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In bedrooms everywhere, the struggle to fall asleep – and get enough of it – is a common problem. Even when you feel tired and you’re in a quiet, comfortable environment, insomnia can affect anyone and disrupt daily routines and productivity at work.
Whether it’s trouble falling asleep, staying asleep or getting enough good quality sleep, insomnia is a common health issue. An estimated 14.5% of U.S. adults have trouble falling asleep during the month, according to an E-Health Project report.
Trouble falling asleep or staying asleep does not necessarily mean you have a sleep disorder, but when it persists and lasts longer than three months, you may be experiencing a form of insomnia. There are two main types of insomnia:
- Short-term (acute) insomnia.
- Chronic insomnia.
Short-term insomnia can last for a few days or up to three months and is often connected to stressful situations. This type of insomnia usually passes without the need to see a doctor and can often be alleviated with lifestyle modifications or over-the-counter medications.
“As long as the acute stressor is going to go away or has gone away, short-term insomnia does not typically need treatment, whether over-the-counter or prescription medicine,” says Dr. Abhinav Singh, a medical review expert at the Sleep Foundation and medical director of the Indiana Sleep Center in Greenwood, Indiana.
Chronic insomnia is persistent sleepless nights that occur at least three times each week, lasting for at least three months.
Some common situations that may cause insomnia are:
- Stress.
- Overnight work shifts.
- Other sleep disorders, such as sleep apnea or restless legs syndrome (an uncontrollable urge to move your legs).
- Medical conditions, such as pain, depression, menopause and perimenopause.
- Environmental factors, such as noise, light and extreme temperatures.
Those with chronic insomnia may benefit from treatment, which could include behavioral and psychological interventions with a therapist or medications to help fall – and stay – asleep. For those who require treatment, available prescription and OTC medications can help.
When falling asleep becomes a persistent problem, there are several OTC medications to try before you go to bed. While there are several natural sleep aids available that include melatonin and magnesium, OTC sleep medications contain some form of antihistamine, including diphenhydramine and doxylamine.
- Diphenhydramine: This antihistamine medication is commonly used to treat allergies, hay fever and the common cold. It works by blocking the action of histamine, a substance in the body that causes allergic symptoms. In addition to its antihistamine properties, diphenhydramine also has sedative effects, which makes it useful for treating insomnia.
- Doxylamine: This is a sedating antihistamine medication used to manage and treat insomnia, as well as nausea and vomiting of pregnancy and allergic rhinitis. Belonging to the first-generation histamine receptor H1 antagonist category, it is available as an OTC remedy.
There are several sleep aids to choose from at your local pharmacy. Such popular brands include:
- Nytol: This OTC sleep aid typically contains diphenhydramine as the active ingredient, which is known for its sedative effect.
- Sominex: Another OTC brand containing diphenhydramine to relieve temporary sleep disturbances. Sominex is available in several forms, including tablets and caplets.
- Tylenol Simply Sleep: Simply Sleep contains a single ingredient diphenhydramine to relieve occasional sleeplessness.
- Unisom: Available in various formulations, Unisom contains diphenhydramine or doxylamine succinate that contain sedative properties. Unisom is available in tablets, minis and gel caps.
- Vicks ZzzQuill: Available in liquid and tablet form, ZzzQuil contains diphenhydramine to help you fall asleep. The brand also offers ZzzQuil Night Pain for pain relief, which contains a combination of diphenhydramine and acetaminophen, and ZzzQuil Ultra, which contains doxylamine succinate as the active ingredient.
Many brands, including Unisom and Vicks ZzzQuil, that manufacture medicinal sleep aids with diphenhydramine or doxylamine also sell sleep supplements using melatonin, a hormone often referred to as the “sleep hormone” that is naturally produced in the brain to regulate the sleep-wake cycle.
Common signs and symptoms of insomnia include:
- Anxiety or worry about sleeping.
- Daytime fatigue.
- Dependence on sleep aids.
- Difficulty falling asleep.
- Feeling unrefreshed in the morning.
- Difficulty staying asleep throughout the night.
- Impaired work performance.
- Waking up early in the morning or frequently at night.
Insomnia can lead to sleep problems at night and daytime symptoms that can have a serious impact on daily functioning at home and work. A 2019 study published in the Journal of Occupational Health Psychology showed that insomnia led to increased risk of workplace injuries. Previous studies have reported that insomnia consistently reduced safety and productivity at the workplace, increased levels of sickness, absence from the workplace, hindered career advancement and reduced job satisfaction among employees. In most cases, people with insomnia report a worse overall quality of life.
There are several different approaches to treating short-term insomnia and chronic insomnia. Short-term insomnia is often triggered by stress; once that resolves, sleep returns to normal. Short-term insomnia is typically managed with OTC sleep aids.
"Chronic insomnia disrupts normal sleep patterns for an extended period of time," says Dr. Russell Rosenberg, founder and director of the Atlanta School of Sleep Medicine and Technology and chief science officer at NeuroTrials Research.
When insomnia lasts for more than three months, doctors may prescribe prescription sleep aids that fall into these main classes of sleep medications:
- Sedatives.
- Anticonvulsants.
- Antidepressants.
- Melatonin agonists.
- Orexin receptor antagonists.
Sleep aids that contain antihistamines often cause daytime drowsiness. Antihistamines may cause:
- Dizziness.
- Constipation.
- Upset stomach.
- Blurred vision.
- Dry mouth.
"Medications come with side effects, so it's important to discuss any reactions with your doctor," Rosenberg says.
When taking medications, precautions should be taken. Always consult your doctor or pharmacist before starting a new medicine, make sure to read and understand the packaging and product information before consuming and take your medication exactly as prescribed.
OTC sleep aids are generally safe when used as instructed, but they can be misused over time. Your body may develop a tolerance to certain sleeping medications and may not be able to fall asleep without the help of these agents.
Mixing sleeping medications with alcohol is never recommended, as alcohol may increase the sedative effects of sleep agents and potentially increase the risk of overdose. Alcohol also disrupts sleeping patterns, so you should avoid alcohol around bedtime.
Avoid combining prescription and OTC sleep medications. If your current medication is not working, talk to your doctor about other options.
Women who are pregnant or breastfeeding should talk to their doctor before starting any sleep medications to ensure safety for unborn babies and newborns.
People with certain medical conditions, particularly liver or kidney disease, should talk to their doctor before trying sleep medications.
Natural remedies may help improve sleep patterns. Talk to your doctor about whether you should try natural treatments in place of OTC medications or in combination with them. These may include:
- Chamomile tea. This popular decaffeinated tea contains an antioxidant, called apigenin, that has been shown to be mildly sedating.
- Magnesium. Magnesium plays an important role in brain function and may relax the mind and body to help initiate sleep. Magnesium has been shown to regulate the production of melatonin, a hormone that guides the body's sleep-wake cycle, as well as other chemicals related to relaxation.
- Melatonin. Melatonin's ability to improve the sleep-wake cycle is well-known. As a result, dietary supplements with melatonin have been used to treat various circadian rhythm sleep disorders, such as advanced and delayed sleep phase disorders, jet lag and shift work disorder.
- Tart cherry juice. Tart cherry juice contains tryptophan and melatonin. As a result, consuming tart cherries may help people stay asleep longer.
- Valerian root. Valerian root is sold as an OTC sleep aid and has a proposed mechanism to increase chemicals that promote relaxation, although it hasn't been well-studied for treating insomnia. Some people who use high doses or use it long term may suffer from liver damage, so talk with your doctor first.
Start by reducing stress and trying to improve your sleep habits, like avoiding screen time before bed. Adopting good sleep habits can help achieve more restful sleep.
If your sleep troubles last longer than three months, you may have chronic insomnia. This means it's time to see your doctor. He or she will try to determine the reason you're not getting a good night's rest and develop a treatment plan that's right for you.
Your primary care provider is a good place to start. If the sleep disorder worsens, consider making an appointment with a board-certified sleep specialist who is specially trained to diagnose and treat sleep disorders.
