Trouble Sleeping? What to Know Before Trying Medication
Oct 29, 2021 Victoria Pelham
Few things in life are as frustrating as lying in bed in the middle of the night with the clock ticking as you toss, turn and count sheep to no avail.
Sleep struggles often get worse during stressful periods, when worries keep your mind racing, and they're a growing problem. Amid the prolonged uncertainty of the COVID-19 pandemic, more than half—56%—of adults surveyed by the American Academy of Sleep Medicine (AASM) experienced sleep disturbances, including trouble falling or staying asleep, concerning dreams and less and worse quality sleep at night.
Sleep is crucial to physical and mental health, explains Cedars-Sinai pulmonologist Dr. Oragun Rojanapairat, because it allows you to regulate your emotions. On the flip side, insomnia and sleep deprivation increase risk of depression, substance abuse and anxiety, as well as behavioral problems such as aggression and mood swings.
Sleep can also effect energy, memory and concentration. And it's a revolving door, where getting too little sleep can make rest even harder to come by.
"Sleep can also effect energy, memory and concentration. And it's a revolving door, where getting too little sleep can make rest even harder to come by."
To cope with "COVID-somnia," many are turning to medication: The AASM found 51% of survey participants reported using sleep aids during the pandemic, while 68% of those who relied on them to fall asleep had been using them more frequently.
"People are desperate for sleep," says Dr. Rojanapairat, who has seen an influx of patients with insomnia at her recently opened sleep clinic.
She shares what to keep in mind when trying to treat insomnia.
Sleeping pills aren't a silver bullet
While medication can be a helpful part of improving your sleep, sleep experts emphasize that each case is different—and there is no one-size-fits-all solution. Talk to your medical provider before taking sleeping aids or natural supplements, including melatonin, AASM suggests, as they can help you weigh your options and determine whether and how to use any medication.
Exercise caution, and always take sleep aids with the guidance of your doctor.
Medication should be just one part of a larger strategy to address insomnia and works best when paired with behavioral changes, AASM stresses.
Practice sleep hygiene
COVID-19 disrupted schedules across the board, which accounts for some of the rise in sleep challenges, Dr. Rojanapairat points out.
Routine vastly influences your body's ability to rest and reset. Consistently going to bed and waking up at the same time every day balances circadian rhythms and can go a long way toward getting a better night's sleep.
Daily exposure to sunlight reinforces those patterns.
Experts also recommend taking time to unwind before bed, device-free, getting out of your bed if you're unable to sleep and avoiding caffeine and alcohol late in the day.
Over-the-counter remedies can provide short-term relief
The market for melatonin grew exponentially in 2020.
Melatonin is a naturally occurring hormone that controls the sleep-wake cycle. It can speed up the time it takes you to fall asleep, Dr. Rojanapairat notes.
Is it safe? Yes, temporarily. She suggests trying a low dose, between 1 and 5 milligrams, and taking it 30 minutes before bedtime.
A smaller dose of .5 milligrams can also be helpful for adjusting circadian rhythm disorders such as jet lag or shift work, as well as advanced- and delayed-phase sleep disorders (when your internal body clock is naturally ahead or behind, creating larks and night owls), Dr. Rojanapairat adds.
If you're groggy the next day after taking melatonin, your dose is probably too high.
Over-the-counter antihistamines including diphenhydramine (Benadryl) and doxylamine can also give you a break when you just can't get any shut-eye. Use these just once or occasionally as needed, Dr. Rojanapairat cautions, and limit them to the recommended dosage of 50 milligrams.
Higher doses can cause side effects such as daytime drowsiness, dry mouth, constipation and urinary retention.
Melatonin isn't intended to treat chronic insomnia
While over-the-counter treatments "can help from time to time," says Dr. Rojanapairat, they're not approved by the Food and Drug Administration (FDA) to treat chronic insomnia, which occurs more than three times a week for at least three months.
"What can happen is when you use melatonin or any over-the-counter medication on a regular basis, they lose their effectiveness," she says.
People often then ramp up the dosage trying to get more sleep, but that just increases side effects, such as next-day sleepiness and headaches.
Also, be aware that these supplements aren't FDA-regulated and may contain less melatonin content than what's found on the label.
Seek professional help
Try sleep aids in combination with sleep hygiene changes for about a week or two, she suggests. If you're still unable to sleep well through the night, it's time to seek out a doctor or sleep specialist.
They can diagnose you with a sleep disorder and offer additional treatment options.
These include different classes of stronger prescription medications including benzodiazepines such as temazepam (Restoril) and triazolam (Halcion), benzodiazepine receptor agonists ("Z" drugs such as Ambien, Lunesta and Sonata), orexin receptor antagonist (Belsomra), melatonin receptor agonists and antidepressants.
Watch out for side effects
As with all prescriptions, your personal medical histories can help your doctor determine which ones would be safest for you.
Benzodiazepines are used to help with short-term insomnia, as there is a high risk of abuse and dependence with long-term use. Others such as "Z" drugs can cause daytime sleepiness and parasomnias.
And many of these also carry the risk of rebound insomnia, sleep disturbances that get worse when going off medications.
These treatments improve sleep quality and help people fall asleep faster. But if you have tried several and they don't seem to be working, Dr. Rojanapairat suggests consulting a sleep physician to see if you might have an underlying sleep problem such as sleep apnea.
The AASM recommends cognitive behavioral therapy for insomnia (CBT-I), which is more effective and longer-lasting than simply taking sleeping aids. It also includes education about your body's sleep cycles and typically lasts four to eight sessions.
Medicinal sleep aids should supplement therapy or be used by those who can't access it or for whom insomnia symptoms have continued.
"Medication alone is not the best way," Dr. Rojanapairat says.