Medicines for sleep problems

Medicines for managing sleep problems are usually only considered when lifestyle changes (sleep hygiene) or CBT (cognitive behavioural therapy) have been unsuccessful.

Key points

  1. Medicines for sleep problems may be effective in the short term but there is no evidence that they are helpful or safe when used long term. 
  2. Sleep studies show that medicines for sleep only help people fall asleep about 8 to 20 minutes faster, and they add less than 35 minutes to nightly sleep.
  3. They can cause daytime drowsiness the next day and affect your ability to concentrate and drive safely. 
  4. If you are having problems getting a good night's sleep, great improvements can be made by making a few changes to your daily routine and habits. Read more about tips to improve your sleep habits

Melatonin

Melatonin is a hormone that is produced naturally in your body by a gland in your brain known as the pineal gland. It helps to control your body's sleep pattern and sleep–wake cycle. The level of melatonin in your body increases soon after the onset of darkness and is highest between 2–3am. Melatonin production is suppressed by light and it seems that less melatonin is produced as you age.

  • In New Zealand melatonin is available as tablets and capsules.
  • Melatonin can be used to help with sleep problems in people over 55 years, or for children and young people up to the age of 18 years who have neurodevelopment disorders that make it difficult to sleep.
  • For people having sleep problems mainly in the second half of the night, melatonin in the evening can make the problem worse.

Read more about melatonin

Antihistamines 

Some sleeping tablets can be bought over the counter from pharmacies such as diphenhydramine (Unisom®). This is a type of antihistamine medicine that causes you to feel drowsy.

  • Taking these sleeping tablets can cause you to feel drowsy the next morning, which can make activities such as driving and operating machinery dangerous.
  • These medicines are not recommended because they don't help the cause of your sleeping problems and they can cause drowsiness that lasts into the next day and can affect your concentration, driving and increase the risk of accidents and falls. 

Read more about antihistamines.

Vitamins and supplements

  • Magnesium: The evidence to support magnesium for sleep problems is unreliable. One study in older people found about a 10 minute decrease in time to fall asleep, 6% improvement in proportion of time spent asleep and better subjective ratings of sleep. There are many different products available of varying quality.
  • Vitamin B: There is no evidence to support its use.
  • 5‑hydroxytryptophan (5‑HTP): There is no evidence to support its use.
  • Herbal remedies such as valerian, chamomile, kava, hops: There is no evidence to support their use and they are not recommended in guidelines.
  • Tart cherry and extracts: The evidence to support its use is unreliable. Limited clinical research suggests that tart cherry, which contains melatonin, may assist with sleep.

Ask to speak to a pharmacist if you are thinking about taking any of these vitamins or supplements. They can give you advice, and check if they are safe to take with your other medicines.

Benzodiazepines

Benzodiazepines such as triazolam, nitrazepam and zopiclone are not often used because they can cause harm, especially when used long term on an ongoing basis. They can make you dependent on them. They can also increase your risk of falls and confusion and make it dangerous to drive.

  • Taking benzodiazepines for more than 10 nights in a row can make sleeping worse.
  • Some people can also get a drug withdrawal effect called ‘rebound insomnia’ when they come off benzodiazepines.
  • Taking benzodiazepines with alcohol or some other medicines can be dangerous.
  • Benzodiazepines do not help the causes of insomnia, but they are used sometimes if your insomnia is severe, to help short term. They should only be prescribed for about 5–10 days, or on an occasional basis.
  • Note: Although zopiclone is not a true benzodiazepine, it acts in a similar way to benzodiazepines in terms of helping with insomnia (sleep problems).

Read more about benzodiazepines

Do sleeping tablets work?

Sleep studies show that medicines for sleep only help people fall asleep about 8 to 20 minutes faster, and they add less than 35 minutes to nightly sleep. They can cause daytime drowsiness the next day and affect your ability to concentrate and drive safely. 

If your doctor prescribes sleeping tablets for you, it will usually be only for a short time (a week or so). This is to help you get over a particularly bad patch. Do not drink alcohol if you are taking these medicines.

Learn more

References

  1. Hypnotics New Zealand Formulary
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 29 Nov 2019