The stress of the pandemic may left one tossing and turning at bedtime, frequently awakening. In a 2021 systematic review, researchers reported that 36 percent of people in the U.S. and 12 other countries have experienced sleep problems during the pandemic, and, according to a 2021 report from the American Psychological Association, 32 percent of U.S. adults reported changes in sleeping habits because of pandemic stress.
Many people with insomnia turn to sleep aids. Good initial selections are older over-the-counter antihistamines — drugs sold under the brand names Benadryl, Sominex and ZzzQuil, which could offer regular relief. Another non-prescription choice is melatonin, a hormone that regulates the body’s sleep cycle. Recently, however, the safety of melatonin has been questioned, especially in children, so I would avoid it until more information is made available. Even though the efficacy of these older antihistamine drugs is minor and controversial, because of their good safety record, they are worth an initial try. The newer antihistamines such as Allegra and Zyrtec do not cause enough drowsiness to be of use for sleep. Beyond these observations, the world of sleep aids becomes more complex and potentially dangerous.
The first thing to know is that not all sleep medications are the same. The myth is, “It doesn’t matter which one you choose, they all work the same way, they all do the same thing.” No, they don’t. Some drugs, like zaleplon (Sonata), decrease the amount of time it takes to fall asleep; while others, such as suvorexant (Belsomra), block signals in the brain that cause you to wake up. The hormone melatonin (noted above), as well as prescription drugs like ramelteon (Rozerem) act on melatonin receptors, which help regulate the body’s internal clock but they don’t necessarily help you stay asleep.
The best drug to take, if necessary, will largely depend on what causes the insomnia. It really is about choosing the right medication for the individual. If your problem is that you can’t fall asleep at bedtime, then a drug that prevents you from waking in the middle of the night may not help. If you fall asleep easily but can’t sleep toward the end of the night, then drugs that wear off within a few hours, like zaleplon (Sonata), aren’t going to do you much good, either.
Many people, too, have sleeping problems that won’t be resolved with any sleeping pill. One such condition is “sleep apnea,” which afflicts 22 million, usually overweight, people in the United States and causes frequent wake-ups, associated with heavy snoring. Best diagnosed by a pulmonary specialist, sleep apnea is best managed with a machine that provides continuous positive airway pressure (CPAP), not with medication.
Sleep aids can also have side effects, some of them serious. A 2017 study found that, when compared with older adults who did not take sleeping medications, those who took prescribed sleep aids of any kind recommended by their doctor were 34 percent more likely to suffer a fall, perhaps because the drugs affected their balance or incited clumsiness. Another study found that people who had recently, for the first time, been prescribed sleep medications such as temazepam, trazodone or zolpidem (Ambien) were 90 percent more likely to be involved in car crashes, and that their increased risk was comparable to that of driving drunk. Some research even suggests that the long-term use of hypnotic drugs such as nordazepam, clonazepam (Klonopin), flurazepam (Dalmane) and zolpidem (Ambien) can more than double the risk of dementia.
Some sleeping pills can also cause physical dependence — a condition where people need higher doses over time to get the same effect, or when they stop taking the medication and experience withdrawal Dependence is possible with zolpidem (Ambien), zopiclone (Imovane) and zaleplon (Sonata), and even more likely with benzodiazepine pills like flurazepam (Dalmane), temazepam (Restoril), quazepam (Doral) and triazolam (Halcion). Perhaps most commonly, people can also experience a psychological form of dependence with many sleeping pills, making them feel unable to sleep without the medication.
Zolpidem (Ambien), in particular, has earned an unsavory reputation for its bizarre ability to cause people to drive or eat while half asleep. Zolpidem can also cause next-day drowsiness, especially among women and older adults, whose bodies slowly break down the drug, possibly because they have lower levels of the hormone testosterone, which plays a role in metabolizing the drug. Consequently, recommended doses of zolpidem for people over 65 have always been lower than for younger adults, and in 2013, the Food and Drug Administration began requiring zolpidem manufacturers to lower its recommended doses for women, too. Nevertheless, in 2018, researchers used survey data to show that about two-thirds of people over 65 were still taking the higher doses.
If necessary, one needs to take the right medication for the circumstances. For best results, talk to your primary care physician or a sleep specialist to get a more tailored recommendation. And remember that as with any medication, they do pose risks.
There are also drug-free alternatives that might even work better for anyone. Cognitive behavioral therapy, which can help people develop better sleeping habits, is widely considered the most effective treatment for chronic insomnia. Even small lifestyle changes can help as well, such as going to bed at the same time each night, maximizing darkness and quiet, putting electronics away well before bedtime, avoiding food coffee and alcohol shortly before bedtime, and not looking at the clock in the middle of the night.
My best advice: Stay away from all medications, but as a last resort, use the mildest form such as an antihistamine, and take any of them only as a temporary aid.