Sleep Series (3): What to Know About Medicines, Drugs, and Supplements for Sleep

09
April / 2021

Sleep medications and supplements are widely used for insomnia, but most have significant side effects and limitations and should be generally used only for short periods of time.  Many of these medications are addictive, cause balance problems or other health concerns, and can leave people groggy or cognitively impaired the next day.  Many of these medications also interact dangerously with alcohol use.  (Disclaimer: be sure to consult with your doctor before you start taking any of these substances.)

Supplements

Melatonin is a naturally occurring hormone produced by the pineal gland that helps to regulate sleep and wakefulness.  It is involved in the entrainment (i.e., synchronization) of the circadian rhythms.  As an over-the-counter supplement (3-10 mg) it is useful for treating insomnia and helping to reduce the effects of jet lag when taken about an hour or two before bedtime. 

It appears to be safe for both short and long-term usage, with few side effects.  Some users note that it heightens the intensity of their dreams.  “Cortisol Calm” is a proprietary product, a blend of herbal extracts and vitamin D.  “Rack Out” is another proprietary blend that was developed by veterans for veterans.  Although these have not been rigorously studied, anecdotal evidence from operators and veterans suggests they may be helpful for promoting calmness and improved sleep.

Over-the-Counter Medications

Diphenhydramine (aka Benadryl) and doxylamine succinate (aka Unisom SleepTabs) are antihistamines commonly used to treat allergies, and they commonly have side effects of drowsiness that make them widely used for insomnia.  In the 1980s and 90s, before the current hypnotics were developed and approved, diphenhydramine was commonly prescribed by physicians to treat insomnia.  When used on a short-term basis, it appears to be very effective for about two-thirds of the population.  However, these are not recommended for people with traumatic brain injury (TBI) because they may cause disturbances in memory and new learning.

Prescription Medications

A variety of prescription medications are known to help with sleep, though some of these should not be taken every night for prolonged periods of time.  Thus, caution is urged when considering the use of prescription medication. 

Perhaps the most commonly used medications that help people sleep are antidepressant medications.  These medications do not cause dependence and should be taken daily if prescribed.  The category of antidepressants used most often is SSRIs (selective serotonin reuptake inhibitors), which include Prozac, Paxil, Celexa, Lexapro, Zoloft, and Luvox.  While these medications are general antidepressants, they often have a broad effect when used daily of improving sleep among people who were depressed or anxious.  However, they do not work by causing drowsiness immediately after being taken.  Thus, even when taken in the morning, they can help improve nighttime sleep.  Other antidepressants, such as Trazodone and Elavil, cause drowsiness and might be prescribed for sleep. 

Anxiolytic medications or a category of medications known as benzodiazepines, which include Valium, Xanax, Klonopin, and Ativan, also may be used to cause drowsiness and sleep, though for only shorter intervals due to their addictive properties (i.e., they cause dependence).  It is generally NOT recommended to use these medications as sleep aids, except in rare/extreme circumstances and never for more than a few nights in a row.

Finally, a category of medications known as “hypnotics” is approved specifically to treat insomnia.  These include Ambien, Lunesta, and Sonata.  These medications are effective for short-term use (2-6 weeks) to help with sleep initiation but are often not helpful in maintaining sleep through the night.  Common side effects are headaches, next morning grogginess (impaired cognitive and psychomotor functioning), and unusual sleep activities, including sleepwalking, sleep-driving, and sleep-eating!  These medications also are associated with tolerance, dependence, and rebound insomnia after cessation of use.

Others

Although understudied and illegal in most states (and in the view of the federal government), there are widespread anecdotal reports that marijuana (cannabis) helps people sleep and/or helps with the management of chronic pain.  Marijuana also has many other well-known side effects and health consequences, and smoking anything is detrimental to pulmonary and cardiovascular health.  CBD oil, a cannabis extract, is legal in most places and provides no “high.” There is some limited evidence though that it may help improve sleep, reduce anxiety, and reduce chronic pain.

About the author

Dr. Chris Frueh
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Christopher Frueh, Ph.D. is a clinical psychologist, Professor of Psychology at the University of Hawaii, and Clinical Professor of Psychiatry, University of Texas Health Science Center, Houston, TX. He has thirty years of professional experience working with military veterans and active-duty personnel and has conducted clinical trials, epidemiology, historical, and neuroscience research, primarily with combat veterans. He has co-authored over 300 scientific publications, including historical analysis of U.S. Army suicides dating back to 1819 and a current graduate textbook on adult psychopathology. Professionally, he has worked with combat veterans since 1991 and devotes much of his time to the military special operations community. He has also published commentaries in the National Review, Huffington Post, New York Times, Time, and Washington Post; and has been quoted in the Wall Street Journal, The Economist, Washington Post, Scientific American, Stars and Stripes, USA Today, Men’s Health, and Los Angeles Times, among others. Under the pen name Christopher Bartley, he has also published nine novels, including THEY DIE ALONE and most recently, A SEASON PAST.

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