Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 10/21/2020
If you often or just occasionally find it difficult to fall asleep, you’re far from alone. An estimated 50 million to 70 million adults in the U.S. have some form of sleep disorder, making nighttime sleep aids some of the most widely used prescription drugs in the country.
Common prescription sleeping medications include:
There are also numerous older-generation sleeping pills that are no longer widely prescribed to treat insomnia, including benzodiazepine medications such as lorazepam (the active ingredient in Ativan®) and alprazolam (Xanax®).
While all of these medications can improve sleep and treat insomnia, there are numerous key differences between each medication that could make one a better choice than others if you’re prone to difficulty sleeping.
Below, we’ve explained how each of these prescription sleeping pills works, as well as how well each medication treats insomnia. We’ve also looked at how they compare to certain older sleep aids that are no longer widely used.
Zolpidem is a widely used and well known prescription sleeping pill in the United States. It’s sold under the brand name Ambien and is used to treat both chronic insomnia (recurring difficulty sleeping) and short-term, acute insomnia.
Tens of millions of people in the U.S. alone use it every year, making it one of the most widely prescribed sleep aids in the country.
Zolpidem is known as a “Z-drug” — a type of nonbenzodiazepine medication known to exhibit fewer side effects than benzodiazepines.
But it’s still worth noting they do offer significant side effects that are still being studied. It also has a high potential for abuse, which generally means it’s not prescribed as a first-line treatment for insomnia.
As a sleeping pill, zolpidem works by binding to your brain and body’s GABA receptors. GABA, or gamma-aminobutyric acid, is an inhibitory neurotransmitter that’s responsible for helping you feel relaxed, calm and sleepy.
By targeting your GABA receptors, zolpidem may make you feel calm, less anxious and ready to go to bed.
As a widely-used and thoroughly-studied medication, zolpidem is backed up by numerous large scientific studies.
One study from 2012 found that people with insomnia who used zolpidem shortly before bed for eight months slept for a longer amount of time, took less time to fall asleep and had better sleep quality than people given a non-therapeutic placebo.
A separate scientific review from 2012 noted that zolpidem is “consistently effective” at reducing sleep latency and increasing sleep duration in people with insomnia.
Zolpidem considered is a safe, effective medication. However, as with many other prescription medications, there are some potential side effects and risks that you should be aware of if you’re considering zolpidem to treat sleep difficulties.
During short-term trials of zolpidem, the most frequently reported side effects were headache, dizziness, drowsiness and diarrhea. In longer-term testing, patients given zolpidem reported a wider range of side effects, although most of these only affected a small percentage of users.
A small percentage of people who use zolpidem report abnormal nighttime behavior, such as sleep-walking, “sleep-driving” or unusual dreams. Zolpidem can also cause some feelings of drowsiness in the morning, especially if it’s taken very late at night.
Zolpidem does come with an increased risk of abuse and dependence. If you’re prescribed zolpidem, follow your healthcare provider’s instructions carefully to avoid overusing or abusing this medication.
You should also speak to your healthcare provider if you have a history of depression. You should also not take zolpidem with alcohol. Taking zolpidem with food also isn’t recommended, as food can slow down the effects of the medication.
Overall, zolpidem is widely used for a reason — it works. However, it’s typically only used as a short-term treatment for insomnia and may cause next-morning impairment.
Doxepin is a tricyclic antidepressant that was approved in 1969 by the FDA to treat major depressive disorder.
In 2010, low dose doxepin was approved by the FDA for use as a treatment for insomnia and other sleep difficulties. In the United States, doxepin is sold under the brand name Silenor® to treat insomnia.
There are millions of prescriptions for doxepin in the United States, although some of these may be for higher-strength versions of doxepin used to treat depression and anxiety.
Doxepin works by blocking the effects of histamine on the body’s H1 receptors. Histamine is an essential neurotransmitter that’s used by your brain and body to regulate your sleep-wake cycle — an internal process that helps you feel energetic during the day and sleepy at night.
By blocking the effects of histamine, doxepin can reduce your feelings of wakefulness, making it easier for you to sleep.
There are several studies of doxepin showing that it’s effective as a treatment for insomnia and other sleep issues.
In a 2013 scientific review, which analyzed data from numerous studies of doxepin, researchers stated that doxepin produces a “significant improvement” in several sleep parameters in people with insomnia, including total sleep time, sleep quality and wake time after sleep onset.
A separate study from 2007 found that doxepin improves sleep efficiency and total sleep time in people with chronic primary insomnia.
Interestingly, doxepin appears to be more effective at increasing total sleep time than reducing the amount of time required to fall asleep. This may make it a good treatment if you don’t have difficulties falling asleep, but often wake up unexpectedly in the middle of the night.
Overall, doxepin is a very safe medication, particularly when it’s used at a low dose for difficulty sleeping. However, a small percentage of doxepin users may experience side effects.
According to FDA trial data, the most common side effects of doxepin are sedation, nausea and nasopharyngitis (common cold). Unlike many other prescription sleeping pills, doxepin typically does not cause next-day drowsiness or sedation.
Although uncommon, like other sleeping pills, doxepin may cause insomnia and certain forms of unusual nighttime behavior, such as sleep-walking or “sleep-driving.”
As a tricyclic antidepressant, doxepin is prescribed at significantly higher doses to treat anxiety and depression than insomnia.
At the doses used to treat depression and anxiety, side effects from doxepin may potentially be more common and severe.
Studies of doxepin have found that it has a lower potential for abuse or dependence than other, older sleep medications.
Overall, doxepin is a safe, effective sleep medication. Since it’s less likely to cause drowsiness the next day than other prescription sleeping pills, it’s worth considering if you often need to be awake, alert and active early in the morning.
Ramelteon is a new type of sleep medication called a melatonin receptor agonist. It’s one of the most recent insomnia treatments on the market, first approved by the FDA in 2005 and available to the public for just over a decade. In the United States, ramelteon is sold as Rozerem.
Ramelteon works by binding to the body’s MT1 and MT2 melatonin receptors. By doing this, it’s able to mimic the effects of melatonin — a naturally-occurring hormone, produced by the pineal gland, that’s responsible for managing the sleep side of your sleep-wake cycle.
Despite being a relatively new drug, ramelteon has been extensively tested in clinical trials and studies. Many of these studies have found that it’s a highly effective sleeping pill, especially for people who struggle to fall asleep in a normal amount of time after going to bed.
In one study from 2006, ramelteon reduced the amount of time required to fall asleep in people with insomnia. Another study from 2007 produced a similar outcome, with researchers finding that people with insomnia who used ramelteon fell asleep faster and slept longer than those who used a placebo.
Both of these studies noted that ramelteon didn’t cause any next-day residual effects, meaning the participants didn’t feel drowsy or hungover after waking up the next morning.
Finally, a series of three clinical trials of ramelteon conducted by the drug’s manufacturer found that it produced a noticeable reduction in the amount of time required for people with insomnia to fall asleep.
Ramelteon is a safe and effective medication. Serious side effects are extremely rare, and the few common side effects that can occur are relatively minor.
According to FDA trial data, the most common side effects of ramelteon are fatigue, dizziness, drowsiness, nausea and exacerbated insomnia. Like other sleeping pills, ramelteon may cause abnormal nighttime behavior such as “sleep-driving,” sleepwalking and more.
Although many studies of ramelteon have found that it produces few to no morning drowsiness, a 2011 study found that ramelteon can produce some level of next-day impairment in cognition, memory and psychomotor performance.
Overall, studies of ramelteon show that it works well, with relatively few side effects compared to older sleeping pills. It appears to be especially effective at reducing sleep onset latency, making it worth considering if you find it difficult to fall asleep.
Certain other prescription insomnia medications, such as eszopiclone (sold as Lunesta®) and zaleplon (Sonata®) are also available to treat sleep difficulties. These are nonbenzodiazepine medications that work similarly to zolpidem (Ambien®) to induce sleep.
Older-generation medications, such as benzodiazepines, were once widely prescribed to treat insomnia. However, these medications can cause significant side effects and have a relatively high potential for abuse and dependence, meaning they’re rarely used for this purpose today.
Examples of older sleeping pills include diazepam (Valium®) and alprazolam (Xanax®). Many of these benzodiazepine medications induce sleepiness, but may cause a hangover-like effect that can affect cognition and performance the next morning — and also have an inclination to abuse and addiction.
There’s also some evidence that these medications can affect sleep quality, meaning that even if you sleep for longer after using them, you may wake up feeling less rested.
Insomnia is a very common problem, with a study from the Perelman School of Medicine at the University of Pennsylvania revealing that about one in four American adults is affected by some degree of acute insomnia each year.
Although 75 percent of these people recover without any long-term sleeping issues or need for ongoing treatment, 21 percent experience persistent difficulties falling asleep.
If you’re experiencing insomnia, you may wish to try an over-the-counter treatment designed to improve your sleep. Over-the-counter supplements such as melatonin may induce sleepiness, making it easier for you to doze off without spending hour after hour in bed.
You may also benefit from making changes to your sleep habits, such as reducing your caffeine intake or doing cognitive behavioral therapy. We’ve listed some of these lifestyle changes in our guide to insomnia and explained how they may be able to help you.
If these tactics don’t work, talk to your healthcare provider about using a prescription medication to treat your insomnia. Based on your symptoms, lifestyle and general health and wellbeing, they may recommend one of the medications listed above.
You can also talk to a healthcare provider online. We offer sleep medications such as doxepin and ramelteon, following a convenient online consultation with a healthcare professional.
Modern prescription sleeping pills aren’t just effective — they’re also significantly safer and less likely to cause side effects or next-morning “hangover” than older sleep medications.
If you’re struggling to fall asleep, it’s best to consider lifestyle changes or over-the-counter sleep supplements first. However, if your insomnia is persistent, consider talking to your healthcare provider about using a prescription sleeping pill.
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