Sleep medications: prescription and over-the-counter options

A bad night’s sleep can throw a wrench in your day. But consistently poor sleep can affect your health in more ways than one. Sometimes, treatments like prescription or over-the-counter sleep medications or supplements can help get your sleep back on track. 

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Many medications can be used to help improve sleep or to treat insomnia. There are natural sleep aids and over-the-counter medications, but many sleep medications are prescription-only. Some of these (often called sedatives or tranquilizers) can help you fall asleep faster and stay asleep longer, while others can help address underlying causes of sleeplessness (such as depression). 

The first choice treatment for chronic insomnia isn’t a medication, though. Cognitive-behavioral therapy (CBT) is more effective than sleep medications alone (Kuar, 2021; Neubaueur, 2022). But access to CBT can be limited or expensive, and adding treatment with medication to CBT is another option. 

Before turning to your healthcare provider for a prescription, you might want to try one of the many effective over-the-counter sleep aids on the market. You can get any of these at your local drug store. Just be sure to follow the dosing instructions on the package, and don’t do anything that might be dangerous to do while sleepy (such as driving a car). 

Melatonin

Melatonin is the natural sleep hormone your body creates to regulate your sleep cycle. Every evening, it builds up in your body when the light begins to fade, which helps you feel sleepy at bedtime (Basit, 2021). Melatonin supplements are a synthetic version of this hormone. Many people who have trouble falling asleep find that taking a melatonin supplement at bedtime can help “remind” their bodies that it’s time for bed.

Melatonin supplements are considered safe, have a low risk of side effects, and are a first-line supplement for treating sleep problems, according to the American Academy of Family Physicians (Savage, 2021).

Antihistamines

Antihistamines like diphenhydramine (Benadryl) and doxylamine (Unisom) are medications available over-the-counter that are often used to treat allergies but can also help with sleep. 

When used to treat insomnia, they’re often recommended for occasional rather than daily use, although they’re often used routinely to treat insomnia, especially by the elderly (Albert, 2017). Still, it’s best to use them for a short period of time or to help you reset your sleep routine. 

If you find that you need to use antihistamines daily to help with sleep, a different sleep aid may be more helpful. Your healthcare provider can help you pick the one that’s right for you.

Herbal remedies

Herbal medicine has been used for centuries to help people deal with all sorts of health issues, including trouble sleeping. Several herbs are known to help with sleep problems—and have the research to back them up:

• Valerian root: This well-known herb helps treat insomnia by activating GABA-A, the same brain receptors targeted by several prescription sleep medications (Momin, 2021). One systematic review found that taking the whole root (e.g. capsules) had more consistent effects than the extract, but more research is needed (Shinjyo, 2020). 

• Passionflower: This is another herb with a long history of helping with sleeplessness and anxiety. A 2020 study showed that those who took passionflower supplements had a significantly greater increase in total sleep time compared with those who didn’t (Lee, 2020).

• Magnolia bark: Magnolia bark is used extensively in Chinese and Japanese traditional medicine for conditions ranging from depression and anxiety to inflammation (Hu, 2018). A component of magnolia bark called magnolol acts on the GABA-A receptor (similarly to valerian root), which has a relaxing and anti-anxiety effect (Chen, 2012). 

Since herbs and supplements are not regulated by the FDA and aren’t subject to the same standards as conventional medicines, it’s important to choose what you take carefully. While natural, herbs can still have potent effects on the body and interact with other medications and medical conditions, so it’s best to speak with a healthcare provider familiar with herbal medicines.

Magnesium

Magnesium is an essential nutrient that does many things in the body, including relaxing the muscles. Many people find that taking a magnesium supplement before bedtime helps them relax and fall asleep. One study on elderly adults with insomnia showed that taking a daily magnesium supplement for eight weeks improved overall sleep quality (Abbasi, 2012).

Magnesium is typically safe and well-tolerated as a dietary supplement. However, it is possible to take too much. For most people, taking too much magnesium can cause temporary digestive upset. But if you have kidney problems, a neuromuscular disease, or are pregnant, speak with your healthcare provider before taking magnesium (Allen, 2021). 

If over-the-counter treatments, supplements, and lifestyle changes aren’t working for you, you can talk to your healthcare provider about trying a prescription sleep medication. 

One thing to remember is that many medications carry a risk of side effects. Most prescription sleep medications can cause daytime sleepiness and dry mouth. All can have the side effect of causing unusual behaviors while asleep (like sleepwalking, eating, driving, having sex, and using the phone), especially for people who are older (Neubaueur, 2022). It’s important to pay close attention to how your medication makes you feel so that you aren’t doing anything (like driving) unsafely.

Some common prescription options include:

Benzodiazepines

Benzodiazepines are a type of sedative with serious staying power—they can stay in your system for days. 

While this can be helpful for some kinds of insomnia or sleep issues, such as sleepwalking and night terrors, it can also make it difficult to function during the day due to grogginess and dizziness. That’s just one of the reasons they’re only recommended for short-term use (two to four weeks max) (Momin, 2021). 

Another reason they’re not good for regular use is they come with some serious drawbacks. They are highly addictive, and you may become so dependent on them that you can’t fall asleep without them. They also carry a black box warning (the FDA’s strongest warning) for their potential to cause breathing issues and excessive sedation, which can lead to overdose and death. 

Benzodiazepines are still a valuable medical tool, appropriate for treating some kinds of insomnia. There are two benzodiazepines approved to treat insomnia:

• Temazepam (Restoril)

• Triazolam (Halcion)

Benzodiazepine receptor agonists (BZRAs)

These drugs are very similar to benzodiazepines but work differently, making them safer. They’re approved to treat sleep disorders. These include:

• Zolpidem (Ambien)—This is often the first sleep medication your provider may prescribe for you to help with both falling and staying asleep.

• Zaleplon (Sonata)—This medication can help with falling asleep, and it stays in your body for the least amount of time.

• Eszopiclone (Lunesta)—This drug can also help with falling asleep and staying asleep. 

These drugs are less habit-forming than benzodiazepines but are still strong and effective medications that can help with sleep. They do carry potential side effects, including grogginess, dizziness, sleepiness, and a small risk of impairing your balance or coordination (Neubaueur, 2022).

Antidepressants

Some types of antidepressants can also help treat sleep problems. These include: 

• Doxepin (Sinequan)

• Amitriptyline (Elavil) 

• Trazodone (Oleptro, Desyrel; see Important Safety Information)

• Mirtazapine (Remeron; see Important Safety Information)

These medications can have a calming and sedating effect, which can help you fall asleep. They can also help reduce some of the issues that may be causing sleep problems, such as depression and anxious thoughts. Doxepin also works the same way as the over-the-counter antihistamine medications by making you sleepy, so it’s often prescribed even for people who might not be candidates for antidepressant medications.

Antidepressants can have a range of side effects and affect each person differently. Your healthcare provider can help you decide which one is right for you. You may need to try a couple of different types before finding the right one.

Dual orexin receptor antagonists (DORAs) 

DORAs are medications used to treat insomnia that work by blocking a brain chemical called orexin that makes you feel awake and alert. They help you fall asleep and stay asleep, and are considered safe for longer-term use. Some DORAs include:

• Lemborexant (Dayvigo)

• Suvorexant (Belsomra)

The most common side effect of DORAs is feeling sleepy during the day, especially in the mornings. 

Anticonvulsants

The anticonvulsant drug used to treat insomnia is gabapentin (brand name Neurontin), an anti-seizure medication. It’s prescribed off-label if a healthcare provider decides it’s a good option for their patient. They can be a good tool for people with sleep trouble who are at risk of drug dependence and may not be able to take benzodiazepines or BZRAs (Kaur, 2021). 

Not many studies have compared the effectiveness of different types of sleep medications, so to find the best sleep medication for you, it helps to start by knowing what your sleep disorder is. Treatment may differ based on the underlying source of your sleep problems, so getting a diagnosis is often an important first step.

Insomnia, sleep apnea, depression, anxiety, and other health conditions can all contribute to sleep disturbances. Your sleep issues could be caused by lifestyle or sleep habits that get in the way of sleep. Or, your sleep issues could be a side effect of a medication. Keeping a sleep journal for a week or two can help inform your next steps, including a conversation with your healthcare provider. 

You can fall asleep more easily and improve the quality of your rest even without medications or therapy. This is called practicing good “sleep hygiene.” Sleep hygiene is how your habits surrounding bedtime can affect your circadian rhythm and ability to fall asleep. Anyone can benefit from these practices, not only people who feel they have sleep problems. Good sleep hygiene includes the following (Kaur, 2021; Momin, 2021):

• Reserve the bedroom for sleeping—not things like TV, eating, and reading.

• Stop screen use at least half an hour before bedtime.

• Limit daytime naps.

• Don’t eat late in the evening.

• Quit or reduce smoking in the evening.

• Don’t drink caffeine in the afternoon or evening.

• Limit late-night alcohol.

• Exercise regularly and maintain a healthy weight.

• Use a weighted blanket or eye mask.

• Sleep in a cool, dark room.

• Use a fan or device for white noise.

Sleep problems don’t have to control your life. Many options can help you start getting more restful sleep.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

May 11, 2022

Written by

Nancy LaChance, BSN, RN

Fact checked by

Yael Cooperman, MD

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About the medical reviewer

Yael Cooperman, MD, Ro

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.