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Are Over-the-Counter Sleep Aids Risky to Take Long-Term?

Is there anything better than crawling into bed after a full day? Your body craves sleep. But it seems as soon as you pull the covers up, your mind immediately fights to stay awake. Over-the-counter (OTC) sleep aids work in a pinch to switch you into sleep mode. But long-term, could these medicines do you harm?

Salma Patel, MD, a sleep medicine specialist at Banner – University Medical Center Tucson offered advice to people who may rely on over-the-counter sleep aids for weeks or months at a time. “Most over-the-counter sleep aides have diphenhydramine, doxylamine, melatonin, valerian or chamomile as the active ingredients,” said Dr. Patel. “Each carries its own risks and benefits.”

OTC sleep aids can be broken down generally into two categories: medications and dietary supplements. Both are known to be relatively safe when taken as recommended.

Sleep aid medications

Diphenhydramine and Doxylamine

Some common examples of OTC sleep medications with these active ingredients include Tylenol PM, Nytol, Sominex, ZzzQuil and Unisom. These drugs are antihistamines, which you also find in Benadryl, Zyrtec and other common allergy medications. Antihistamines block certain chemicals in your brain, helping you relax and making you feel sedated. Tolerance to these active ingredients can be developed rather quickly, which tempts users to increase dosage beyond the recommendation.

Risks for sleep aid medications

Side effects associated with sleep aid medications include dry mouth, urinary retention, blurred vision, confusion and constipation. Dr. Patel added, “The use of these medications is especially concerning in older or elderly individuals as they may be at a higher risk for confusion, dizziness and falls.”

Many decongestants containing pseudoephedrine (Sudafed) and allergy medications ending in “D” (Claritin-D) can be dangerous to people with heart conditions and those on heart medication. The active ingredient constricts blood vessels and could put additional stress on the heart, especially when used long-term. Since many of these are labeled as “drowsy,” some may consider taking them as a sleep aid. This should be avoided. Diphenhydramine and doxylamine, which are antihistamines, are generally safe for the heart. You can learn more about your heart health by taking our Heart Age Test.

Additionally, sleep aid medications often pair the active ingredient for sleep with other medications. For example, Tylenol PM includes diphenhydramine to help you sleep, and also acetaminophen, a medication prescribed for pain relief. If you are taking other medications, you should consult with the pharmacist to make sure occasional sleep aids are safe.

Dietary supplements


Melatonin is a hormone that your body releases naturally when it’s time to sleep. Taking melatonin triggers this response and helps your body relax. Some have reported side effects including headaches and confusion, but the supplement is generally very safe and can be effective in adjusting the timing of your sleep phase.

Chamomile and Valerian root

If you’re a lover of teas, then you know all about chamomile. It has been used for centuries to help people sleep and comes with very little risk. Similarly, Valerian root is a natural supplement that can be effective and very low- risk for side effects. Allergies exist for both, so take caution if you are trying these for the first time.


“Studies have shown saffron also has the ability to relax and soothe us into more restful sleep,” said Dr. Patel. “The supplement may also have positive effects on pain relief and emotions.”

Risks for dietary supplements

Melatonin, chamomile, Valerian root, saffron and other dietary supplements are generally safe options to help you fall asleep. A word of caution however – the FDA doesn’t regulate dietary supplements. Which means there’s no guarantee the package contains what the manufacturer claims.

Long-term risks of over-the-counter sleep aids

“All of the sleep aids can be associated with daytime grogginess, and although addiction is not common, the efficacy of the drugs can wear off as your body grows a tolerance,” said Dr. Patel. While most won’t find themselves addicted to sleep aids, they may find that higher doses may be required to get the same effect. Dr. Patel warned against exceeding the recommended dosage, even if you still can’t fall asleep.

Dangers of prescription sleep aids

Prescription sleep aids are typically classified as sedative hypnotics. They are much stronger than OTC options and come with serious side effects including dizziness, nausea, hallucinations, depression and more. Studies have also found links to increased heart risk among other concerns.

Still can’t sleep?

If you feel the need to use a sleep aid for more than one week or if you are escalating your dosage, chances are good that something bigger is affecting your sleep.

“There may be underlying issues that can be easily addressed,” commented Dr. Patel, “such as sleep apnea (stopping breathing during sleep), poor sleep-related behaviors (such as excessive use of electronics), stress or anxiety.” Schedule a meeting with a sleep specialist to learn the root causes behind your trouble sleeping. Reliance on sleep aids for sleep problems can only last for so long. Sometimes a sleep medicine physician may need to perform a sleep study which allows for a thorough evaluation of brain waves, movements and breathing during sleep.

To determine your risk for sleep apnea and if seeing a sleep specialist is right for you, take our free sleep assessment

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