If your sleep is not improving despite trying good sleep hygiene and other non-medication methods, your doctor might recommend a sleep medication for you. Sleep medications are not right for everyone, so talk to your doctor before taking any sleep medication or supplement.
When they are used, sleeping medications should be used at the lowest dose possible and for the shortest amount of time. If sleeping pills are needed long-term, ideally they should not be taken every night, only intermittently when needed.
Benzodiazepines (e.g., temazepam, triazolam) can help make it easier to fall asleep or stay asleep, depending on which one is used and how it's taken. Not all benzodiazepines are used for sleep and only 4 - triazolam, temazepam, nitrazepam, flurazepam - are approved in Canada to treat insomnia. Benzodiazepines can cause dizziness, lightheadedness, daytime drowsiness, poor coordination, and memory problems. Flurazepam and nitrazepam are rarely used because they stay in the body longer than other benzodiazepines and increase the risk of confusion and falls, especially for seniors.
Hypnotic-sedatives (e.g., zopiclone, zolpidem) work in the brain the same way as benzodiazepines, but may be less likely to cause drowsiness during the day. They may also be less likely to cause tolerance (reduced effectiveness over time) or withdrawal symptoms compared to benzodiazepines. Side effects of hypnotic-sedatives include bitter taste, dizziness, lightheadedness, headache, diarrhea, poor coordination, and memory loss. Very rarely, zopiclone and zolpidem can cause sleep behaviours such as sleep-eating and sleep-driving. Chloral hydrate was used frequently as a sleep aid but because of its side effects, a long list of interactions with other medications, and the loss of effectiveness after a few weeks of use, it is no longer recommended as a sleep-aid.
Diphenhydramine causes drowsiness and is a non-prescription sleep medication. It is also an antihistamine used to treat allergies. Side effects include confusion, constipation, and problems with urination. These side effects can be particularly bothersome for seniors. If you are having trouble sleeping for more than a few days, it is better to see your doctor for a thorough assessment and diagnosis.
Concerns with sleep medications
Sleep medications might help in the short-term, but their long-term use is usually not recommended because of the potential problems associated with them. These problems can include:
- Reduced effectiveness over time: When used regularly, your body becomes used to the effects of most sleep medications and this leads to tolerance. With tolerance, the effectiveness of a sleep medication decreases over time so you need higher doses to get the same effect.
- Withdrawal symptoms: Withdrawal symptoms such as anxiety, irritability nervousness, and seizures can occur if you stop taking sleeping pills after taking them regularly. This doesn't mean you are addicted or that you won't be able to stop taking them. You will just need to stop them gradually as directed by your doctor.
- Rebound insomnia: If you take a sleep medication, you might experience even worse insomnia when you don't take it. This is called rebound insomnia. Your doctor may suggest that you gradually stop your sleeping medication or change to another medication to manage rebound insomnia.
- Interactions with other medications and alcohol: Sleep medications suppress the central nervous system (i.e., the brain). Other medications (such as, but not limited to, codeine, antiseizure medications, antihistamines) and alcohol also affect the central nervous system, and when mixed with sleeping medications, the consequences can be dangerous and even life-threatening. Do not mix sleeping pills with other medications (prescription or non-prescription) unless recommended by your doctor.
- Side effects: Some people (e.g., those with breathing problems, seniors) are more susceptible to the side effects of sleeping pills. Drowsiness caused by sleeping pills can make it dangerous to drive or operate machinery. Daytime grogginess can be bothersome to many people.
If you are prescribed a medication to help you sleep, understand the risks and benefits of taking them, and follow the instructions of your doctor and pharmacist. If the medication doesn't seem to be working, don't take more of the medication without talking to your doctor first. Your doctor may want to change your medication and suggest other methods to help you sleep.