Prescription sleep medications include a range of sedative agents that promote drowsiness and help people fall asleep and/or stay asleep. 

These medications are an important therapeutic tool for the short-term management of insomnia, a condition characterized by poor sleep quality, difficulty falling asleep, and/or the inability to stay asleep. 1 Kaur H, Spurling BC, Bollu PC. Chronic Insomnia. 2023 Feb 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30252392.

Research indicates that about 8% of adults in the United States take sleep medication every night or most nights to fall asleep or stay asleep. 2 Reuben C, Elgaddal N, Black L. Sleep Medication Use in Adults Aged 18 and Over: United States, 2020. www.cdc.gov. Published January 2023. Accessed July 17, 2023. https://www.cdc.gov/nchs/data/databriefs/db462.pdf.

Watch this Video: 11 Unconventional Sleep Tips: How to Get to Sleep and Stay Asleep in our Video Center.

The ability to fall asleep—and stay asleep long enough to feel restored and refreshed in the morning—is vital to your overall health and well being. Sleep is also essential in helping your body heal from an injury, and/or to cope with pain or illness. Try one or a combination of these 11 tips to help you sleep more soundly and wake up rested and refreshed:

Number one, force your worries.
If worrying kicks in just after you close your eyes or awakes you in the middle of the night, consider scheduling a daily "worry time" during the day. Choose a 15 minute period at the same time every day when you try to think of every possible worry, and then tell them to a trusted confidant or write them out in a journal. Getting your worries out during the day can help keep your mind from dwelling on them during the night.

You can also try keeping a pen and notebook by your bed—that way if you wake up with worries or anxiety you can write about it. Sometimes simply knowing that your concerns are recorded will allow you to rest easier.

Number two, consider taking the supplement valerian.
While many sources recommend sleep medications or melatonin, personally I have found valerian to be more effective. Valerian is an herb and is made from the root of a perennial flower. Some people believe that valerian is more effective at helping you stay asleep longer, allowing a deeper and more restful night's sleep. As with many herbal supplements, there are not enough well-structured studies to be definitive about whether it is effective, or what doses and duration are optimal—though always check with your doctor and/or pharmacist to be safe. Also, beware of the odor—the capsules have an unpleasant smell.

Number three, nap lightly every day.

Many sleep sources say to avoid napping, but as long as the nap is not overly long it can help you get through the day and keep to a better bedtime routine. Keep to a schedule. Napping at the same time every day will allow your body to regulate itself to fall asleep more quickly at that time.

Make it in the early afternoon. The optimal time for napping is about an hour after lunch, which is when your body is naturally inclined to feel sleepy, and it's early enough in the day to not interfere with falling asleep at night. Keep it short. A 10- to 20-minute power nap provides enough sleep to help you feel refreshed and more alert, yet it won't make you feel groggy or interfere with falling asleep at night.

Number four, try out a more comfortable mattress.

Do you wake up and shift positions a lot? Do you have to try 3 or 4 positions before you can fall asleep? Does back pain, shoulder pain, or any type of joint pain wake you up? Any mattress will work well for you if it provides a balance of both supporting the natural curves in your spine and providing enough comfort for your joints to rest comfortably through the night.

A mattress that sags—meaning that you can see a compression in some part of the mattress—will always create sleep discomfort and can worsen back problems.

Number five, get out in the sunlight soon after waking up in the morning.
When you wake up, don't lounge around in bed. Get out in the morning sun—or at least sit near a sunny window—soon after getting up. The bright sunlight tells your body's natural biological clock that it's time to wake up, and that same internal clock will then be set to tell your body it's time to go to sleep about 14 to 16 hours later.

Number six, avoid taking a hot bath.
A lot of people advise taking a hot bath to relax yourself, but since the body needs to lower its temperature in order to fall asleep, a hot bath right before bed will actually keep you up. If you enjoy a soak in a hot bath, take it earlier in the evening—2 or more hours before bedtime—so your body has enough time to cool down.

Number seven, make your room colder.
Your body needs to cool down in order to fall asleep and stay asleep, so do what you can to make your room cool—add a fan, open a window, or turn up the AC. Many people like the combination of a cold bedroom and heavy blankets or comforters, as nestling in under the covers can have a soothing, cocooning feeling that nurtures sleep.

Number eight, exercise intensely.
Nothing beats intense exercise as a path to achieving deep, restorative sleep. When I say "intensely," I mean intense relative to your capability. For some this may mean running 5 miles, for others it may mean a brisk 20 minute walk that elevates the heart rate. Physical tiredness is essential to getting a good night's sleep.

For anyone with back pain or other medical issues that make it difficult to exercise intensely, try to find another way to get your heart rate up. Maybe you can tolerate water therapy—the water in the pool supports your joints and provides gentle resistance, making it possible for you to get a wonderful workout without too much pain. Exercising to the point of elevating your heart rate has the added benefit of producing more of your body's own feel-good hormones: endorphins.

Number nine, block out background noise.
White noise is restful, and even more importantly, it means that you won't be woken up with every little thump that the house makes. A fan is ideal because it does double duty of providing consistent soft background noise as well as keeping your room cool. Similarly, an air cleaner will serve to both provide white noise and help keep your room free of dust.

You can also buy a white noise machine or download an app that will provide several white noise options like the sound of rain, wind, and more. Many people prefer pink noise, which includes more varied sounds such as a waterfall or babbling brook.

Number ten, match your pillows to your sleep position.
Pillows can be a great sleep aid. For example, if you like to sleep on your back, use a pillow to support your knees. Keeping your knees supported and slightly bent helps take stress off your lower back.

If you sleep on your side, place a pillow between your knees. Keeping your knees slightly apart maintains better alignment with the hips, and helps keep your lower back from twisting, which is easier on the spinal discs, joints, and soft tissues.

If you like to sleep lying on your stomach, make sure to use a flat (or no) pillow for your head so that your neck is not strained. To maintain the natural inward curve of your lower back (lordosis), place a relatively flat pillow beneath your hips/abdomen.

And finally, number eleven, empower yourself to reduce stress.
At some points in our lives, we are burdened by a great deal of stress. It may be chronic pain, a family or work situation, financial stress, or all of these combined. Many believe that they just need relaxation to reduce stress. However, the opposite of stress is not relaxation, it's empowerment.

So do what you can to empower yourself. Daily meditation generally works well, as it frees up all the clutter to float to the surface, be recognized, and be gone. For others it is guided imagery, either with the help of a professional or with CDs, regular massage, yoga or tai chi, calming music, or a therapeutic run or bike ride to get powerful endorphins flowing.

I hope everything we've talked about will give you some new ideas and help you get as much restful, restorative sleep as possible. Sweet dreams and stay healthy!

In This Article:

When Sleep Medications are Prescribed

Sleep medications may be prescribed when an individual’s quality of life is significantly affected due to the lack of quality sleep. 

  • Prescription medications are usually considered when over-the-counter (OTC) and non-drug therapies (eg, sleep hygiene and cognitive behavioral therapy) are ineffective. In general, cognitive behavioral therapy is considered the first-line therapy for chronic insomnia. 3 Dujardin S, Pijpers A, Pevernagie D. Prescription drugs used in insomnia. Sleep Medicine Clinics. 2020;15(2):133-145.
  • In some cases, a sleep aid may be prescribed before trying OTC drugs or other therapies, and after a specific period of time, non-prescription options may be continued.

The duration of treatment and type of medication depends on the underlying cause, severity, and duration of insomnia. 

Prescription Sleep Medications

Common prescription medications used to treat insomnia include medications that work directly on the areas of the brain that regulate sleep/wake cycles and medications that have sedating side effects.

Sleep aids approved by the FDA for treating insomnia

Sufficient research has shown the following sleep aids are effective for treating insomnia:

  • Melatonin receptor agonists. These drugs help regulate the body’s sleep/wake cycle through an action similar to melatonin, a natural hormone that signals when it is time to fall asleep or wake up.
  • Benzodiazepines and Z-drugs (benzodiazepine receptor agonists). Benzodiazepines and Z-drugs are sedative-hypnotic medications. These drugs act on the gamma-aminobutyric acid (GABA) receptors in the brain and produce sedation by calming the nervous system.
  • Dual orexin receptor antagonists (DORAs). DORAs block receptors in the brain that keep people awake for extended periods of time during the day.
  • Antidepressants. Some low-dose antidepressants have sedating side effects, which may help people stay asleep.

Sleep aids used off-label for treating insomnia

Certain types of antidepressant drugs, such as trazodone and tricyclic antidepressants (eg, amitriptyline), have sedative properties that may help people fall asleep or stay asleep longer and may be used off-label to treat some cases of insomnia.

Prescription medications used off-label for treating nightmares

For individuals with post-traumatic stress disorder (PTSD), nightmares have the potential to disrupt sleep duration and quality. In these cases, medications are prescribed to reduce the occurrence of nightmares rather than inducing sleep. 4 Basquez R, Pippin MM. Prazosin. [Updated 2023 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555959/

Prazosin is an antihypertensive medication that has demonstrated effectiveness in reducing nightmares associated with PTSD. However, it is still unknown whether this medication is beneficial in individuals without PTSD. 4 Basquez R, Pippin MM. Prazosin. [Updated 2023 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555959/

advertisement

Specific Sleep Medications and Their Effects

The following table lists the medications approved by the FDA for treating insomnia, the primary symptoms they treat, and the average recommended duration of treatment.

Medication Helps fall asleep Helps stay asleep Average Duration of Treatment
Melatonin receptor agonist
Ramelteon (Rozerem) 5 Rozerem. Package Insert. Takeda Pharmaceuticals America, Inc.; 2023 ✓   Variable
Benzodiazepines
Temazepam (Restoril) 6 Restoril. Package Insert. SpecGx LLC; 2023 ✓ ✓ 1 to 2 weeks
Triazolam (Halcion) 7 Halcion. Package Insert. Pharmacia & Upjohn Company LLC; 2023 ✓   1 to 2 weeks
Benzodiazepine receptor agonists
Zolpidem (Ambien) 8 Ambien. Package Insert. Sanofi-Aventis U.S. LLC; 2019 ✓   4 to 5 weeks
Zaleplon (Sonata) 9 Zaleplon. Package Insert. Aurobindo Pharma Limited; 2021 ✓   4 to 5 weeks
Eszopiclone (Lunesta) 10 Lunesta. Package Insert. Sunovion Pharmaceuticals Inc.; 2023 ✓ ✓ 6 months
Dual orexin receptor antagonists
Suvorexant (Belsomra) 11 Belsomra. Package Insert. Merck Sharp & Dohme LLC; 2023 ✓ ✓ Variable
Daridorexant (Quviviq) 12 Quviviq. Package Insert. Idorsia Pharmaceuticals Ltd; 2023 ✓ ✓ Variable
Lemborexant (Dayvigo) 13 Dayvigo. Package Insert. Eisai Inc.; 2023 ✓ ✓ Variable
Antidepressants
Doxepin (Silenor) 14 Silenor. Package Insert. Currax Pharmaceuticals LLC; 2023   ✓ Variable

Sleep medications approved by the FDA are generally considered to be equally effective, but doctors take several factors into consideration before prescribing a specific class of medication. 15 Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine. 2017;13(02):307-349. doi:10.5664/jcsm.6470

Factors that Affect the Type of Prescription Sleep Medication

Choosing the right medication involves consideration of multiple factors. In most cases, insomnia is associated with a co-occurring condition, which can be physical (eg, chronic pain or obstructive sleep apnea) or psychiatric (eg, depression). Medication selection is typically based on both factors, in addition to individual preference. 14 Silenor. Package Insert. Currax Pharmaceuticals LLC; 2023

Additional considerations for choosing the most appropriate sleep aid include: 

  • Comorbid medical conditions. Liver disease can impact how long a medication stays in the body, which may increase or decrease its effect and side effects.
    Other conditions such as heart disease and chronic obstructive pulmonary disease may potentially increase the risk of severe adverse events, such as slowed or depressed breathing. 4 Basquez R, Pippin MM. Prazosin. [Updated 2023 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555959/ - 13 Dayvigo. Package Insert. Eisai Inc.; 2023
  • Current medications. Several prescription and non-prescription medications can interact with sleep aids. These interactions can impact how well the medications work or increase the risk of certain side effects.
    For example, taking zolpidem with certain antidepressants, like Zoloft or Prozac, can increase the amount of zolpidem that gets into the bloodstream. 4 Basquez R, Pippin MM. Prazosin. [Updated 2023 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555959/ - 13 Dayvigo. Package Insert. Eisai Inc.; 2023
  • History of insomnia. Acute (short-term), intermittent, or chronic sleep disturbances determine how long a person will likely need medication. In such cases, it is important to assess the benefits and risks of long-term use of certain sleep medications. 13 Dayvigo. Package Insert. Eisai Inc.; 2023
    While rare, some cases of chronic insomnia may require longer-term treatment.
  • Lifestyle and daily schedules. Individuals with nonstandard schedules (eg, shift work) often benefit most from short-acting medications with a lower potential for next-day impairment. 16 Auger RR, Burgess HJ, Emens JS, Deriy LV, Thomas SM, Sharkey KM. Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2015;11(10):1199-1236. Published 2015 Oct 15. doi:10.5664/jcsm.5100

It is important to discuss personal treatment goals with a doctor to determine when to begin a prescription sleep medication.

advertisement

Restorative sleep helps heal from inflammatory or referred back pain.

Insomnia often coexists with back pain and neck pain, and managing sleep disorders is an important component of pain management. Pain and sleep disturbances go hand-in-hand because they both impact similar areas in the brain. 17 Afolalu EF, Ramlee F, Tang NKY. Effects of sleep changes on pain-related health outcomes in the general population: A systematic review of longitudinal studies with exploratory meta-analysis. Sleep Med Rev. 2018;39:82-97. doi:10.1016/j.smrv.2017.08.001

Why sleep medication may be helpful for back or neck pain

Difficulty sleeping can be caused by the pain itself, the psychological impact of dealing with pain, and the long-term use of certain pain medications (eg, opioids). Chronic pain and functional disability can be worsened by poor sleep quality.

See Medications for Back Pain and Neck Pain

Prescription sleep aids aim to enhance the quality of sleep, which may help ease the stress caused by insomnia and improve pain symptoms. 16 Auger RR, Burgess HJ, Emens JS, Deriy LV, Thomas SM, Sharkey KM. Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2015;11(10):1199-1236. Published 2015 Oct 15. doi:10.5664/jcsm.5100

Specific actions of sleep medications in managing chronic pain are:  

  • Reduced pain perception and sensitization. Adequate sleep can improve the threshold for pain and help the nervous system to become less sensitive to pain signals. 16 Auger RR, Burgess HJ, Emens JS, Deriy LV, Thomas SM, Sharkey KM. Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2015;11(10):1199-1236. Published 2015 Oct 15. doi:10.5664/jcsm.5100
  • Improved healing. Restorative sleep fosters an environment that helps promote tissue repair, healing, and inflammation reduction. 16 Auger RR, Burgess HJ, Emens JS, Deriy LV, Thomas SM, Sharkey KM. Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2015;11(10):1199-1236. Published 2015 Oct 15. doi:10.5664/jcsm.5100
  • Better emotional well-being. Getting adequate sleep can help reduce emotional distress and make it easier to cope with pain. 16 Auger RR, Burgess HJ, Emens JS, Deriy LV, Thomas SM, Sharkey KM. Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2015;11(10):1199-1236. Published 2015 Oct 15. doi:10.5664/jcsm.5100

Improving sleep quality is an important component of pain management.

Pain-relieving medications with a sedative effect

When sleep medications are not prescribed or cannot be taken, insomnia may be managed with the use of certain pain medications that cause drowsiness as a side effect. 

These medications include neuropathic pain medication (eg, Neurontin, Lyrica), muscle relaxers (eg, Soma, Zanaflex), and some types of opioid analgesics (eg, tramadol). 

Safety Profile of Sleep Medications

Prescription sleep medications are relatively safe when used in the short-term at the recommended doses. The side effects are generally mild and related to the sedating effects of these drugs. There is limited research on the long-term impact of side effects and the safety of these medications.

Serious adverse events are rare, but certain drug classes and the presence of some underlying medical conditions may increase the risk of complications. 

Common side effects of prescription sleep aids

Illustration showing a skeleton showing dizziness.

Dizziness is a common side effect of prescription pain medication.

Treating Insomnia from Back Pain or Neck Pain

The common side effects of all prescription sleep medications include 4 Basquez R, Pippin MM. Prazosin. [Updated 2023 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555959/ - 13 Dayvigo. Package Insert. Eisai Inc.; 2023 :

  • Drowsiness
  • Dizziness
  • Headache
  • Gastrointestinal upset
  • Dry mouth

The impact of these side effects varies, and for most people, these effects do not pose a major risk to daily activities. Additional side effects vary depending on the mechanism of action of the medication.

Serious adverse events of prescription sleep aids

All prescription medications indicated for insomnia have warnings for 4 Basquez R, Pippin MM. Prazosin. [Updated 2023 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555959/ - 13 Dayvigo. Package Insert. Eisai Inc.; 2023 :

  • Complex sleep behaviors, such as sleepwalking, sleep-driving, and engaging in other activities while not fully awake
  • Impairment of alertness, driving, and motor coordination the next day
  • Behavior changes and abnormal thinking, including agitation, depersonalization, and bizarre behavior
  • Worsening depression in individuals diagnosed with depressive disorders

Factors like underlying medical conditions and use with alcohol may increase the risk for some of these warnings. Additional warnings exist and are unique to the mechanism of action of the medication. 

Addiction risk of prescription sleep aids

In general, prescription sleep aids have a low addiction risk when used at the recommended dose. However, tolerance to benzodiazepines (Restoril, Halcion) may occur quickly so these medications should be used for a short duration of time (1 to 2 weeks). 5 Rozerem. Package Insert. Takeda Pharmaceuticals America, Inc.; 2023 , 6 Restoril. Package Insert. SpecGx LLC; 2023

Withdrawal symptoms of sleep aids

When stopping some medications, it is possible to experience withdrawal symptoms. These symptoms are most common with higher doses of benzodiazepines (Restoril, Halcion) when used long-term but may also occur with the Z-drugs (Ambien, Lunesta, Sonata). 14 Silenor. Package Insert. Currax Pharmaceuticals LLC; 2023

advertisement

Sleep Medications for Kids and Adolescents

In rare situations, prescription sleep aids may be prescribed to children or adolescents. 18 Bruni O, Angriman M, Calisti F, et al. Practitioner Review: Treatment of chronic insomnia in children and adolescents with neurodevelopmental disabilities. J Child Psychol Psychiatry. 2018;59(5):489-508. doi:10.1111/jcpp.12812

Certain medical conditions may necessitate the need for sleep medications

Serious injuries (eg, traumatic brain injury) and severe cases of psychiatric and neurodevelopmental disorders (eg, autism spectrum disorder) are sometimes associated with sleep disturbances and may require prescription sleep aids.

Prescription sleep medications are not FDA-approved for kids

It is important to note that FDA-approved prescription medications for managing insomnia in adults are not approved for use in children. Limited research is available regarding the safe use of prescription sleep aids in the pediatric population. The use of these medications for children is off-label.

The dosing, side effects, and adverse events of these drugs differ for children and adults. It is essential to note that sleep aids should not be given to a child without a prescription or evaluation by a licensed medical professional. 

Melatonin as a sleep aid for kids and adolescents

While not a prescription medication, the use of melatonin as a sleep aid for kids is increasing due to its availability over the counter and its classification as a natural product. However, melatonin’s rise in popularity is also leading to an increase in the number of reported overdose cases. 19 Health Advisory: Melatonin Use in Children and Adolescents. American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers. Accessed August 28, 2023. https://aasm.org/advocacy/position-statements/melatonin-use-in-children-and-adolescents-health-advisory/

Taking more than the recommended does not usually cause significant harm, but accidental overdose may lead to serious side effects requiring hospitalization. 20 Lelak K. Pediatric Melatonin Ingestions — United States, 2012–2021. MMWR Morbidity and Mortality Weekly Report. 2022;71. doi: 10.15585/mmwr.mm7122a1

This product is beneficial in some cases of developmental disabilities or psychiatric conditions. However, it is not recommended to be given to kids without supervision by a qualified healthcare professional. 19 Health Advisory: Melatonin Use in Children and Adolescents. American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers. Accessed August 28, 2023. https://aasm.org/advocacy/position-statements/melatonin-use-in-children-and-adolescents-health-advisory/

See Natural Remedies and Herbal Supplements as Sleep Aids

Sleep Medications for Older Adults

Use of sleep medications in older adults is common due to the increase in sleep disturbances that can naturally occur as people age. Insomnia also impacts people with neurodegenerative disorders (eg, Parkinson’s disease, Alzheimer’s disease, and dementia).

Increased risk of side effects with sleep medications in older adults

The use of sleep aids in older adults carries a higher risk for side effects and adverse events due to multiple factors:

  • The body’s ability to process and clear medications is naturally reduced with age, and older adults are more likely to have impaired liver or kidney function, which can enhance the side effects of sleep medication. 
  • Older adults usually take multiple medications and supplements, which may increase the risk of potentially dangerous drug interactions with sleep aids.
  • Medical conditions common in older adults (such as sleep apnea and respiratory disorders) increase the risk of respiratory depression (slowed breathing) for some sleep medications.
  • Certain sleep medications may cause cognitive impairment, and this effect can be enhanced in older adults, which increases the risk of falls or worsened overall cognitive function.

The most significant side effect risk is cognitive impairment (eg, memory, concentration, visual perception, and orientation). These effects can be dangerous and are linked to an increased risk of falls and injury. 

Non-drug options, such as sleep schedules and relaxing bedtime routines, are generally the preferred therapy due to the safety risks of medication. When sleep aids are prescribed, lower doses and routine monitoring for side effects and adverse events are recommended. 21 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372

Safe use of sleep medications in older adults

To reduce the risk of complications in older adults, it is advisable to implement the following safe practices when using sleep medications:

  • Take the medication right before bedtime
  • Avoid driving or drinking alcohol after taking sleep medication
  • Avoid combining prescription sleep medication with OTC sleep aids

It is also beneficial to limit using sleep medication to 3-4 times per week and allow the body to try to fall asleep naturally on the other days to prevent reliance on the medication.

Sleep Medications in Pregnancy and Lactation

Pregnant or lactating women should use caution when deciding whether to use sleep medications. There is limited research on the safe use of sleep aids in this population, and the risks to the developing fetus or infant should be carefully weighed against the benefit to the mother. 

The use of a sleep aid when pregnant or breastfeeding should be under the supervision of a doctor. Non-drug therapies, such as sleep hygiene and relaxation techniques, are generally the preferred and safest approach to managing insomnia in new or expectant mothers. 

See Using Supplements, Natural Remedies and OTC Sleep Aids Safely

Kathee de Falla

Dr. Kathee de Falla is a licensed and certified pharmacist. She has more than a decade of experience providing medical advice and supplying prescription medications in a retail setting. Dr. de Falla spent several years developing drugs at Abbott Laboratories, a pharmaceutical company where she holds a patent for a drug formulation.

  • 1 Kaur H, Spurling BC, Bollu PC. Chronic Insomnia. 2023 Feb 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30252392.
  • 2 Reuben C, Elgaddal N, Black L. Sleep Medication Use in Adults Aged 18 and Over: United States, 2020. www.cdc.gov. Published January 2023. Accessed July 17, 2023. https://www.cdc.gov/nchs/data/databriefs/db462.pdf.
  • 3 Dujardin S, Pijpers A, Pevernagie D. Prescription drugs used in insomnia. Sleep Medicine Clinics. 2020;15(2):133-145.
  • 4 Basquez R, Pippin MM. Prazosin. [Updated 2023 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555959/
  • 5 Rozerem. Package Insert. Takeda Pharmaceuticals America, Inc.; 2023
  • 6 Restoril. Package Insert. SpecGx LLC; 2023
  • 7 Halcion. Package Insert. Pharmacia & Upjohn Company LLC; 2023
  • 8 Ambien. Package Insert. Sanofi-Aventis U.S. LLC; 2019
  • 9 Zaleplon. Package Insert. Aurobindo Pharma Limited; 2021
  • 10 Lunesta. Package Insert. Sunovion Pharmaceuticals Inc.; 2023
  • 11 Belsomra. Package Insert. Merck Sharp & Dohme LLC; 2023
  • 12 Quviviq. Package Insert. Idorsia Pharmaceuticals Ltd; 2023
  • 13 Dayvigo. Package Insert. Eisai Inc.; 2023
  • 14 Silenor. Package Insert. Currax Pharmaceuticals LLC; 2023
  • 15 Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine. 2017;13(02):307-349. doi:10.5664/jcsm.6470
  • 16 Auger RR, Burgess HJ, Emens JS, Deriy LV, Thomas SM, Sharkey KM. Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2015;11(10):1199-1236. Published 2015 Oct 15. doi:10.5664/jcsm.5100
  • 17 Afolalu EF, Ramlee F, Tang NKY. Effects of sleep changes on pain-related health outcomes in the general population: A systematic review of longitudinal studies with exploratory meta-analysis. Sleep Med Rev. 2018;39:82-97. doi:10.1016/j.smrv.2017.08.001
  • 18 Bruni O, Angriman M, Calisti F, et al. Practitioner Review: Treatment of chronic insomnia in children and adolescents with neurodevelopmental disabilities. J Child Psychol Psychiatry. 2018;59(5):489-508. doi:10.1111/jcpp.12812
  • 19 Health Advisory: Melatonin Use in Children and Adolescents. American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers. Accessed August 28, 2023. https://aasm.org/advocacy/position-statements/melatonin-use-in-children-and-adolescents-health-advisory/
  • 20 Lelak K. Pediatric Melatonin Ingestions — United States, 2012–2021. MMWR Morbidity and Mortality Weekly Report. 2022;71. doi: 10.15585/mmwr.mm7122a1
  • 21 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372

Editor’s Top Picks

Find a Spine Center Near You

stethoscope-icon
Search for a Spine Center
advertisement