Are Over-the-Counter Sleep Aids the Answer to a Full Night’s Rest?

Is there anything more irritating than feeling exhausted but being unable to fall asleep? Okay, probably, but struggling to drift off is still the worst. That said, if you feel like the only one in the world who can’t seem to get a little shut-eye, know that you’re not alone: One in three adults worldwide is affected by insomnia, according to the Cleveland Clinic.

Perhaps unsurprising given this, data from the National Health Interview Survey in 2020 found that 8.4 percent of U.S. adults take a sleeping pill or over-the-counter sleep aid, often every day. Additionally, proctors found that women were more likely than men to take sleep supplements, and the older women get, the more likely they are to reach for insomnia medication.

That said, while the use of sleep vitamins and natural supplements has seemingly risen over the years—in 2022, a Consumer Reports survey found that approximately one in three U.S. adults say they’ve taken sleep supplements—recent research shows that the sleeping pills prescriptions have dwindled by a hefty 31 percent.

While lifestyle changes could certainly be a factor contributing to this shift (given behavioral therapy is often suggested as a means for insomnia treatment), another major reason why the prescription of sleep medications is being curbed is likely because so many great natural sleep remedies and safe over-the-counter sleeping aids now exist. The global sleep aids market is already valued at $76 billion as of 2023, and it’s expected to grow to just over $103B by 2028.

How does an over-the-counter sleep aid work?

Many OTC sleep aid rely on the hormone melatonin as the active ingredient. “When cortisol becomes disrupted as a result of chronic stress, it can interfere with melatonin production, which means you’ll have trouble falling asleep, staying asleep, or both,” says integrative medicine physician Taz Bhatia, MD, an ambassador for the vitamin brand OLLY. “Sleep aids that contain melatonin, a naturally occurring hormone, help regulate the internal clock that controls your sleep cycle.”

In addition to decreasing the time it takes to fall asleep, Dr. Bhatia says that melatonin also increases rapid-eye-movement (REM) sleep, a phase of the sleep cycle characterized by vivid dreaming, increased brain activity, and rapid eye movements, during which most dreaming occurs. This is why some people have more vivid dreams while taking sleep medications. (Intrigued? The OLLY Sleep Gummies, $10, are my personal faves.)

Melatonin isn’t the only type of over-the-counter sleep aid, though. OTC sleep medications can take the form of antihistamines, including allergy meds like diphenhydramine, which is found in ZzzQuil Nighttime Sleep-Aid LiquiCaps ($5), according to the Centers for Disease Control and Prevention. A side effect of these medications is drowsiness, which is why they can be helpful at bedtime. (Just keep in mind: They may not always cause a restful sleep, and may result in a “sleep hangover” the next day.)

What is the OTC equivalent to Ambien?

As beneficial as sleep gummies and other sleep supplements can be for sinking into a steady slumber, it’s important to note that no OTC sleep aid is equivalent to Ambien (aka Zolpidem), a prescription sleeping pill that acts as a sedative designed to help users fall asleep faster and stay asleep longer.

While no true substitute exists without a prescription, Sleepless in NOLA sleep expert Nilong Vyas, MD, who is a medical review expert at SleepFoundation.org, says that Benadryl and Unisom mimic Ambien thanks to their sedative properties. That doesn’t mean you should go gulping the medications or double-dosing pills, though.

Is it safe to take OTC sleep aids regularly?

Although the wellness industry would have you believe that melatonin supplements and other OTC sleep aids are necessary additions to your nightly routine, clinical psychologist Michael Breus, PhD, founder of TheSleepDoctor.com, says that taking over-the-counter sleep aids every evening isn’t advisable.

“Very few people need one every night,” he says. “While there are some extenuating circumstances—for example, pain, certain mental health issues, some medical diagnoses, and some medications—I never recommend [OTC sleep aids] for daily use.”

This is due to their potential side effects, according to Dr. Breus. “There is at least one study showing how daily use has a direct correlation to severe cognitive disorders like Alzheimer’s,” he says. (Though, it’s worth noting that this study specifically speaks to pharmacological sleep medication, such as benzodiazepines. This is an important differentiation, as OTC sleep aids are non-pharmacological medications.)

That said, there’s another study that reveals that there may be a link between OTC sleep aids (as well as prescription sleeping pills) and strokes that was conducted on middle-aged to older individuals with no history of stroke.

Beyond the potential risks associated with taking sleeping pills long-term, Dr. Breus points out that it’s possible to overdose on over-the-counter sleep aids. “In addition, many people use alcohol while taking them which only makes things worse,” he says. It’s also possible for sleeping pills to mask a true underlying sleep problem that should be addressed for healthy sleep long term.

How to fall asleep faster without an over-the-counter sleep aid

While OTC sleeping pills offer temporary relief from insomnia and sleep disturbances, their potential side effects have not been extensively studied enough, and the little research there is indicated potential serious health risks from regular use. Because of this, many doctors and sleep experts suggest starting with lifestyle changes before reaching for sleeping pills, even of the OTC variety.

“My clients who have trouble falling and/or staying asleep have seen dope outcomes in the realm of lifestyle changes,” says licensed therapist Kier Gaines, who, like Dr. Bhatia, is an OLLY ambassador. “The three most recurring being cognitive behavioral therapy [CBT], improving sleep hygiene, and moving your body. CBT is the therapy that I practice. My clients and I build coping skills and search through the ways our thoughts, feels, and behaviors are connected. It helps with anxiety and depression, which are closely linked to sleeplessness.”

When it comes to boosting sleep and improving your sleep, you’ll just want to be mindful of the movement you choose. If you’re working out at night (even if it’s earlier in the evening), you’ll want to implement calmer sequences, such as yoga, tai chi, barre, or Pilates. If you prefer higher-intensity workouts like HIIT, heavy lifting, and endurance training, practice them earlier in the day. While you may feel exhausted after such energy expenditures, research suggests that it takes longer to fall asleep following vigorous exercise—and it’s more difficult to stay asleep.

Meanwhile, sleep hygiene may not be what you think—it’s about how snooze-friendly your routine and space are. Are you going to bed and waking up at consistent times? Are you filling your diet with the best foods for sleep? Do you have a bedtime routine that allows you to unwind before you need to fall asleep? (Sipping on a cup of tart cherry juice or Moon Juice’s Magnesi-Om, $42, both of which are natural sleep aids, can help.) Is your lighting warm and soothing? Are your sheets comfortable and breathable? Is your bed positioned in sight of a window so you can still benefit from sunrise? If not, do you have a sunrise alarm clock (like the Hatch Restore 2, $200) to mimic the natural event, which proves beneficial for our circadian rhythms?

These are all small changes you can make that can greatly impact the quality of your sleep, as well as how quickly you drift off.

The takeaway

As Dr. Vyas sees it, an over-the-counter sleeping aid is helpful temporarily to recover from jetlag or to get back into a healthy sleep routine, but it shouldn’t be used nightly. If you feel compelled to always keep a jar of melatonin gummies by your bedside (guilty as charged), it may be time to call a doctor to determine any other underlying conditions that could be present. If they find nothing, consulting with a sleep coach may help.

—reviewed by Angela Holliday-Bell, MD