Sleep Enhancers

Over-the-counter Sleep Aids

With dozens of different brand names on the market, many over-the-counter sleep aids contain antihistamines or melatonin. 

Antihistamines are allergy medications that cause sleepiness as a side effect. These are primarily in the family of Diphenhydramine (Benadryl) or Doxylamine. Initially, they may induce drowsiness but the National Sleep Foundation states that due to their half life, they can have a “residual sedative effect” the following day and also may have negative interactions with other medications. It is important to note that the U.S. Food and Drug Administration (FDA) warns that higher-than-recommended doses of diphenhydramine can lead to serious medical problems. 

Sleep Foundation. (2021, June 23). Sleep medications: Over the counter options. Retrieved September 2020, from https://www.sleepfoundation.org/sleep-medications/otc-sleep-aids. 

Melatonin is classified by the FDA as a dietary supplement . Before learning about melatonin as a supplement, it is important to understand how it is naturally produced in your body. According to the National Center for Complementary and Integrative Health (NIH), “melatonin is a hormone that your brain produces in response to darkness.” Melatonin release is associated with our circadian rhythm, the natural pattern of sleep-wake cycles that our bodies repeat every 24 hours. Ideally, our bodies will produce enough melatonin to allow us to easily fall asleep and maintain a healthy sleep-wake cycle. However, due to a variety of factors, such as stress, irregular sleep schedules, and late night exposure to light, our internal clocks can be thrown off, delaying the release of melatonin. This difficulty falling asleep is one of the primary motivators behind the development and usage of melatonin supplements. (To learn more about your “internal clock” check on the information on circadian rhythms in our Bedtime Routines module). 

Hopp, D.C., & Shurtleff, D. (2021, January). Melatonin: What You Need to Know. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/melatonin-what-you-need-to-know

Everything You Need to Know About Your Circadian Rhythm. (2019, January 15). Liveli. https://www.liveli.com/blogs/the-wave/circadianrhythm

As with all substances, it is important to weigh the potential benefits and consequences of melatonin to determine whether or not it may be right for you. Research on melatonin varies, with some studies suggesting possible benefits, and others finding little to none. 

Evidence suggests that melatonin supplements may help to reset one’s circadian rhythm. For example, jetlag can occur when two or more time zones are crossed, causing your internal clock to go out of sync with that of your current location. Jetlag can make it difficult to fall asleep at a proper hour because your body is not producing melatonin at the correct time. According to the National Library of Medicine, melatonin supplemental treatment can be a useful short-term solution for jet lag. Over-the-counter melatonin may help to realign your circadian rhythm and induce sleepiness at an appropriate time. In a literature review written in 2002, researchers found evidence for decreased jetlag in those crossing five or more time zones when melatonin was administered close to the desired bedtime. Make sure to consult with your healthcare provider to identify the proper dosage.

Herxheimer, A., & Petrie, K. J. (2002). Melatonin for the prevention and treatment of jet lag. The Cochrane database of systematic reviews, (2), CD001520. https://doi.org/10.1002/14651858.CD001520

Members of the Agency for Healthcare Research and Quality conducted a study on melatonin, examining how it may be used to treat sleep disorders. According to the researchers, “Evidence suggests that melatonin is not effective in treating most primary [and secondary] sleep disorders with short-term use, although there is some evidence to suggest that melatonin is effective in treating delayed sleep phase syndrome with short-term use.” The Stanford Health Care Center defines delayed sleep phase syndrome as “ a disorder in which a person’s sleep is delayed by two hours or more beyond what is considered an acceptable or conventional bedtime." This study also did not discover any benefits among individuals without a sleep disorder. If you believe you have delayed sleep syndrome, please do not self-diagnose! Talk to your health care provider.

Buscemi, N., Vandermeer, B., Pandya, R., Hooton, N., Tjosvold, L., Hartling, L., Baker, G., Vohra, S., & Klassen, T. (2004). Melatonin for Treatment of Sleep Disorders. Agency for Healthcare Research and Quality, 108, 1-7. https://archive.ahrq.gov/clinic/epcsums/melatsum.pdf

Stanford Health Care. (n.d.).​​ Delayed Sleep Phase Syndrome. Stanford Health Care. Retrieved August 2021, from https://stanfordhealthcare.org/medical-conditions/sleep/delayed-sleep-phase-syndrome.html

 
Sack, R. L., Lewy, A. J., & Hughes, R. J. (1998). Use of melatonin for sleep and circadian rhythm disorders. Annals of medicine, 30(1), 115-121. https://doi.org/10.3109/07853899808999393

Herxheimer, A., & Petrie, K. J. (2002). Melatonin for the prevention and treatment of jet lag. The Cochrane database of systematic reviews, (2), CD001520. https://doi.org/10.1002/14651858.CD001520

Ultimately, if you are looking to improve your sleep habits, the research suggests that melatonin may be helpful in instances where your circadian rhythm is out of sync, but is not considered the best long-term solution. If you are looking for something to help you sleep after drinking too much caffeine or experiencing a bout of anxiety, melatonin may not be the best choice. Instead, focus on other ways you can improve your sleep quality. For example, by limiting your exposure to light a few hours before bedtime (including light from TV and cell phones), your body will be able to more easily produce melatonin naturally, allowing you to have a good night’s sleep. 

Prescription Sleep Aids 

Prescription sleep aids are often used in conjunction with behavioral therapies and are usually taken for a short period of time (to help re-regulate sleep before transitioning off of the medication). Physician Dr. Ali Javanbakht from Student Health Services notes, there are many different families of prescription sleeping medications. Anti-anxiety medications, such as Alprazolam (Xanax), Lorazepam (Ativan), or Diazepam (Valium) can help induce sleep but also negatively disturb the sleep cycle. Other prescription medications such as Zolpidem (Ambien) and Trazodone (Desyrel) can help people get to sleep while preserving the normal sleep cycle. All these substances can be addictive and can also result in increased tolerance over time, where higher doses are needed to get the same effect. If used on a regular basis, they can cause withdrawal symptoms when stopped abruptly. Withdrawal symptoms are usually negative symptoms that occur after a person stops consuming an addictive substance.

If you are looking into prescription medications for insomnia, it is important to discuss which path to take with your doctor. Everyone reacts differently to medication, and it might take a few tries to find one that works for you. Make sure to communicate with your doctor about your needs.