Sleeping Pills: Insomnia Causes, Treatment and Prevention

Sleeping pills are medicines that help you fall asleep or stay asleep, but for most people with poor sleep they're not the first step. Better sleep habits and a doctor's review of what's keeping you awake come first, because they deal with the cause. Sleeping pills can help for a few nights in a crisis, yet they lose their effect with regular use and carry real risks, including next-day drowsiness, falls and dependence.

Key takeaways

• Regular sleep habits and treating the cause of poor sleep come first, and their benefits last.
• See a doctor if poor sleep lasts more than a few weeks or affects your days.
• Cognitive behavioural therapy for insomnia is the first treatment doctors recommend for poor sleep that won't settle.
• Prescription sleep medicines are for short-term use only, and stopping should be gradual.
• Never mix sleep medicines with alcohol or other sedating drugs.

What Sleeping Pills Are

Sleeping pills are medicines that make you drowsy or calm the brain so that sleep comes more easily. Some are sold by pharmacists and others are only available on prescription in Australia. There is no top 3 sleeping pills list that suits everyone, because the right choice, if any, depends on the cause of your sleep problem, your age and your health. The main groups are compared below.

Prescription sleeping medicines are meant for the shortest time possible, usually no more than two to four weeks, and at the lowest dose that works.

How to Tell if You Have Insomnia

You have insomnia if you regularly struggle to get to sleep, wake during the night and can't get back to sleep, or wake too early, despite having the chance to sleep, and it affects how you feel the next day. Short-term insomnia lasts days to weeks and often follows stress, illness or travel. Chronic insomnia is poor sleep on at least three nights a week for three months or more. Daytime signs include tiredness, poor concentration, low mood, irritability and worrying about sleep itself. Being tired isn't the same as daytime sleepiness, where you nod off without meaning to; that points to another sleep problem, such as sleep apnoea. Before you think about medicine, a sleep diary kept for two weeks, noting bedtimes, waking times, caffeine, alcohol and naps, helps you and your doctor see the pattern.

Common Causes of Poor Sleep

Poor sleep usually has more than one cause, and finding them matters more than reaching for a pill. Common causes include stress, anxiety and depression, pain, an irregular routine, shift work and jet lag, and caffeine, nicotine or alcohol late in the day. Alcohol may help you nod off, but it breaks up sleep later in the night. Health problems such as sleep apnoea, restless legs, reflux, an overactive thyroid, menopause and needing to pass urine at night also disturb sleep. Some prescription medications, decongestants and recreational drugs can keep you awake, and stopping sleep medicines suddenly can cause rebound, a few nights of worse sleep than before. Using a phone or laptop in bed and lying awake watching the clock can keep the cycle going.

Types of Sleep Medicines in Australia

The types of prescription sleeping pills in Australia are benzodiazepines, the z-drugs, orexin blockers, and melatonin for people under 55. Benzodiazepines have been used for decades; they work well for a short time but cause dependence and withdrawal if taken for weeks or months. The z-drugs act on the same part of the brain for a shorter time. One of them, zolpidem, which is only available on prescription in Australia, carries a warning about complex sleep behaviours such as sleepwalking, eating and even driving while not fully awake.

Orexin blockers are a newer group that turns down the brain's wakefulness signal rather than sedating it, and they're used when it's hard to fall or stay asleep. Doctors sometimes use a low dose of a sedating antidepressant when poor sleep comes with low mood. All of these are only available on prescription in Australia, and each suits different people.

Without a prescription, pharmacists sell sedating antihistamines for a night or two of sleeplessness, and slow-release melatonin for people aged 55 and over. Antihistamines lose their effect within a few days and can leave you groggy the next morning, so they suit occasional sleeping problems, not ongoing ones. Medio's doctors don't prescribe Schedule 8 medicines in a standard phone consultation, and whether any sleeping medicine suits you is a doctor's decision.

How Insomnia Is Treated

Insomnia is treated first by finding and treating its cause, and then with cognitive behavioural therapy for insomnia, known as CBT-I. This structured program, run by psychologists, some GPs and trusted online courses over about six weeks, changes the habits and worries that keep poor sleep going. It includes setting a fixed wake time, spending less time awake in bed, getting up when you can't sleep, and learning to quieten a racing mind. It helps most people who complete it, and its benefits tend to last after the program ends. Treating pain, anxiety, depression, sleep apnoea or reflux often improves sleep on its own. Prescription sleep medicines are kept for short periods, such as a few nights during a crisis, and are best avoided in older people because of falls and confusion.

Avoiding Dependence and Stopping Gradually

The way to avoid dependence is to use sleep medicines for the shortest time, at the lowest dose, and ideally not every night. After two to four weeks of nightly use, the body gets used to them: the same dose works less well, and stopping brings rebound insomnia and withdrawal symptoms such as anxiety, restlessness and vivid dreams. It's tempting to see a sleeping med as the easy fix, but long-term use rarely keeps people asleep better than before they started.

If you've been taking sleep medications for more than a few weeks, don't stop suddenly. Your doctor can plan a gradual reduction, often cutting the dose a little every week or two, sometimes with nights off before stopping. Doing the therapy at the same time makes stopping easier. Never mix sleep medicines with alcohol, opioid pain medicines or other sedating drugs, because together they can slow your breathing dangerously.

When to See a Doctor About Poor Sleep

See a doctor if poor sleep lasts more than three or four weeks, keeps coming back, or affects your work, mood, relationships or safety. Go sooner if you snore loudly or someone notices you stop breathing or gasp in your sleep, if you have uncomfortable legs at night, or if you fall asleep at the wheel or in quiet moments during the day. See your doctor, too, if you've used sleep tablets for more than a couple of weeks, want to stop medications you've taken for months, or are using alcohol or drugs to get to sleep. If poor sleep comes with low mood or thoughts of harming yourself, call Lifeline on 13 11 14, or 000 in an emergency.

Sleep Hygiene Habits That Help

Sleep hygiene habits help by giving your body clock a regular rhythm and your bed a strong link with sleep. Get up at the same time every day, weekends included, and go to bed only when you feel sleepy. If you're not asleep after about 20 minutes, get up and do something quiet in dim light until you feel drowsy, then go back to bed. Get daylight in the morning and stay active during the day, but finish hard exercise a few hours before bed. Cut caffeine after midday, avoid alcohol and heavy meals late in the evening, and keep naps short and before 3 pm. Keep the bedroom dark, quiet and cool, leave phones and laptops outside it, and wind down for an hour before bed. These habits keep helping when sleep tablets stop working, and they help any medicine you do take work better too.

Herbal and Natural Sleep Aids

Herbal and natural sleep aids are widely sold, but the evidence that they help you fall asleep is weak for most of them. Valerian, chamomile, lavender, passionflower and magnesium are popular, and some people find a calming routine with them helpful. "Natural" doesn't always mean safe: some herbs cause drowsiness the next day, interact with prescription medications, or aren't suitable in pregnancy, so tell your doctor or pharmacist what you take. Melatonin is a hormone rather than a herb; it helps more with jet lag and body clock problems than with ongoing sleeplessness. Unlike a sleeping med, these aids don't usually cause rebound insomnia when you stop, but they also don't treat the cause of poor sleep.

Summary

Sleeping pills can help for a short time, but the lasting answers to poor sleep are regular habits, treatment for the cause and cognitive behavioural therapy for insomnia, with any medicine used briefly and stopped gradually. If you're wondering whether sleeping pills suit you, a Medio GP can talk through your sleep by phone, suggest the right next step and decide with you whether any medicine is suitable.

Frequently asked questions

Which pills are best for sleep?

No pill is best for everyone, because the right choice depends on why you can't sleep, your age, your health and your other medicines. For poor sleep that keeps going, doctors recommend therapy and sleep habits before any pill. Are there OTC sleeping tablets that actually work? Pharmacy antihistamines can help for a night or two, but the effect fades quickly and they can leave you groggy. A doctor can tell you whether any medicine suits you.

What's the most effective sleeping pill?

There isn't one most effective sleeping pill. Prescription sleep medicines help people fall asleep a little faster and sleep a little longer, but the gains are modest and fade with regular use. What are their side effects? Next-day drowsiness, dizziness, falls, memory problems and, with some, sleepwalking or sleep-driving. A doctor weighs these against your sleep problem before suggesting anything.

Can a doctor help with sleeping pills?

Yes. A GP can find out what's keeping you awake, treat the cause, suggest therapy for insomnia and, if a medicine is suitable, prescribe it for a short time. How do you stop taking them? Your doctor can plan a gradual reduction rather than a sudden stop. A Medio GP can help by phone, for adults 18 and over; Medio's doctors don't prescribe Schedule 8 medicines in a standard consultation, and no medicine is promised.

What are the top 3 sleeping pills?

Doctors don't rank them, because each suits different people. The three groups people usually mean are pharmacy antihistamines, melatonin, and prescription medicines such as benzodiazepines and the z-drugs. How long can you safely take OTC sleeping tablets? Only a few nights in a row; if you still need them after a week, see a doctor about the cause.

Is a sleeping pill a good idea?

A sleeping pill can be a good idea for a few nights in a crisis, but rarely for longer. Who shouldn't take one? People who are pregnant or breastfeeding, who have sleep apnoea or breathing problems, who drink alcohol or take opioids, older people at risk of falls, and anyone with a history of dependence, unless a doctor advises otherwise. Can you become dependent? Yes, often after two to four weeks of nightly use.

Is it better to not sleep or take a sleeping pill?

It's usually better to ride out one bad night: your body catches up, and the next night's sleep is often deeper. Repeated bad nights are a reason to see a doctor rather than to keep taking pills. Never take a sleeping pill if you've been drinking, or if you need to drive or make important decisions within eight hours.