Prescription sleeping pills: What's right for you?

If you regularly have trouble either falling or staying asleep — a condition called insomnia — make an appointment with your health care provider. Treatment depends on what's causing your insomnia. Sometimes, an underlying cause, such as a medical condition or a sleep-related 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 ongoing insomnia. Sleeping on a regular schedule, exercising regularly, avoiding caffeine later in the day, avoiding daytime naps and keeping stress in check also are likely to help. But there are times when the addition of prescription sleeping pills may help you get some much-needed rest.

All prescription sleeping pills have risks, especially for people with certain medical conditions, including liver or kidney disease, and for older adults. Always talk with your health care provider before trying a new treatment for insomnia.

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

Types of prescription sleeping pills

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 medicine to help you sleep, your health care provider generally should:

• Ask 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 medicine, 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 a different prescription sleeping pill if the first medicine 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 medicine

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

Prescription sleep medicine options include the following.

Side effects of prescription sleeping pills

Always ask your health care provider about potential side effects before deciding which sleeping pills to consider taking. Depending on the type, prescription sleeping pills may include side effects such as:

• Dizziness or lightheadedness, which may lead to falls
• Headache
• Diarrhea or nausea
• Prolonged drowsiness, more so with drugs that help you stay asleep
• Severe allergic reaction
• Sleep-related behaviors, such as driving or eating when not fully awake
• Changes in thinking and behavior, such as hallucinations, agitation, trouble remembering events, suicidal thoughts and bizarre behavior
• Daytime memory and performance problems

Antidepressants with a sedating effect

Sometimes prescription medicines used mainly to treat depression may ease insomnia when taken in lower doses. Although widely used, these are not approved by the U.S. Food and Drug Administration (FDA) for insomnia. When insomnia is related to depression or anxiety, these antidepressants may be added to treatment.

Examples include:

• Amitriptyline
• Mirtazapine (Remeron)
• Trazodone

Side effects of antidepressants with a sedating effect

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

• Dizziness and lightheadedness
• Headache
• Prolonged drowsiness
• Dry mouth
• Nausea
• Irregular heartbeat
• Changes in weight
• Daytime memory and performance problems
• Constipation or diarrhea
• Suicidal thoughts

Safety considerations

Prescription sleeping pills (and even some nonprescription sleeping aids), as well as certain antidepressants, may not be safe if you are pregnant, breastfeeding 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 health care provider may prescribe a lower dose of medicine to reduce your risk of problems.

Some health conditions — for example, kidney disease, low blood pressure, heart rhythm problems or a history of seizures — may limit your options. Also, prescription sleeping pills and nonprescription sleep aids may interact with other medicines. And taking certain prescription sleeping pills can lead to drug misuse or drug dependence, so it's important to follow your health care provider's advice.

Taking sleeping pills

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 health care provider for a thorough exam. Often your provider may be able to find specific causes for your insomnia. If you're taking sleeping pills for more than a few weeks, talk to your provider about an appropriate follow-up schedule to discuss your medicines.
• Read the medication guide. Read the medication guide for patients so that you understand how and when to take your medicine and what the major potential side effects are. If you have any questions, ask your pharmacist or health care provider.
• 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, immediately before you plan on sleeping.
• Take your sleeping pill when you can get a full night's sleep. Only take a sleeping pill when you know you can get a full night's sleep of at least 7 to 8 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 at least four hours.
• Watch for side effects. If you feel sleepy or dizzy during the day or if you experience any other side effects that bother you, talk to your health care provider. Your provider may suggest trying a different medicine, changing your dose or weaning you off pills. Don't take a new sleeping pill the night before an important appointment or activity because you won't know how it affects you.
• 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. Combining alcohol with certain sleeping pills can lead to dangerously slowed breathing or unresponsiveness. And alcohol can actually cause insomnia.
• Don't take sleeping pills with opioids. Opioids are a wide class of pain-relieving drugs. They include prescription medicines, such as oxycodone, hydrocodone, morphine, methadone and the synthetic opioid fentanyl. This class also includes illegal drugs, such as heroin. Combining an opioid with sleeping pills can be dangerous. The combination increases the sedative effects of the pills and can lead to slowed breathing or unresponsiveness. It can even cause you to stop breathing.
• Take sleeping pills strictly as prescribed by your health care provider. Some prescription sleeping pills are for short-term use only. Be sure to contact your provider for advice. Also, don't take a higher dose than prescribed. If the initial dose doesn't produce the intended effect on sleep, don't take more pills without first talking to your provider.
• Quit carefully. When you're ready to stop taking sleeping pills, follow your health care provider's or pharmacist's instructions or the directions on the label. Some medicines 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 health care provider for more help.