When You Can't Sleep: How to Treat Insomnia | Everyday Health

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Before turning to medication, your doctor should rule out other possible health issues. Insomnia is often a side effect of an underlying issue, such as depression or an anxiety disorder, in which case an antidepressant might be more beneficial than a sleep aid.

Attarian says sleep apnea and medication side effects are also common culprits that can lead to insomnia.

In some cases, over-the-counter or prescription sleep medication can be helpful if used for a short period of time while you establish a healthier sleep routine and form good sleep habits. Ideally, once you do get into a routine, you can stop taking the medication and still continue to sleep well.

If medication is prescribed, take it for as little time as necessary — three months max — since it can be habit forming. And be sure to discuss the medication’s purpose and side effects with your doctor.

For example, some medicines may help you fall asleep but leave you dealing with grogginess in the morning. Others can cause complications, such as sleepwalking or sleep-driving. And some drugs have been found to increase mortality risk, regardless of preexisting conditions, according to research. Your doctor should discuss any previous, current, or potential mental health problems with you before prescribing a sleep aid, as some of these medications can heighten the risk of depression and suicide, according to a study published in the January 2017 American Journal of Psychiatry. Types of prescription sleep aids include, according to Stanford Medicine and the guidelines published in 2017 in the journal American Family Physician:

Sleep medicine researchers have pointed out that there’s not a lot of evidence comparing the effectiveness of various insomnia medications in a head-to-head way, according to a review published in the Lancet in July 2022. To try to answer this question, those researchers conducted a systematic review and network meta-analysis of existing data.

The researchers concluded that some of the drugs with highest efficacy and safety profiles did not have high-level data to support long-term use. Additionally, some drugs that had high-quality data to show they were safe did not necessarily have high-quality data showing they were effective. The researchers concluded that patients should discuss the risks and benefits of various drug options with their doctor before starting any.

Over-the-counter (OTC) sleep aids, in some cases, can help insomnia. Some include:

  • Melatonin This hormone naturally helps you regulate your sleep-wake cycle. Studies suggest it’s better at treating circadian rhythm issues (such as jet lag) than insomnia. “Melatonin is not an effective medication for everyday insomnia, and it’s not FDA-approved,” explains Attarian. He says melatonin may be helpful in very specific instances, where people might have jet lag or a delayed sleep/wake cycle due to shift work. “In those cases, careful timing of melatonin at very low doses can help,” he says, recommending a dosage of .5 milligram (mg) to 1 mg.
  • Diphenhydramine (Benadryl) Benadryl is an antihistamine that has a sedating effect. While the medicine may help you fall asleep at first, most experts warn that it shouldn’t be used regularly as a sleep aid. Studies over the years have shown people can develop a tolerance to antihistamines after taking them for just a short amount of time. The American Academy of Sleep Medicine doesn’t recommend antihistamines as an appropriate treatment for chronic insomnia. Side effects of antihistamines may include dry mouth, daytime drowsiness, constipation, and urinary retention. “Chronic use of this drug can also lead to dementia,” says Attarian. This has been well-established in research, he adds, so doctors and patients should avoid this as a long-term approach to treating insomnia.
  • Doxylamine (Unisom) Like Benadryl, Unisom is a sedating antihistamine. It can also lead to tolerance and causes similar risks and side effects.

“You should absolutely talk to your doctor before trying any type of over-the-counter medicine for insomnia,” says Attarian.


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