Battling insomnia night after night can leave you frustrated and exhausted. Sleeping pills may help, but they're not without risks. Get the scoop on the pros and cons of sleep aids. By Mayo Clinic Staff

You've followed the usual tips for getting enough sleep — sticking to a regular schedule, avoiding caffeine and daytime naps, exercising regularly, and managing stress. Still, it's been weeks and a good night's sleep remains elusive. Is it time to consider sleeping pills?

Before you pick up over-the-counter sleeping pills, check in with your doctor. Your doctor can evaluate whether an underlying medical disorder is contributing to or causing your sleep problems.

It's also a good idea to ask your doctor if over-the-counter sleeping pills will interact with medications you take or complicate existing health problems.

Here's a list of common choices and potential side effects:

  • Diphenhydramine (Benadryl, Unisom SleepGels). Diphenhydramine is a sedating antihistamine. Side effects might include daytime drowsiness, dry mouth, dizziness and memory problems.
  • Doxylamine (Unisom SleepTabs). Doxylamine is a sedating antihistamine. Side effects are similar to diphenhydramine, including daytime drowsiness, dry mouth, dizziness and memory problems.
  • Melatonin. The hormone melatonin helps control your natural sleep-wake cycle. Some research suggests that melatonin supplements might be helpful in treating jet lag or reducing the time it takes to fall asleep — although the effect is typically mild. The most common melatonin side effects include daytime sleepiness, dizziness and headaches.
  • Valerian. Supplements made from this plant might reduce the amount of time it takes to fall asleep as well as promote better sleep overall. However, the active ingredient isn't clear and potency can vary. Side effects of valerian supplements might include headache, abdominal discomfort, excitability or uneasiness, and heart disturbances.

If your sleep problems continue after trying over-the-counter sleep aids, see your doctor. He or she can evaluate whether prescription sleeping pills might be appropriate for you.

Today's prescription sleeping pills don't carry the same level of risks of dependence and overdoses as sleeping pills of the past. But risks remain — especially for older adults, pregnant or breast-feeding women, and people with certain medical conditions, including liver or kidney disease.

The most common side effects with prescription sleeping pills are daytime drowsiness, dizziness, lightheadedness, cognitive and motor impairment, and dependence. Long-term use may be habit-forming, and rebound insomnia may occur when medications are discontinued. Less common side effects include sleep-related behaviors, such as walking, driving and eating while not fully awake. Be sure to discuss the potential risks and benefits with your doctor.

Here's a list of commonly prescribed sleeping pills and potential side effects:

  • Doxepin (Silenor). Although the exact mechanism isn't known, doxepin is thought to work by blocking the effects of histamine in the brain, allowing you to stay asleep after you fall asleep. Doxepin may cause weight gain.
  • Estazolam. Estazolam works by depressing the central nervous system, causing sedation. Estazolam may interact with many other medications and can be habit-forming.
  • Eszopiclone (Lunesta). Eszopiclone works by helping to increase certain chemicals in the brain that cause sleep. Stopping eszopiclone abruptly may cause symptoms of withdrawal such as anxiety, unusual dreams, nausea and vomiting.
  • Ramelteon (Rozerem). Ramelteon works by acting on melatonin receptors in the brain, which helps you fall asleep. Ramelteon may interact with alcohol.
  • Temazepam (Restoril). Temazepam works by depressing the central nervous system, causing sedation. Temazepam may interact with alcohol and many medications, and it can be habit-forming.
  • Zaleplon (Sonata). Zaleplon works by depressing the central nervous system, causing drowsiness. Zaleplon may interact with other medications and can be habit-forming.
  • Zolpidem (Ambien, , Edluar, Zolpimist). Zolpidem works by helping to increase certain chemicals in the brain that cause sleep. Zolpidem may become less effective over time. Recently the recommended dose for women was lowered because of data showing that next-day blood levels of the drug may be high enough to impair activities that require alertness, such as driving.

To reduce your risk of side effects and of becoming dependent on drugs to promote sleep, your doctor likely will prescribe sleeping pills for two to four weeks. If you experience side effects, such as feeling groggy the next day, talk to your doctor about whether you need to change your dose or change medications. You may need to try more than one prescription sleeping pill before finding one that is right for you.

Sep. 28, 2013