After a draining day, you just want to plop on your bed and pass out. For some, this happens the moment their head touches the pillow. But for others, falling asleep is a challenge.
Insomnia means you have difficulty either falling or staying asleep, or both. If you occasionally experience insomnia, there’s probably nothing to worry about — almost everyone has trouble sleeping at one time or another. However, if you are regularly finding yourself struggling to fall or stay asleep, you may decide to seek further medical evaluation.
Sleep medication may seem like a lifesaver. And used sparingly, it may help you get the sleep you need. However, long term use is not recommended for most sleep aids.
There are many types of sleeping aids. Two that will be discussed in further detail below are melatonin and zolpidem (a.k.a. Ambien).
What Is Melatonin?
Melatonin is a hormone that helps control your daily schedule of sleeping and waking up. Here’s how it works:
Step 1: The sun goes down, which is your brain’s cue that bedtime is soon.
Step 2: This pea-sized gland just above the center of your brain, called the pineal gland, starts to release melatonin into your bloodstream.
Step 3: As your levels of melatonin increase, you start to get drowsy.
Step 4: As morning approaches and the sun rises, melatonin levels drop, telling your brain it’s time to wake up.
Many people take over-the-counter melatonin supplements to help them fall asleep. These are considered natural sleep-aids, and are not recognized by the Food and Drug Administration (FDA) as drugs.
Who Benefits from Melatonin Supplements?
Melatonin supplements can be very beneficial if you have certain sleep disorders, such as:
- Delayed sleep phase disorder: This disorder makes it difficult to fall asleep at a normal bedtime and wake up in the morning. Many patients with this disorder may not be able to fall asleep until 2 to 4 a.m. Combined with behavioral changes, such as gradually advancing your bedtime or exposing yourself to natural sunlight in the early morning, melatonin supplements can help you adjust your sleep schedule to a more “normal” routine.
- Jet lag: Jet lag occurs when you travel rapidly between time zones. It can cause sleep disturbances, indigestion, or daytime fatigue. Melatonin supplements can reduce these symptoms and improve sleep during or after traveling between time zones.
- Shift work disorder: If you work the late shift, you may be at risk for shift work disorder. This disorder can cause many symptoms, such as excessive sleepiness, insomnia, lack of energy, or irritability. Melatonin supplements can help you get a better quality sleep when your job requires that you sleep during the daytime.
- Insomnia: While the research is still out as to whether or not these sleep aids can reduce the time it takes to fall asleep, or make it easier to stay asleep, anecdotal evidence suggests that some people with insomnia find them helpful.
The Drawbacks of Melatonin Supplements
At this point, melatonin supplements may seem like the answer to your prayers — they are often effective, and they're all natural.
If you take melatonin every once in a while, or your health care provider prescribes it to treat a sleep disorder, then you will likely be fine. Melatonin is also considered relatively safe.
So what’s the problem?
Well, melatonin may cause a few issues:
- Taking too much melatonin, or taking it often, can throw off your sleep cycle. That means that your sleep patterns may actually get worse in the long run.
- You have to be very careful with timing. If you take melatonin too early, you risk drowsiness when you need to be alert, such as while driving. If you take it too late, you may not start feeling tired until past the time you had hoped to get to bed. Your best bet, especially if using melatonin supplements for insomnia, is to take it 30 to 60 minutes before going to sleep.
- Dosing is complicated. Most people only need between two tenths of a milligram to five milligrams, and taking too much can cause headaches, dizziness, nausea, irritability, or daytime drowsiness.
- Since melatonin is not considered a drug, it is not monitored by the FDA. The melatonin bottle may list certain ingredients, or specify a dosage, but the actual pill may contain unlisted ingredients or have an inaccurate dose.
If you plan to start taking melatonin supplements, especially if you are currently prescribed to other medications, be sure to consult your health care provider first, as melatonin may interact with other medications.
What Is Zolpidem?
Zolpidem, commonly known as Ambien, slows down activity in the brain, allowing you to sleep. The immediate release form dissolves right away, helping you fall asleep fast. The extended release version has two layers — the first helps you fall asleep, and the second dissolves slowly to help you stay asleep.
The Benefits of Zolpidem
Zolpidem offers several benefits, including:
- It tends to work very quickly — generally within 30 minutes.
- Studies have confirmed that zolpidem can help initiate the sleep process.
- Sleep problems often improve within just 7 to 10 days of being on the medication.
Used correctly, zolpidem may be a great option if you need a short-term medication to help you overcome a temporary bout of insomnia.
The Drawbacks of Zolpidem
If your health care provider prescribes zolpidem, and you take it as directed, zolpidem may help improve your sleep. However, if you have certain side effects, take it incorrectly, or have other medical conditions, it can cause serious issues, such as:
- Side effects: Like many prescription drugs, zolpidem comes with a list of possible side effects, from dizziness, to constipation, to uncontrollable shaking. Some side effects, such as rash, chest pain, or difficulty breathing can become serious medical concerns that require immediate care. Rarely, Zolpidem can cause unusual nighttime behaviors, such as night-eating or sleep walking. Contact your health care provider immediately if this occurs.
- Dependency: Zolpidem may be great for short-term insomnia relief, but it is not meant to be used for longer than a few weeks. The drug can be habit-forming, meaning you eventually will have trouble sleeping without it.
- Next-day impairment: Taking more than the prescribed dosage, or taking zolpidem and then not getting a full night's sleep (about 7 to 8 hours), can cause problems the next day, like difficulty driving, daytime drowsiness, dizziness, blurred or double vision, reduced alertness, or prolonged reaction time.
- Drug interactions: Zolpidem can interact with other medications or supplements, which can cause side effects or impact their effectiveness. And vice versa — drugs for other medical conditions or concerns can impact how well zolpidem works. Let your health care provider know what prescription and nonprescription medications, vitamins, herbal products, or nutritional supplements you’re currently taking, as they may need to adjust dosages.
Alcohol can make these side effects worse, so if you’re an active drinker or vacationing at a winery, you may need to steer clear of zolpidem.
The Bottom Line: Talk to Your Health Care Provider
“It’s important to make a game plan with your health care provider before starting a sleep aid,” suggests Lisa Felkins, CRNP, a nurse practitioner with Penn Sleep Medicine.
Your provider can determine if your insomnia may actually be caused by an underlying condition, such as restless leg syndrome or sleep apnea. They can also help you develop a treatment plan, and make sure you’re using sleeping aids correctly.
“Instead of prescribing medication, they may also refer you to Cognitive Behavioral Therapy for Insomnia (CBT-I). This is a 6-8 week program which is a behavioral treatment for insomnia that has been shown to be as effective as medication. This treatment includes things you can do yourself to improve your sleep. For example, your CBT-I provider would help you find the right sleep schedule to make your sleep better. They would also discuss what to do if you are unable to sleep and address lifestyle factors than can influence sleep,” says Felkins.
If you have been having trouble sleeping, and are considering sleeping aids like melatonin and zolpidem, make sure to check in with your health care provider first. The providers at Penn’s Division of Sleep Medicine can help you come up with the best plan to get your sleep back on track.
Learn how our sleep medicine specialists can help you get a better night's rest.