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Many Americans turn to sleep aids to relieve their insomnia. Numbers vary, but up to a quarter of Americans use some sort of sleep aid to help them fall asleep, according to the American Academy of Sleep Medicine. Between 6 and 12 percent of Americans use over-the-counter (OTC) sleep aids specifically.
OTC sleep aids generally contain one of two primary active ingredients: Diphenhydramine HCI or Doxylamine Succinate. Both are types of sedating antihistamines, but each has a slightly different effect. Diphenhydramine HCI tends to be milder with fewer side-effects, while Doxylamine Succinate is more effective over a longer term.
While OTC sleep aids are non-habit forming, they still need to be used with care. They’re meant to be taken on a short-term basis and are not a substitute for more long-term treatment of insomnia or other sleep issues.
This guide will tell you everything you need to know about over-the-counter sleep aids so you can make an informed decision the next time you have a sleepless night. We’ll also share our top picks for the best OTC sleep aids.
The Best Over-the-Counter Sleep Aids of 2019
Editor’s Pick (Diphenhydramine HCl) – Vicks ZzzQuil Nighttime Sleep Aid
Best Value (Diphenhydramine HCl) – ValuMeds Nighttime Sleep Aid
Editor’s Pick (Doxylamine Succinate) – Kirkland Signature Sleep Aid
Best Value (Doxylamine Succinate) – Basic Care Sleep Aid
ZzzQuil is from the makers of NyQuil, the popular nighttime cold medication. Unlike NyQuil and similar medications, ZzzQuil doesn’t contain any pain medications, like acetaminophen or ibuprofen. Its active ingredient is the antihistamine Diphenhydramine HCl. ZzzQuil is sold as a liquid or liquid capsule and is also available in alcohol-free versions.
Users are instructed to take it 30 minutes before bed on nights when they can commit to seven or eight hours of sleep. It’s designed for temporary relief from sleeplessness, and it’s recommended you speak to your doctor if insomnia lasts longer than two weeks.
Side effects include dizziness, drowsiness, loss of coordination, dry eyes or blurred vision, dry mouth, constipation or upset stomach, and daytime drowsiness.
ValuMeds Nighttime Sleep Aid is another Diphenhydramine HCl sleep aid that’s sold at an excellent value. It comes in a two pack for a total of 192 softgels, and it’s a fraction of the cost of similar products. Softgels are easy to take, thanks to the smooth gel covering.
This sleep aid is intended to help relieve temporary sleeplessness, and you should talk to your doctor if your sleep issues last longer than two weeks. You should also talk to your doctor before use if you have emphysema or chronic bronchitis, glaucoma, or trouble urinating due to an enlarged prostate gland.
Kirkland, the private brand of Costco, is popular among consumers, and the brand’s Signature Sleep Aid does not disappoint. The tablets are very small and easy to take, and you only have to take one per night.
The product’s active ingredient is Doxylamine Succinate, which is slightly stronger than Diphenhydramine HCl. The product claims to help users fall asleep faster, but users should plan to take it when they have eight hours or so to devote to sleep. If sleep issues continue for more than two weeks, consult your doctor.
Side effects include drowsiness, dizziness, dry mouth, blurred vision, and constipation.
Basic Care Sleep Aid tablets are an effective OTC sleep aid offered at an excellent price. Similar to the above pick, Doxylamine Succinate is this product’s active ingredient.
Each pill is 25 mg, but they’re also scored down the middle so users can take a half dose if desired. The tablets are also small and easy to take.
Like other sleep aids, it’s recommended that users take these when they can devote eight hours to sleep. If sleeplessness continues for more than two weeks, it’s time to consult your doctor.
There’s a lot to understand when it comes to OTC sleep aids. And like any product you put into your body, you want to know how to safely use them. In our buying guide, we’ll outline everything you need to know about OTC sleep aids, including how they work, different types, safety information and other techniques for improving sleep.
The main way to distinguish between different OTC sleep aids is by looking at their active ingredients. Most products on the market contain either Diphenhydramine HCl or Doxylamine Succinate. Both are antihistamines, which are typically used to treat allergy symptoms, like a runny nose or itchy eyes. When you have an allergic reaction or a cold, histamines are released in your body to increase blood flow to the site of invasion. Antihistamines work by blocking histamine receptors in cells to reduce the allergy symptoms related to the histamine response.
Many first-generation antihistamines, like Diphenhydramine HCl and Doxylamine Succinate, also make you drowsy. That’s because they don’t differentiate among various histamine receptors and inhibit histamines that regulate sleep. That might not be desirable if you’re taking an antihistamine for allergy relief, but it makes both compounds ideal for use in sleep aids.
Diphenhydramine HCl and Doxylamine Succinate function fairly similarly, but there are some marked differences:
Diphenhydramine HCl is used in sleep aids more often than Doxylamine Succinate. That might be because it’s often less expensive than its counterpart. It also leaves the body fairly quickly, making it milder than Doxylamine Succinate. It’s a great choice for those who have never used a sleep aid before because it’s less likely to cause drowsiness, or the hangover effect, the next morning. The downside is that users can build up a tolerance fairly quickly, so it loses its effectiveness relatively fast. That makes it a better fit for someone who only plans to take it for a couple of nights at a time.
Doxylamine Succinate is the stronger of the two sedating antihistamines. It can be a bit more expensive than Diphenhydramine HCl, but some users find it more effective. That’s because it tends to leave the body more slowly, helping users stay asleep longer. Most people who use sleep aids with Doxylamine Succinate remark that they feel the effects fairly quickly after taking a dosage. Users tend not to develop a tolerance very quickly, too, so it’s a good fit for those who need to take it over a longer period of time. The drawback is that Doxylamine Succinate is more likely to cause the hangover effect the next morning.
Sleep aids fall into three main categories: over-the-counter, natural or herbal supplements, and prescription drugs.
In this article, we are focusing on over-the-counter sleep aids. For information on other types of sleep aids, refer to our resource pages for Natural Sleep Aids, Prescription Sleep Medications, Valerian, and Melatonin.
Generally, sleep aids are considered safe for short-term use. It is when people misuse sleep aids, particularly by using them on a long-term basis, that they become dangerous.
Unfortunately, this describes a significant number of the people who use sleep aids. Just under 20% of people take sleep aids to help them fall asleep every night. Among older adults, that number is even higher: over a third of adults age 65-80 regularly rely on some form of OTC, prescription, or natural sleep aid on a daily basis.
Because they are not addictive the same way other drugs are, the FDA allows the “non-habit forming” label to be used for OTC sleep aids – but that’s assuming safe use. Given the frequency with which people don’t use sleep aids safely, and the billion-dollar industry they’ve become, researchers are concerned about the risk for dependence.
For example, one 2008 study of rats found that diphenhydramine and cocaine – a highly addictive substance – had a similar effect on dopamine release in the brain.
OTC sleep aids are simply not designed to be a long-term solution for insomnia. Insomnia requires treatment that can address underlying conditions. When people take higher than the recommended dose of an OTC sleep aid, use them on a long-term basis, or otherwise don’t follow safe use guidelines, their risk of dependence and other adverse outcomes may increase.
Sleep aids should be used on a short-term basis to relieve difficulty falling asleep during a period of two weeks or fewer. Good examples of this may include:
Sleep aids are designed to help you fall asleep when there is a temporary situation causing difficulty sleeping. They are not designed to cure chronic insomnia. It’s important to use sleep aids sparingly and on a temporary basis, for both your immediate sleep needs and your long-term help.
Sleep aids work because they are highly effective, but that’s also what can make them potentially addictive. If a person comes to rely on the sleep aid to help them fall asleep, instead of adjusting their lifestyle or behavior, or addressing the underlying health conditions that contribute to their insomnia, they’ll always have trouble sleeping without the sleep aid. If sleep aids are used as a long-term solution, the underlying issue is never resolved. Not only will their insomnia persist, but the person may begin to experience other unfortunate side effects as well.
Instead of applying a short-term fix to a long-term problem, the healthier, more sustainable approach is to implement lifestyle and behavioral changes for better sleep. Just a few lifestyle changes can relieve insomnia for a majority of people. We’ll review these in a later section of the article.
Even when used on a short-term basis, sleep aids, like most drugs, may cause side effects that make them unsafe for some people. Over-the-counter sleep aids do have fewer side effects than prescription sleep aids, but they are still important to be aware of. They include:
There are instances where over-the-counter sleep aids pose a stronger risk for certain groups of people. If you fall into one of the following categories, you should probably avoid sleep aids altogether or at the very least consult your doctor first before using them.
Generally, most OTC sleep aids should be avoided by children younger than 12 years old. Depending on their age, children have different physiologies than we do as adults. Taking the same dosage or medication as recommended for adults can be very unsafe for children. Doctors even recommend that the pediatric dosage be adjusted for natural sleep aids like melatonin.
Also, there are a variety of insomnia triggers that may be unique to a child’s experience, such as a fear of the dark, nightmares, sleepwalking, or trouble at school.
If your child is having trouble sleeping, our Parents Guide to Healthy Sleep offers behavioral strategies you can try to help them sleep better. You may also speak to their pediatrician about their sleep issues as well.
During pregnancy, a woman’s body goes through extreme changes that can make restful sleep difficult to achieve. Unfortunately, sleeping well is important to a healthy pregnancy. But the hormonal and physical changes associated with pregnancy can increase the mother’s risk of suffering adverse side effects from taking over-the-counter sleep medication.
Consult with your doctor before using natural sleep aids, too. The body’s production of melatonin naturally increases at 24 and 32 weeks of pregnancy, and scientists have not yet determined whether melatonin is safe for pregnant mothers. One study of rats found that melatonin negatively impacted the size, health, and mortality rate of their pups.
Our guide to Pregnancy and Sleep offers safe sleep products and behavioral tips you can try to help you sleep better.
If you are temporarily sick and are taking other over-the-counter medications to relieve your symptoms, they may negatively interact with a sleep aid. Since most over-the-counter sleep aids are antihistamines, and you are also taking antihistamines for a cold or allergy, you may inadvertently overdose and cause adverse side effects.
It is best to avoid taking sleep aids in addition to other medication when you’re sick, unless your doctor has given you the go-ahead. Instead, try switching to “nighttime” versions of your medication at night to help you fall asleep.
If you have a chronic condition and regularly take other medications to manage your system, you’ll want to consult with your doctor before introducing an over-the-counter sleep aid into the mix. You just want to be sure that the ingredients don’t interact negatively with each other.
Chronic conditions that pose a particular risk include sleep apnea, asthma or another chronic lung disease, glaucoma, severe liver disease, Alzheimer’s, or urinary retention or problems due to an enlarged prostate.
Your doctor may be able to suggest a healthy sleep aid option for you that won’t affect your medication, or you may rely on the behavioral methods below to help you fall asleep better.
For a long-term fix to your insomnia, healthcare professionals, sleep experts, and researchers alike recommend employing behavioral techniques. Studies consistently show that lifestyle modifications and behavior changes can solve a multitude of sleep problems for most people.
Review the following list of research-backed sleep tips. Consider how you can incorporate more of these into your life so you don’t need to rely on over-the-counter sleep aids.