Most people sometimes have a night or two when they just can’t fall asleep, but if it becomes a recurring problem and it impacts your daytime routine, there are many sleep aids to consider. Sarah Clever, a general internal medicine doctor with Johns Hopkins Personalized Care, a concierge medicine practice, provides the following overview of options.

What kinds of sleep aids are available?

There are many sleep aid options, from nonmedicated methods to over-the-counter and prescription medication. They can be used to treat occasional sleeplessness or long-term sleep problems. Medicated options may come with side effects, risks and possible drug dependencies, so discuss your options with your doctor.

“Getting enough sleep is an important part of staying healthy,” says Clever. “Good sleep has positive effects on memory, blood pressure and immune regulation. Getting enough sleep can even help regulate appetite. With so many options to improve your sleep, it’s important to find relief that matches your need.”

A lack of sleep can cause a range of problems beyond fatigue, including:

• Trouble with mood
• Reduced concentration and shorter reaction times
• Higher risk for hypertension, diabetes, heart disease and dementia

When are sleep aids needed?

The type of sleep problem a person has helps determine if and when to use a sleep aid. It can also depend on personal preference — some people prefer to avoid medication if possible. Here’s in-depth information about options to find relief for different types of sleep trouble:

• Occasional trouble falling asleep or staying asleep
• Following good sleep habits, which is called sleep hygiene
• Using natural remedies, such as soothing teas and melatonin
• Taking over-the-counter sleep aids occasionally is OK, but always check with your doctor about side effects, possible drug interactions and risk for dependency
• Consistent trouble falling asleep and staying asleep
• Cognitive behavior therapy, which can focus on particular issues keeping you awake and teach you skills to help go to sleep
• Prescription sleep aids

Nonmedication Ways to Improve Sleep

Sleep Hygiene

Forming habits that help you fall to sleep is called sleep hygiene. Being consistent in these habits is important to get a good night’s sleep.

Good sleep habits include:

• Picking a time that you can reliably go to sleep — good mornings starts the night before, with a consistent bedtime
• No caffeine after noon
• No exercise an hour before bed — higher core body temperature interferes with sleep
• Keeping your bedroom temperature under 70 degrees — this is another way to maintain lower body temperature
• Avoiding falling asleep with the television or radio on — advertisements may be loud and disturb your sleep
• No screens for an hour before bedtime — the light from TVs, laptops and phones tells your brain it’s time to be awake (electronics use within an hour of bedtime can cause as much as an hour less of sleep)
• No clock by the bed — position your clock so you can’t easily check the time while you sleep
• Avoiding alcohol for at least three hours before bed —drinking alcohol before bed can lead to frequent awakenings and low-quality sleep (long-term alcohol use can lead to chronic sleep problems, including sleep apnea)

If you can’t fall asleep, or if you wake up in the middle of the night, try the following.

• Listen to a sleep or meditation app to help soothe you into sleep.
• Think about a favorite dream, before other thoughts can crowd in.
• If you are distracted by your thoughts, ask yourself, “Is this something I have to do right now?” If it is, then do it. If not, then tell yourself, “Now is the time for sleep.”
• If you’ve been awake for 30 minutes, get out of bed and read something boring. After 15 minutes, try to go back to sleep.

Read more about healthy sleep routines.

Natural Sleep Aids

There are many things in addition to practicing good sleep habits that you can do regarding short-term bouts of sleeplessness. Learn more about natural sleep aids, including melatonin.

Cognitive Behavior Therapy

During cognitive behavior therapy, a therapist helps you focus on the stressors that keep you up at night. Over the course of typically five to 10 visits, you work through how to calm your mind when those stressors occur. It takes practice, but these exercises will help you to fall asleep and stay asleep.

Over-the-Counter Sleep Aids

Even if you follow good sleep habits, you may have restless nights due to stress, travel or even anticipation of a happy event. Occasionally turning to a non-prescription sleep medication can help you get a better night’s sleep. However, it’s very important to be aware of possible side effects and risks, so consider these sleep aids only for short amounts of time and discuss them with your care practitioner.

Sleep Aids with Antihistamines: Diphenhydramine and Doxylamine Succinate

Diphenhydramine is a sedating antihistamine that is in a wide range of nonprescription sleep and allergy medicines. Doxylamine succinate is also a sedating antihistamine, and it is in many over-the-counter sleep aids. They both help make you sleepy by decreasing histamine levels in your brain, which is how the brain naturally helps you get ready for sleep.

When to use: Taken on occasion, such as after a stressful day or while having jet lag, both can help you fall asleep.

Side effects and risks: Diphenhydramine and doxylamine succinate are not recommended for regular use. If taken frequently, each medicine has risks and side effects, including the following.

• Increased dementia risk for older adults
• Diphenhydramine and doxylamine succinate both have anticholinergic properties, which impact the nervous system. In a 2018 case study, researchers found that taking anticholinergic medications increased the risk for dementia for up to 20 years after exposure.
• Other side effects include:
• Grogginess during the day
• Dry mouth
• Constipation
• Trouble emptying your bladder
• Blurred vision

Diphenhydramine and doxylamine succinate are not recommended for people who are:

• Age 65 or older
• Pregnant or breastfeeding

These antihistamine-based sleep aids are also not recommended if you have the following health conditions.

• Closed-angle glaucoma
• Peptic ulcer
• Urinary retention

Additional cautions include:

• Avoid alcohol if you take prescription sleep aids. The combination can increase the sedative effects.
• Do not drive or perform activities that require alertness until the medicine has worn off.
• If you take diphenhydramine for other indications, such as allergies, talk to your doctor about long-term use and possible alternatives.

Melatonin

The body produces melatonin to help control the sleep-wake cycle. Unlike antihistamines, a melatonin supplement doesn’t directly make you sleepy — it helps melatonin levels rise, which helps promote sleep.

When to use: Melatonin helps with occasional insomnia and to help fight jet lag. It’s most helpful if taken an hour before bedtime. It comes in short-acting and long-acting forms — long-acting forms may reduce the number of times people wake up after falling asleep.

Side effects and risks: You may experience nausea, headaches and daytime sleepiness. Some studies show that it may lower sperm counts in mice, so men being evaluated for infertility should talk to their doctor before using it.

Do not use melatonin if you:

• Are pregnant or breastfeeding
• Have an autoimmune disorder, a seizure disorder or depression

Read more about when and how to use melatonin.

Valerian

Valerian is an herb that has been used as a natural sleep aid for hundreds of years.

When to use: There is no clear indication of its benefits.

Side effects: These are mild and may include headache and weakness.

Additional Nonprescription Sleep Aids

Many supplements and vitamins may be associated with helping people fall asleep. However, before trying any of these, it is important to talk to your health care practitioner to be sure you understand possible side effects. In addition, because supplements and herbal remedies are not regulated in the U.S., it is important to identify a reputable manufacturer.

Prescription Sleep Aids

If good sleep habits and other sleep remedies are not working, discuss with your doctor options for prescription sleeping pills. Some are geared for occasional use, and others are for longer term use if you have insomnia or other conditions that consistently keep you awake. Be aware that these medications may come with side effects and risks including possible drug dependencies, so talking with your doctor before using them is important. Be sure to let your doctor know if you experience side effects.

Generic medicine names are listed below, but the medicines are also sold under brand names that you may know. The prescription bottle will list the generic medicine name as well as the brand name.

Daridorecant

• Helps with falling asleep
• Helps with staying asleep
• Has potential for dependence

Doxepin

• Helps with staying asleep

Eszopiclone

• Helps with falling asleep
• Helps with staying asleep
• Has potential for dependence

Lemborexant

• Helps with falling asleep
• Helps with staying asleep
• Has potential for dependence

Ramelteon

• Helps with falling asleep

Suvorexant

• Helps with falling asleep
• Helps with staying asleep
• Has potential for dependence

Temazepam

• Helps with falling asleep
• Helps with staying asleep
• Has potential for dependence

Triazolam

• Helps with falling asleep
• Has potential for dependence

Zalepon

• Helps with falling asleep
• Has potential for dependence

Zolpidem, Zolpidem Extended Release

• Helps with falling asleep
• Helps with staying asleep
• Has potential for dependence

Prescription Sleep Aid Side Effects

Talk to your doctor if you experience side effects from sleep aids. Side effects may include:

• Dizziness or lightheadedness, which could lead to a fall
• Nausea or diarrhea
• Prolonged drowsiness
• Severe allergic reaction
• Dangerous sleep-related behaviors, such as driving or eating when not fully awake
• Hallucinations, agitation, memory issues, suicidal thoughts, bizarre behavior
• Daytime memory and task issues

Antidepressant Medicines with a Sedating Effect

Some medicines used to treat depression, when taken at low doses, also bring more consistent sleep. While not approved by the Food and Drug Administration for insomnia, these medicines may be used to ease insomnia that is related to depression or anxiety. There are many types of these medicines, and they may have generic or brand names. These medicines include:

• Amitriptyline
• Mirtazapine
• Trazodone

Side Effects of Antidepressant Medicines

As with prescription sleep aids, antidepressants that have a sedating effect also come with side effects. These may include:

• Dizziness
• Headache
• Prolonged drowsiness
• Dry mouth
• Lightheadedness
• Nausea
• Irregular heartbeat
• Weight change
• Memory and performance problems
• Constipation
• Diarrhea
• Suicidal thoughts

Safe Use of Prescription Sleep Aids

In addition to working with your doctor to find a sleep aid that is appropriate for the issues you are experiencing, there are routine precautions to keep in mind for your safety and the safety of others:

• Talk to your doctor and read medication materials so you understand side effects and risks.
• Only take a sleeping pill as directed.
• For example, don’t take a pill earlier in the day. It will make you drowsy and unable to continue your activities.
• Only take medication when you can get a full night’s sleep. Most prescriptions are intended to make you sleep for seven to eight hours, so if you wake at 2 a.m., do not take the medicine unless it is specifically prescribed for use in the middle of the night.
• Allow yourself time to adjust to new medication. Don’t take a new sleeping pill the night before a big presentation, since you don’t know if side effects may impact your behavior.
• Do not mix alcohol or opioids with sleep medication.
• Alcohol increases the sleep effects of the medication, and the combination can lead to dizziness, confusion, fainting and, depending on the type of medicine, dangerously slowed breathing or unresponsiveness. Alcohol can also cause insomnia.
• Combining opioids and prescription sleep aids increases the medicine’s sleep effects, which can lead to slowed breathing, unresponsiveness or no breathing.

Most prescription sleep aids are not intended for long-term use. It is important to evaluate their efficacy with your doctor on a regular basis.

• If you decide to stop taking the medicine, discuss with your doctor before doing so. For some medicines, use needs to be decreased slowly.
• As you get older, your body may respond to medicines differently. Reviewing all medications regularly with your doctor helps you use them appropriately.

“Remember: Good sleep is an important part of your overall health, and your doctor or health care provider is there to help,” says Clever. “Be sure to talk to them about your options and to review possible side effects and risks. If sleep troubles persist, you can also consider consulting with a sleep specialist.”