According to Gallup's most recent state of sleep report, ⅓ of American adults describe their sleep as ranging from "poor" to "fair." That's about 84 million adults across the U.S. who struggle to consistently get deep, restorative sleep.¹ And with the massive impact sleep has on everything from daily performance to our relationships to long-term health — it makes sense why many of us opt for sleeping pills as a "surefire" way to hit our sleep goals.

The problem: A lot of sleeping drugs aren't as "surefire" as you might think...

➤ Some help you fall asleep faster, but only by a few minutes.

➤ Others suppress slow-wave deep sleep, limiting sleep's therapeutic effects.

➤ They come with a long line-up of potential side effects, including increased risk for dementia.

Here's what we'll cover:

• A brief history of modern sleep medications
• The current state of sleeping pill use in the U.S.
• Deep dive into the 3 most prescribed sleep medications
• Benzodiazepines [flurazepam, temazepam (Restoril), triazolam (Halcion), estazolam]
• Sedative Hypnotics [“Z-drugs”: zaleplon (Sonata), zolpidem (Ambien), zopiclone (Imovane), eszopiclone (Lunesta)]
• Antidepressants [trazodone, doxepin]
• Somnee vs. sleeping medications

A Brief History of Modern Prescription Sleep Medications

While humans have sought sleep aids for hundreds of years, modern sleeping medicines only date back to the mid-nineteenth century, starting with the development of chloral hydrate.²

By the early 1900s, glutethimide, methaqualone, and a new class of medications called barbituates gained ground as the "safest" sleeping medications available. In the decades following, experts noted problematic side effects like less effectiveness over time, risk of dependence, dangerous withdrawals, respiratory suppression, and toxicity at low overdoses.²

In the 1950s, benzodiazepines became the shiny new "safe" alternative to barbiturates. Then, their side effects began worrying experts, leading to a new class of "safer" prescription sleep aids in the 1980s called non-benzodiazepine hypnotic sedatives, or "Z-drugs." But in 2019, the FDA placed a Black Box Warning on Z-drugs based on their link with complex sleep behaviors (like sleepwalking), which have resulted in serious injuries and death.^2,3

Antidepressants like trazodone also emerged in the 1980s as possible treatments for insomnia. Since then, several other medications (ramelteon, suvorexant, and doxepin) have garnered attention as the next-gen of "safer" drugs for sleep.²

There's a clear pattern when it comes to sleeping medications. Each new generation of drugs is spurred on by a desire to create a safer version than the last. Only with time do the more subtle but significant long-term side effects of sleeping pills become more noticeable. 

Where are we today with sleeping medications in the U.S.?

Today, the most commonly prescribed medications include:

• Benzodiazepines
• Flurazepam
• Temazepam (Restoril)
• Triazolam (Halcion)
• Estazolam
  
  
• Sedative hypnotics (“Z-drugs”)
• Zaleplon (Sonata)
• Zolpidem (Ambien)
• Zopiclone (Imovane)
• Eszopiclone (Lunesta)

• Antidepressants
• Trazodone
• Doxepin

Statistics on sleeping pill use in recent years:

➤ Between 1993 and 2010, prescription of benzodiazepines increased by 69% ⁴

➤ From 1993 to 2010, use of sedative-hypnotics increased by 140% ⁴

➤ Across 386,457 ambulatory care visits between 2003 and 2015, 7.4% ended with a prescription for benzodiazepines. ⁵

➤ Data from 29,400 people from a National Health and Nutrition Examination Survey (2013–2018) found that prescription sleeping pill use decreased by 31%. Researchers suggest this may have resulted from increased awareness campaigns about sleep medication side effects. ⁶

➤ Now, the National Center for Health Statistics reports that about 18% of adults in the U.S use sleep medication. ⁷

If sleeping pills were side effect-free and didn’t work by essentially knocking out certain parts of your brain — these ebbs and flows in usage wouldn't matter. But that's the problem. Most of today's most popular sleeping medications come with a range of known and little-known common side effects ranging from mild to downright dangerous.

For example, estimates suggest as many as 80% of people who take sleep drugs experience a "hangover" effect the next morning. This daytime sleepiness can persist throughout the day, making it hard to think clearly and impacting your ability to work, drive, and function. ⁸

^{With that context, let’s deep dive into the 3 types of sleeping medications most used today.}

#1 Benzodiazepines

First approved by FDA: chlordiazepoxide (Librium) (1960)

Benzodiazepines commonly prescribed for sleep:

• Flurazepam (Dolman) 
• Temazepam (Restoril)
• Triazolam (Halcion)
• Estazolam
• Quazepam

How they work: Benzodiazepines suppress central nervous system (CNS) activity, cultivating feelings of calm. Specifically, they bind to receptors for GABA (gabba aminobutyric acid), which encourages more GABA to bind and suppresses CNS activity, making people feel more relaxed.

Commonly prescribed for: Anxiety and sleep disorders

*Other benzodiazepines approved by the FDA for anxiety (like Lorazepam, Clonazepam, and Alprazolam) are also prescribed for insomnia.

Short-term side effects: ⁹

• Tremors
• Drowsiness
• Headaches
• Diarrhea
• Digestive issues
• Nausea and vomiting
• Feelings of mental confusion
• Respiratory depression (shallow breathing)
• Respiratory arrest (breathing stops)

Added risks: ^6,11

• Impairment of memory
• High potential for abuse
• High potential for dependency
• Increased incidence of dementia
• Higher risk of motor vehicle accidents
• Heightened risk of falls and fractures in older adults
• Rebound insomnia (significantly worse insomnia symptoms that persist for several days)

Research facts you ought to know:

➤ When compared to a group receiving a placebo, one study found that benzodiazepines only reduced the time to fall asleep by 4.2 minutes. ¹²

➤ Studies have found benzodiazepines can increase total sleep time by as much as an hour. However, research has also found they impair deep, slow-wave stage 3 sleep. ^12,13

➤ Benzodiazepines suppress REM sleep (critical for dreaming, memory consolidation, emotional processing, and more). ¹⁴

#2 Sedative hypnotics / “Z-drugs”

First approved by FDA: Zopiclone (Imovane) (1989)

Z-drugs commonly prescribed for sleep:

• Zaleplon (Sonata)
• Zolpidem (Ambien)
• Zopiclone (Imovane)
• Eszopiclone (Lunesta)

How they work: Z-drugs work similarly to benzodiazepines in that they also bind to GABA receptors in ways that encourage GABA to bind and suppress CNS activity. Z-drugs just do it more selectively, binding to specific subsets of GABA receptors.

Commonly prescribed for: Insomnia and sleep conditions

*General guidelines include only taking Z-drugs short-term, for no more than 4 weeks at a time, and not using them more than 3 days a week.

Short-term side effects: ¹⁵

• Vertigo
• Nausea
• Drowsiness
• Double vision
• Slurred speech 
• Loss of balance
• Slowed reflexes
• Mental confusion
• Memory impairment
• Parasomnia (sleepwalking, sleep driving)
• Lightheadedness and dizziness
• Loss of muscle coordination (ataxia)

Added risks: ^11,15,16,17

• Impairment of memory
• Intense withdrawal symptoms
• Increased incidence of dementia
• Respiratory depression and failure
• May promote storage of specifically more negative memories
• Moderate risk for developing a tolerance and requiring higher doses

*Ambien is only intended to be taken for 7 to 10 days. If you've been taking Ambien longer, you may experience withdrawal.

Withdrawal symptoms: ¹⁵

• Tremors
• Sweating
• Low mood
• Convulsions
• Panic attacks
• Rebound insomnia
• Increased anxiety and restlessness
• Stomach and muscle cramps

Research facts you ought to know:

➤ Randomized controlled trials found that Z-drugs decreased the time to fall asleep by about 20 minutes. ¹⁸

➤  However, a meta-analysis of 45 studies and over 2,000 people found that zopiclone didn't offer more benefits than benzodiazepines for sleep. ¹²

➤ As mentioned earlier, the FDA placed a Black Box Warning on several Z-drugs to caution users about the risk of complex sleep behaviors. The FDA notes that serious and fatal injuries have occurred "even at the lowest recommended doses" and "after just one dose." ³

➤ Cases of complex sleep behaviors by the FDA included: ³

• Falls
• Burns
• Hypothermia
• Accidental overdoses
• Carbon monoxide poisoning
• Driving while asleep and car accidents

➤ Experts are divided on the tolerance-building effects of Z-drugs, with several studies failing to find that tolerance developed within 4 weeks of use, while a few studies have indicated otherwise. As with previous sleep medications, these effects will likely be revealed over time. ¹⁹

➤ After stopping use, insomnia symptoms often come back within 2-3 weeks. ¹⁹

 #3 Antidepressants

FDA approval: The FDA has only approved doxepin (tricyclic antidepressant) for insomnia. All other antidepressants haven't been approved for insomnia without depression by the FDA due to a lack of evidence of benefits.

Antidepressants commonly prescribed for sleep:

• Trazodone
• Doxepin

*It's recommended that doxepin not be taken for longer than 4-8 weeks for sleep.

How they work: As a tricyclic antidepressant, doxepin blocks histamine receptors, increasing the neurotransmitter histamine in the brain to promote drowsiness. Trazodone is a serotonin agonist and reuptake inhibitor. So in addition to increasing histamine levels, it increases serotonin (a precursor to melatonin) in the brain.

Commonly prescribed for: Depressive disorders, off-label for sleep conditions

Short-term side effects: ²⁰

• Nausea
• Dry mouth
• Headaches
• Drowsiness
• Constipation
• Numbness
• Disorientation
• Blurred vision
• Hallucinations
• Fast heart rate
• Digestive issues
• Low or high blood pressure
• Loss of controlled motor movements (ataxia)
• Impaired parasympathetic nervous system function (responsible for the body’s ability to recover from stress and cultivate relaxation)

Added risks with long-term use: ²⁰

• Withdrawal
• Dependence
• Reduced focus
• Impaired memory
• Worse heart health
• Rebound insomnia after discontinuing use

Research facts you ought to know:

➤  Studies show that very low doses (3-6 mg) of doxepin can increase total sleep time. However, it won't help you fall asleep faster. ²⁰

➤  Research has found that antidepressants often suppress REM sleep and prolong its onset. While this impacts depression symptoms positively, it means a significant part of sleep's restorative effects are restricted, which could have long-term effects. ²¹

Sleeping Drugs vs. Somnee’s Smart Sleep Headband

Even though the types of sleeping pills we just discussed interact with sleep uniquely, they all have a sedating effect. Rather than promoting your brain's natural sleep systems, they increase certain chemicals at unnatural levels to essentially knock you out.

Somnee's Smart Sleep Headband takes a different approach. Instead of introducing unnatural levels of chemicals, Somnee enhances your brain's unique sleep activity. 

How Somnee works: This process starts with Somnee using EEG tech to observe your brain's natural patterns of electrical activity as it winds down for sleep. Somnee then personalizes gentle transcranial electrical stimulation (TES) to mimic and promote those optimal sleep patterns over time. 

Safety: Somnee involves two key pieces of technology: EEG and TES. The EEG acts as a microphone, receiving information only. TES refers to the gentle stimulation designed to match your brain's sleep activity and has been around for over two decades. A meta-analysis of over 18,000 TES sessions found that TES was safe and had no serious adverse side effects. ²²

Results (backed by 7 years of research):

✔️ Fall asleep in half the time
✔️ 30+ minutes of extra sleep
✔️ 33% fewer nightly wake-ups
✔️ 2x more effective than CBT-i
✔️ 1.5x more effective than Ambien
✔️ 4x more effective than melatonin

The best part: Unlike medications that become less effective over time, with every 15-minute session, Somnee gets progressively better at helping you sleep. In fact, 80% of users note that the best results come (and stay!) after about 2-3 weeks of personalization.

Ready for Somnee to fix your sleep?

Try Somnee risk-free for 45 days >>

 

Resources:

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3. Research, C. for D. E. and. (2019). FDA adds Boxed Warning for risk of serious injuries caused by sleepwalking with certain prescription insomnia medicines. FDA. https://www.fda.gov/drugs/drug-safety-and-availability/fda-adds-boxed-warning-risk-serious-injuries-caused-sleepwalking-certain-prescription-insomnia
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12. ‌McKillop, L. E., Fisher, S. P., Milinski, L., Krone, L. B., & Vyazovskiy, V. V. (2021). Diazepam effects on local cortical neural activity during sleep in mice. Biochemical Pharmacology, 114515. https://doi.org/10.1016/j.bcp.2021.114515
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21. Antal, A., Alekseichuk, I., Bikson, M., Brockmöller, J., Brunoni, A. R., Chen, R., Cohen, L. G., Dowthwaite, G., Ellrich, J., Flöel, A., Fregni, F., George, M. S., Hamilton, R., Haueisen, J., Herrmann, C. S., Hummel, F. C., Lefaucheur, J. P., Liebetanz, D., Loo, C. K., & McCaig, C. D. (2017). Low intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines. Clinical Neurophysiology, 128(9), 1774–1809. https://doi.org/10.1016/j.clinph.2017.06.001