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Unveiling the Truth About Over-the-Counter Sleep Aids: Efficacy, Safety, and Alternatives

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As a sleep physician, I understand the struggle that many individuals face when it comes to getting a good night’s sleep. The allure of over-the-counter (OTC) sleep aids is understandable, but it’s crucial to tread carefully in this realm. However, before reaching for that bottle of sleep medication, it’s crucial to understand the efficacy and safety concerns associated with these OTC remedies.

Common OTC Sleep Aids and Their Mechanisms of Action

The primary categories of OTC sleep aids include:

Antihistamines: These medications work by blocking histamine, a neurotransmitter that promotes wakefulness. Examples include diphenhydramine (commonly known as Benadryl) and doxylamine succinate (Unisom). These antihistamines have sedative effects, but their long-term use for sleep is questionable. Moreover, these medications can cause dry mouth, constipation, and urinary retention, especially in older adults.

Melatonin: A naturally occurring hormone that regulates sleep-wake cycles, melatonin supplements are marketed to promote sleepiness and improve sleep quality. While melatonin is generally considered safe, it’s important to note that its efficacy can vary from person to person. Additionally, excessive use may disrupt the body’s natural production.

Herbal Supplements: Various herbal remedies, such as valerian root and lavender, are often touted for their sleep-inducing properties.

Doxepin: A Low-Dose Antidepressant for Sleep : Doxepin, an old tricyclic antidepressant, has found a new role in low doses for the treatment of insomnia. Sold as Silenor, it targets histamine receptors to induce drowsiness. However, caution is advised, as side effects may include dry mouth, constipation, and blurred vision. It is not recommended for individuals with certain medical conditions.

CBD: Exploring Cannabidiol for Sleep : Cannabidiol (CBD), derived from the cannabis plant, has gained popularity for its potential relaxing effects. While some studies suggest CBD may help with sleep, the evidence is still in its early stages. Concerns about the purity and regulation of CBD products also exist, making it important to choose reputable brands.

Some of the commonly known and popular OTC sleep aids include:

  1. Melatonin Supplements: Melatonin is a hormone that helps regulate the sleep-wake cycle. It’s available in various forms, including tablets, gummies, and liquids.
  2. Diphenhydramine (Benadryl): Diphenhydramine is an antihistamine commonly used in allergy medications. Its sedative effects make it a component of some OTC sleep aids.
  3. Doxylamine (Unisom): Similar to diphenhydramine, doxylamine is an antihistamine found in certain OTC sleep aids like Unisom.
  4. Valerian Root: Valerian root is an herbal supplement believed to have mild sedative effects. It is available in various forms, including capsules and teas.
  5. ZzzQuil: ZzzQuil is an OTC sleep aid that often contains diphenhydramine as the active ingredient. It is marketed specifically for its sleep-inducing properties.
  6. Advil PM and Tylenol PM: These pain relievers combine analgesics (ibuprofen or acetaminophen) with an antihistamine (usually diphenhydramine) to address pain and induce sleep.
  7. Sominex: Sominex is another OTC sleep aid that commonly contains diphenhydramine as its active ingredient.
  8. Alteril: Alteril is a sleep aid that typically combines ingredients such as melatonin, L-tryptophan, and valerian root.
  9. ZZZquil PURE Zzzs: This is another product by the makers of ZzzQuil, featuring different formulations that may include melatonin and other herbal ingredients.

Efficacy of OTC Sleep Aids

The effectiveness of OTC sleep aids varies depending on the specific product and the individual’s sleep concerns. Antihistamines, while effective in inducing drowsiness, can cause daytime grogginess and potential cognitive impairment. Melatonin may offer modest improvements in sleep duration and quality, but its efficacy is not universally established. Herbal supplements, on the other hand, lack substantial scientific evidence to support their claims of sleep enhancement.

Safety Considerations

While OTC sleep aids are generally considered safe for occasional use, there are potential risks associated with their prolonged or improper use. Antihistamines can lead to daytime drowsiness, impaired coordination, and increased risk of falls, especially in older adults. Melatonin, though relatively safe, may interact with certain medications and may not be suitable for individuals with specific medical conditions. Herbal supplements, while often perceived as natural remedies, can interact with other medications and may cause adverse effects.

Alternative Approaches to Sleep Enhancement

Before resorting to OTC sleep aids, it’s essential to address potential underlying causes of sleep disturbances. Stress, anxiety, and poor sleep habits can significantly impact sleep quality. Lifestyle modifications, such as establishing a regular sleep schedule, creating a relaxing bedtime routine, and avoiding caffeine and alcohol before bed, can make a substantial difference.

If sleep problems persist despite lifestyle changes, consulting a Sleep Medicine specialist is recommended. They can assess the underlying cause of your insomnia and recommend appropriate treatment options, which may include cognitive behavioral therapy or prescription medications.

Recommendations for Safe and Effective Use

Adhere to recommended dosages: Never exceed the recommended dosage of any OTC sleep aid, as this can increase the risk of side effects and potential overdose.

Avoid long-term use: OTC sleep aids are intended for short-term use, typically up to two weeks. Prolonged use can lead to dependence and diminishing effectiveness.

Be mindful of interactions: Disclose any medications or supplements you are taking to your healthcare provider, as OTC sleep aids can interact with certain drugs, potentially causing adverse reactions.


While OTC sleep aids may offer temporary relief for occasional sleep disturbances, they should not be considered a long-term solution. If sleep problems persist, seeking professional evaluation and addressing underlying causes are essential for achieving sustainable sleep improvement. Remember, a good night’s sleep is not just about the number of hours spent in bed; it’s about the quality of that sleep and its restorative impact on your overall health and well-being.


Imtiaz Ahmad, MD, MPH, FCCP

Dr. Imtiaz Ahmad is a highly qualified physician, Board Certified in Pulmonary and Sleep Medicine. He has been actively serving the community of Lee County, Florida since 2004, with a strong focus on a proactive healthcare approach. Dr. Ahmad has received advanced training from some of the most prestigious institutions, including Harvard University, Cornell University, State University of New York at Brooklyn, and the University of Mississippi. SOMNAS is a medical facility that is committed to improving and maintaining the health of patients with sleep disorders. The expert team at SOMNAS is known for their compassionate and high-quality care. They offer unparalleled treatment and care to patients on the Gulf Coast of Florida, ensuring a better and healthier life for them.

Job Title: Board Certified in Pulmonary Medicine

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