prescription sleeping pills including the most common brand name and the generic medication name.

  • Zolpidem (brand name Ambien)

    Zolpidem is a z-drug. These drugs work by increasing the effectiveness of the neurotransmitter GABA, which makes the brain less excitable. Although somewhat less risky than benzodiazepines, z-drugs are associated with a risk for dependency/addiction and should not be used daily or long term.

  • Zaleplon (brand name Sonata)

    Zaleplon is another z-drug used to treat insomnia.

  • Lunesta

    Lunesta is the brand name for eszopiclone. It’s also a z-drug approved for sleep disorder treatment.

  • Temazepam (brand name Restoril)

    Temazepam is one of five FDA-approved benzodiazepines for insomnia. Extreme caution should be used when taking benzodiazepines due to the high level of risk of developing dependency/addiction.

  • Trazodone (brand name Desyrel)

    Trazodone is an off-label drug that is prescribed for sleep disorders. This means that although they are not FDA-approved as sleeping aids, they can still be prescribed for insomnia. Trazodone is an antidepressant and is currently one of the most common sedative-hypnotic type drugs prescribed for insomnia.

Sleeping Pill Side Effects

Different classes of sleeping pills may have different side effects, but all have been associated with symptoms like:

  • Daytime drowsiness
  • Complex sleep behaviors (sleepwalking, sleep-eating)
  • Dry mouth
  • Headache
  • Dizziness
  • Memory loss
  • Attention deficits
  • Unusual dreams.

One of the most dangerous side effects of sleeping pills are complex sleep behaviors like sleepwalking. Even people with no history of sleepwalking may sleepwalk after taking sleeping pills. Reports of people dying while performing complex behaviors while they are asleep led the FDA to require several prescription sleeping medications to carry “black box warnings”, which alert users to potentially lethal risks associated with the drug. Examples of lethal complex sleep behaviors include automobile accidents (with the patient driving), drowning, apparent suicide and poisoning.

Nonfatal injuries associated with complex sleep behaviors include burns, gunshot wounds and attempted suicide. Even first-time and low-dose users can exhibit these behaviors, underscoring the importance of using caution when taking prescription sleeping pills.

Additionally, all sleeping aids have been reported to cause at least some level of psychological dependency (including OTC drugs), and most prescription drugs (particularly BZDs and barbiturates) are linked to physical dependence/addiction.

How Long Do Sleeping Pills Stay in Your System?

Most sleeping pills will be metabolized relatively rapidly. Z-drugs have the shortest half-life (1-7 hours), and BZDs have intermediate half-lives (up to 24 hours for FDA-approved sleeping pills, up to 80 hours for off-label BZDs).

How long sleeping pills stay in your system and show up in a drug test depends on the test. Sleeping pills may be detected in:

  • Blood: Approximately 2-5 days
  • Urine: Approximately 2-5 days
  • Hair: Up to months
  • Breastmilk: Approximately 2-5 days. If you are breastfeeding, it is imperative that you discuss plans to use OTC or prescription sleeping pills with your pediatrician before you take the first dose. Some drugs are safe to use while breastfeeding, while others can have profoundly negative impacts on your baby.

Sleeping Pill Addiction

The answer to the question “can you get addicted to sleeping pills?” is a resounding yes, although different drugs have different levels of risk associated with them. The most dangerous sleeping pills are barbiturates, which are not only addictive but can have severe consequences when mixed with other drugs or alcohol. Benzodiazepines are also associated with a high risk of dependency and addiction. Z-drugs (Ambien, Sonata, Lunesta) have lower risks for dependency. OTC drugs are generally not thought to cause physical addiction, but psychological addiction is commonly reported and can be challenging to overcome.

If you suffer from insomnia, the safest long-term way to deal with it is behavioral modifications like establishing a strict bedtime, refraining from looking at a screen in bed or making sure your bedroom is dark and quiet. Cognitive-behavioral therapy has shown success in treating sleep disorders. It usually works as well as sleeping pills but without the risks.

Key Points: Understanding Sleeping Pills

Sleeping pills are widely used; therefore, it is important to have an understanding of how they work and what effects they may have. Here are a few important points to remember:

  • “Sleeping pills” is an umbrella term that includes a number of prescription and over-the-counter drugs.
  • OTC sleeping pills include melatonin, antihistamines, and valerian.
  • The most commonly prescribed sleeping pills are in the z-drug class, and include zolpidem (Ambien), zaleplon (Sonata) and eszopiclone (Lunesta).
  • Other prescription sleeping pills are benzodiazepines, melatonin receptor agonists, and sedative antidepressants.
  • Although each drug may exhibit drug-specific side effects, most sleeping pills are associated with similar side effects, including daytime sleepiness, dry mouth, dizziness, headache, unusual dreams, attention deficits, and memory loss.
  • Complex sleep behaviors include sleepwalking and sleep-eating, and are frequently reported with prescription sleeping aids. Ambien infamously causes complex sleep behaviors.
  • Sleeping pills are addictive, although the degree of addiction risk is different for each drug. OTC drugs may be the least likely to lead to physical dependence, but psychological addiction is common.

If you or a loved one is struggling with sleeping pill dependency, The Recovery Village Palm Beach at Baptist Health can help. Call us today to learn how we can help you get your days and nights back in order.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.