Everything You Need to Know About Sleep Meds
Consider this your complete guide to the drugs that claim to help you get more sleep
When you just can’t fall asleep—or stay asleep—you’ll do nearly anything to long some quality shuteye.
But how smart is taking sleep medication? How dangerous are the drugs, really? What makes the difference between being a fully functioning human and a zombie? Who are which pills best for?
Here’s what you need to know.
Sleep Drug: Antihistamines
WHAT ANTIHISTAMINES ARE
Antihistamines, the sleep meds men often reach for first—say, for example, Vicks NyQuil (doxylamine succinate), Benadryl/Tylenol PM/Excedrin PM/Vicks ZzzQuil (diphenhydramine).
WHAT ANTIHISTAMINES DO
Block histamines by binding to the histamine receptors in your brain. Histamines are the compounds that bring allergy-season misery.
They’re also among the main wakefulness-promoting neurochemicals in the brain, says Daniel Buysse, M.D.
Related: Is Your Allergy Medicine Draining Your Gains At the Gym?
SHOULD YOU TAKE ANTIHISTAMINES?
Their half-life—the time needed for half the drug to clear your system—is eight or more hours. So you may feel groggy in the a.m.
Animal studies suggest that antihistamines block deep REM sleep, but how that translates to human sleep function is unknown.
Tolerance can develop quickly, so limit use to a few days. And skip ‘em if you have prostate problems: They can make peeing more difficult.
Sleep Drug: Melatonin
WHAT MELATONIN IS
A hormone made by your brain that sets your internal clock by regulating your day and night cycle. It can be purchased over-the-counter as a sleep aid supplement.
WHAT MELATONIN DOES
Some people say melatonin helps them fall asleep, but many find it ineffective. It may be useful for jet lag or shift-work scenarios.
It’s not a sedative per se, and the body produces it naturally; so unless your internal clock is messed up or your body is not producing enough, adding more isn’t likely to slide you into dreamland any faster.
SHOULD YOU TAKE MELATONIN?
The downsides are few; it’s relatively safe compared with other sleep aids.
Related: Should You Take Melatonin to Fall Asleep?
Start with 1 to 3 milligrams a few hours before bedtime and take a higher dose if needed, but don’t go over 6 milligrams. Higher amounts may start to overwhelm your brain’s natural melatonin production and could worsen sleep troubles.
Sleep Drug: Ambien (zolpidem)
WHAT AMBIEN IS
A non-benzodiazepine GABAA receptor agonist, or Z-drug.
WHAT AMBIEN DOES
Z-drugs (eszopiclone, zaleplon, zolpidem) bind to brain receptors to activate gamma-aminobutyric acid (GABA) type A, a chemical that dials back neural activity.
Translation: The drug chills you out.
If you tend to wake up in the night, an extended-release Ambien provides you with a quick dose at bedtime and then slowly releases more to keep you asleep.
SHOULD YOU TAKE AMBIEN?
Can you stay in bed for eight hours? If you can’t, you risk the downsides of a GABA boost—like problems with memory, balance, and reaction times.
Studies find that the use of hypnotics such as Ambien nearly double the risk of car crashes in new users.
But the weirder effects “are rare enough that you can’t study them carefully in a lab,” Dr. Buysse says.
Related: Gambling Addictions, Purple Sweat, Driving While Asleep—the Scary Side Effects Of Popular Meds
Sleep Drug: Sonata (zaleplon)
WHAT SONATA IS
A Z-drug with a short half-life—about one hour instead of Ambien’s two to three hours.
WHAT SONATA DOES
Z-drugs were an improvement over older sleep drugs like Valium because they have shorter half-lives and don’t significantly disturb sleep stages.
They’re designed to knock you out and clear your system by morning.
And Sonata is out of your system especially fast, so it’s less likely to cause problems like next-day amnesia. It has few if any residual effects.
SHOULD YOU TAKE SONATA?
If falling asleep is your problem, Sonata is a good option.
Related: 7 Sleep Doctors Reveal What They Do When They Need to Fall Asleep Fast
But it clears your system so fast it may not help much if you also wake in the middle of the night. Some docs say this may be a drug of choice if, for whatever reason, you plan to get up before you’ve logged seven or eight hours.
But be careful: While it’s in your system, it can have the same side effects as Ambien.
Sleep Drug: Lunesta (eszopiclone)
WHAT LUNESTA IS
A Z-drug with a long half-life—about six hours.
WHAT LUNESTA DOES
Lunesta works the same way other Z-drugs do, but its longer action increases the likelihood that the drug’s effects will spill into daytime life.
One study found that a 3-milligram dose impaired driving, memory, and coordination for as long as 11 hours—but patients often didn’t believe anything was amiss.
Related: 6 Easy Things You Can Do to Protect Your Memory Today
SHOULD YOU TAKE LUNESTA?
Sleep docs consider Lunesta attractive for people who have trouble staying (rather than falling) asleep, though it can help with both.
But there are other long-acting options, including extended-release Ambien, and whether you take Lunesta may depend on factors such as other meds you’re taking.
And for what it’s worth, some people ditch the drug simply because it can leave a bitter, metallic taste in the mouth.
Sleep Drug: Silenor (doxepin)
WHAT SILENOR IS
A low-dose tricyclic antidepressant drug. In high doses (up to 300 milligrams), doxepin is an antidepressant, but low doses (3 to 6 milligrams) can help with sleep.
WHAT SILENOR DOES
Doxepin binds to histamine receptors in the brain, so it acts more as an antihistamine than a mood drug.
Related: Road Rage, Daydreaming, and 7 Other Strange Predictors Of Depression
But it’s still a hypnotic medication, so there’s the risk of nighttime sleepwalking,-driving,-eating, and-sex without remembering it, especially if you pair it with alcohol or other drugs.
SHOULD YOU TAKE SILENOR?
With a half-life of 15 hours, Silenor is long-lasting. It’s designed to help you stay asleep for up to seven hours.
It’s less likely to leave you groggy in the morning (possibly because a natural rise in histamine early in the morning counteracts the drug), and there’s no evidence that it’s habit forming—a selling point for people concerned about addiction.
Richard Laliberte is an award-winning veteran health journalist and former senior writer at Men's Health who writes for some of the nation's best-known magazines, blogs for WeightWatchers.com, and has authored several books.
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