The distinction matters
"Sleeping pills" is colloquial. The pharmacology underneath that phrase covers everything from over-the-counter antihistamines to controlled substances. They work differently, fail differently, and carry different risks. We try to use the right one only when it is the right one.
Sleep medication (hypnotics)
Prescription medications that act directly on sleep-related brain circuitry. Examples include benzodiazepines, non-benzodiazepine "Z-drugs" (zolpidem, eszopiclone), and dual orexin receptor antagonists.
- Generally effective for sleep onset and maintenance
- Tolerance and dependence are real concerns with longer use
- Side effects can include daytime sedation, memory issues, complex sleep behaviors
- We prescribe at the minimum effective dose, for the shortest duration, with a clear taper plan
Sleep inducers (over-the-counter & melatonin)
Substances that promote sleep onset more indirectly — through histamine blockade, melatonin signaling, or sedating mechanisms.
- Antihistamines (diphenhydramine, doxylamine) — short-term help; daytime grogginess common; not recommended long-term in older adults
- Melatonin — most effective for circadian-rhythm problems, less for primary insomnia; quality varies dramatically across products
- Herbal preparations — evidence varies; quality control is inconsistent
What we recommend
- Treat the underlying cause first — most "insomnia" has a treatable contributor
- CBT-I as first-line for chronic insomnia
- Pharmacology, when used, matched to the specific clinical situation
- Avoid chronic OTC antihistamine use, particularly in older adults
- Use melatonin for what it is good at (circadian alignment), not for what it is not (primary insomnia)
The right tool, briefly, beats the wrong tool, indefinitely.— Seoul Sleep Center pharmacology principle