Sleeping pills help when stress, travel or other disruptions keep you awake. If you have chronic insomnia, a better approach may be to find and remove the cause.

By Mayo Clinic Staff

If you're regularly having trouble either falling or staying asleep (insomnia), make an appointment with your doctor. Treatment depends on what's causing your insomnia. Sometimes, an underlying medical or sleep disorder can be found and treated — a much more effective approach than just treating the symptom of insomnia itself.

Behavior changes learned through cognitive behavioral therapy are generally the best treatment for persistent insomnia. Sleeping on a regular schedule, exercising regularly, avoiding caffeine and daytime naps, and keeping stress in check also are likely to help.

However, there are times when prescription sleeping pills may be helpful. Although sleeping pills don't treat the underlying cause of your sleeping problems, they may help you get some much needed rest.

Sleeping pills that are benzodiazepines belong to a group of medicines called central nervous system depressants, which slow down the nervous system. In comparison, newer, nonbenzodiazepine sleeping pills appear to have a safer side effect profile. But risks remain — especially for people who have certain medical conditions, including liver or kidney disease. Always talk with your doctor before trying a new treatment for insomnia.

Here's information on some of the most common types of prescription sleeping pills used today.

Prescription sleeping pills may help you fall asleep easier or stay asleep longer — or both. The risks and benefits of various prescription sleeping pills can differ. To find the right prescription medication to help you sleep, your doctor may:

  • Ask you several questions to get a clear picture of your sleep patterns
  • Order tests to rule out any underlying conditions that may be causing difficulty sleeping
  • Discuss options for taking prescription sleeping medication, including how often and when to take it and in what form, such as pills, oral spray or dissolving tablets
  • Prescribe a sleeping pill for a limited period of time to determine the benefits and side effects for you
  • Have you try more than one prescription sleeping pill if the first medication you take doesn't work after the full prescribed course
  • Help you determine whether there is a generic version, which is typically less expensive than brand-name drugs

Insurance companies may have restrictions on which sleeping pills are covered, and they may require that you try other approaches to your insomnia first.

Sleep medication Helps you fall asleep Helps you stay asleep Can lead to dependence
Doxepin (Silenor)    
Estazolam
Eszopiclone (Lunesta)
Ramelteon (Rozerem)    
Temazepam (Restoril)
Triazolam (Halcion)  
Zaleplon (Sonata)  
Zolpidem (Ambien, Edluar, Intermezzo, Zolpimist)  
Zolpidem extended release (Ambien CR)

Always ask your doctor about potential side effects before making a decision about which sleeping pills to consider taking. Depending on the type, prescription sleeping pills may include side effects such as:

  • Dizziness or lightheadedness
  • Headache
  • Gastrointestinal problems, such as diarrhea and nausea
  • Prolonged drowsiness, more so with drugs that help you stay asleep
  • Severe allergic reaction
  • Sleep behaviors, such as sleep-driving and sleep-eating
  • Daytime memory and performance problems

Sometimes prescription drugs used mainly to treat depression may ease insomnia when taken in lower doses. Although widely used, these are not approved by the Food and Drug Administration for insomnia only. When insomnia is secondary to depression or anxiety, antidepressants may improve both conditions at the same time. Examples include:

  • Amitriptyline
  • Mirtazapine (Remeron)
  • Trazodone (Oleptro)

Antidepressants that have a sedating effect may include side effects such as:

  • Dizziness and lightheadedness
  • Headache
  • Prolonged drowsiness
  • Dry mouth
  • Nausea
  • Irregular heartbeats
  • Weight gain
  • Daytime memory and performance problems

Prescription sleeping pills (and even some nonprescription sleeping pills) as well as certain antidepressants may not be safe if you are pregnant, breast-feeding or an older adult. Sleeping pill use may increase the risk of nighttime falls and injury in older adults. If you're an older adult, your doctor may prescribe a lower dose of medication to reduce your risk of problems.

Some health conditions — for example, kidney disease, high blood pressure or a history of seizures — may limit your options. Also, prescription drugs and over-the-counter sleep aids may interact with other medications. And taking certain prescription sleeping pills can lead to drug abuse or drug dependence, so it's important to follow your doctor's advice.

If your best attempts to get a good night's sleep have failed, prescription sleeping pills may be an option. Here's some advice on how to use them safely.

  • Get a medical evaluation. Before you take sleeping pills, see your doctor for a thorough exam. Often your doctor may be able to find specific causes for your insomnia. In addition, if you're taking sleeping pills for more than a few weeks, talk to your doctor about an appropriate follow-up schedule to discuss your medications.
  • Read the medication guide. Read the medication guide for patients so that you understand how and when to take your medication and what the major potential side effects are. If you have any questions, ask your pharmacist or your doctor.
  • Never take a sleeping pill until you're going to bed. Sleeping pills can make you less aware of what you're doing, increasing the risk of dangerous situations. Wait to take your sleeping pill until you've completed all of your evening activities, about 15 minutes or less before you plan on sleeping.
  • Plan to take your first sleeping pill when you can get a full night's sleep. Don't take a new sleeping pill the night before an important appointment or activity because you won't know how it affects you. Make sure you take a sleeping pill for the first time when you know you can get a full night's sleep, such as on a Friday night if you work weekdays. Generally, sleeping pills should be taken only when you know you can stay in bed seven to eight hours. A few short-acting sleeping pills are intended for middle of the night awakenings, so you may take them when you can stay in bed for 4 hours.
  • Watch for side effects. If you feel sleepy or dizzy during the day or if you experience any other significant side effects, talk to your doctor about changing your dose or weaning off your pills.
  • Avoid alcohol. Never mix alcohol and sleeping pills. Alcohol increases the sedative effects of the pills. Even a small amount of alcohol combined with sleeping pills can make you feel dizzy, confused or faint. And alcohol can actually cause insomnia.
  • Never take sleeping pills longer than your doctor advises. Some prescription sleeping pills are for short-term use only — such as seven to 10 days. Be sure to contact your doctor for advice.
  • Quit carefully. When you're ready to stop taking sleeping pills, follow your doctor's or pharmacist's instructions or the directions on the label. Some medications must be stopped gradually. Also, be aware that you may have some short-term rebound insomnia for a few days after you stop taking sleeping pills.

If you continue to have trouble sleeping, ask your doctor for additional help.

Dec. 27, 2014