Prescription sleeping pills: What's right for you?

Sleeping pills may help when stress, travel or other disruptions keep you awake. For long-term insomnia, behavior changes learned in behavioral therapy is usually the best treatment.

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 cause, such as a medical condition 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. 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. 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.

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 medication to help you sleep, your doctor 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 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 a different 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.

Prescription sleep medication options include the following.

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)
Suvorexant (Belsomra)

Side effects of prescription sleeping pills

Always ask your doctor 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
  • Gastrointestinal problems, such as diarrhea and 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
  • Daytime memory and performance problems

Antidepressants with a sedating effect

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. When insomnia is secondary to depression or anxiety, antidepressants may improve both conditions at the same time.

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
  • Weight gain
  • Daytime memory and performance problems
  • Constipation

Safety considerations

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, low blood pressure, heart rhythm problems (arrhythmias) 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.

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 doctor for a thorough exam. Often your doctor 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 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, 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 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 at least four 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. 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.
  • Take sleeping pills strictly as prescribed by your doctor. Some prescription sleeping pills are for short-term use only. Be sure to contact your doctor 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 doctor.
  • 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.

From Mayo Clinic to your inbox

Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health.

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

Jan. 30, 2018 See more In-depth

See also

  1. Ambien: Is dependence a concern?
  2. Anorexia nervosa
  3. Antidepressant withdrawal: Is there such a thing?
  4. Antidepressants and alcohol: What's the concern?
  5. Antidepressants and weight gain: What causes it?
  6. Antidepressants: Can they stop working?
  7. Antidepressants for children and teens
  8. Antidepressants: Side effects
  9. Antidepressants: Selecting one that's right for you
  10. Antidepressants: Which cause the fewest sexual side effects?
  11. Atypical antidepressants
  12. Bedtime routines: Not just for babies
  13. Biofeedback
  14. Can't sleep? Try daytime exercise
  15. Central sleep apnea
  16. Chase away the winter blues
  17. CJD - Creutzfeldt-Jakob Disease
  18. Clinical depression: What does that mean?
  19. Coffee after dinner? Make it decaf
  20. Cognitive behavioral therapy
  21. CPAP machines: Tips for avoiding 10 common problems
  22. Creutzfeldt-Jakob disease
  23. Depression and anxiety: Can I have both?
  24. Depression, anxiety and exercise
  25. Depression: Diagnosis is key
  26. Depression in women: Understanding the gender gap
  27. Depression (major depressive disorder)
  28. Depression: Provide support, encouragement
  29. Depression: Supporting a family member or friend
  30. Drug addiction (substance use disorder)
  31. Sleep and psoriatic arthritis
  32. Fatigue
  33. Headaches and stress
  34. Sleep guidelines
  35. How opioid addiction occurs
  36. How to tell if a loved one is abusing opioids
  37. Huntington's disease
  38. Insomnia
  39. Insomnia: How do I stay asleep?
  40. Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills
  41. Jet lag disorder
  42. Kratom for opioid withdrawal
  43. Lack of sleep: Can it make you sick?
  44. Male depression: Understanding the issues
  45. MAOIs and diet: Is it necessary to restrict tyramine?
  46. Marijuana and depression
  47. Mayo Clinic Minute: Restless legs syndrome in kids
  48. Mayo Clinic Minute: What you should know about bats and rabies
  49. Melatonin side effects
  50. Monoamine oxidase inhibitors (MAOIs)
  51. Napping do's and don'ts
  52. Natural remedies for depression: Are they effective?
  53. Nervous breakdown: What does it mean?
  54. Nicotine dependence
  55. Not tired? Don't go to bed
  56. Obstructive sleep apnea
  57. Obstructive Sleep Apnea
  58. Pain and depression: Is there a link?
  59. Persistent post-concussive symptoms (Post-concussion syndrome)
  60. Pinworm infection
  61. Polysomnography (sleep study)
  62. Porphyria
  63. Postpartum depression
  64. Premenstrual dysphoric disorder
  65. Premenstrual syndrome (PMS)
  66. Prescription drug abuse
  67. Pulmonary edema
  68. Rabies
  69. Restless legs syndrome
  70. Seasonal affective disorder (SAD)
  71. Seasonal affective disorder treatment: Choosing a light box
  72. Selective serotonin reuptake inhibitors (SSRIs)
  73. Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  74. Skip booze for better sleep
  75. Antihistamines for insomnia
  76. OTC sleep aids
  77. Sleep apnea
  78. Sleep apnea and caffeine: Any connection?
  79. Sleep tips
  80. CPAP masks
  81. Stress symptoms
  82. Take headache relief into your own hands
  83. Tapering off opioids: When and how
  84. Teen depression
  85. Tension headache
  86. Relieving tension-type headaches
  87. Treatment-resistant depression
  88. Tricyclic antidepressants and tetracyclic antidepressants
  89. Valerian: A safe and effective herbal sleep aid?
  90. CPAP: How it works
  91. Obstructive sleep apnea: What happens?
  92. Vitamin B-12 and depression
  93. What are opioids and why are they dangerous?
  94. What is reflexology?