It's 2:00 a.m. and you're staring at the ceiling. You check the clock every five minutes to calculate how much sleep you can squeeze in before the alarm jolts you awake. You've tried warm milk and relaxation tapes, yet you're still wide-awake. Should you take a sleeping pill?

If this sounds like your nightly routine, take heart. Insomnia affects millions of people, and new sleep aids and other remedies claiming to solve the problem are plentiful. What's the best course of action and how do you know if sleeping pills or other sleep preparations are safe enough for regular use?

Talk to Your Doctor First

Before taking an over-the-counter sleep aid, speak to your doctor. Gary K. Zammit, PhD, president of the Sleep Disorders Institute at St. Luke's Hospital in New York City, advises that "not all sleep aids are the same and over-the-counter preparations may not be recommended for your problem. Overall, one should keep in mind that insomnia not only results in considerable nighttime distress for the insomnia sufferer, it is associated with next-day impairment, and may even have effects on health and mood."

Dr. Zammit also stresses that everyone's needs are different. "Some people need to use a medication nightly, [while] others need medication that offers flexible options and few side effects," he says.

Over-the-Counter vs. Prescription Medication

Sleeping pills are available over-the-counter and by prescription. Use these tips when considering the use of sleep aids:

  • Take the medication exactly as prescribed.
  • Try the medication only after you have tried changing your behavior.
  • Use the lowest possible effective dose.
  • Don't automatically take a pill every night; use the medication only when you must have an uninterrupted night of sleep. Even then, it's a good idea to take only a few sleeping pills per week.

Over-the-Counter Sleep Aids

Many over-the-counter sleep aids contain antihistamines, while other contain the hormone melatonin.

Sleep aids containing antihistamines are common and include medications such as Tylenol PM, Nytol, and Unisom, among others. Some people take a pure antihistamine drug, such as Benadryl, to help them fall asleep. The main problem with these remedies is known as the "hangover effect," in which the next morning you may feel sluggish, sleepy, or have difficulty performing daily tasks.

Melatonin is a hormone that is secreted in the brain and helps our bodies to regulate the sleep-wake cycle. Melatonin is sold as a dietary supplement, rather than as a medication, and is therefore not subject to regulation by the Food and Drug Administration (FDA) for standards of potency and purity, so proceed with caution.

Dr. Zammit concurs, "Over-the-counter health food products are not exposed to the same kind of rigorous clinical testing as prescription medications. Therefore, people should speak with their doctors and consider prescription medication if it is advised. Insomnia results in distress and impairment, so using no treatment or the wrong treatment may pose risks."

There is some research that supports that melatonin may help treat jet lag and insomnia. However, initial studies are incomplete and an optimal dosage has not officially been established. If you decide to try melatonin, be sure to first consult your physician.

Prescription Medications

There are several prescription sleep aids available. Most physicians prescribe a class of drugs called benzodiazepines or an antidepressant. Benzodiazepines include medications such as Valium, Xanax, Klonopin, and many others.

Some prescription sleep aids, such as the benzodiazepines, have been associated with problems of dependence, but, according to Dr. Zammit, "Recent data suggests that most people who are given sleep aids use them appropriately." Studies are showing that dependence may be less of a problem with newer medications, such as Ambien and Sonata.

Side effects

According to the National Sleep foundation, many factors can influence potential side effects of prescription sleep aids, including:

  • Age
  • Dose of the drug
  • The drug's half-life (the amount of time it takes for one-half of the drug to be lost through biological processes)

"Rebound Insomnia"

High doses of sleep medications may result in what is known as rebound insomnia. This occurs when a person stops taking a sleep medication and subsequently experiences a few nights of insomnia that is more severe than what was originally experienced prior to treatment. Rebound insomnia generally occurs with medications that have a short half-life and can be avoided by slowly tapering the dose. Consult your physician prior to stopping or increasing your dose.

Healthy Sleep Habits

The goal is to have healthy sleep habits, which may prevent the need for sleep aids. The National Sleep Foundation recommends the following:

  • Keep a regular sleep schedule.—Our sleep-wake cycles are regulated by a circadian clock in our brain and the body's need to balance sleep and wake times. It is beneficial to go to bed and get up at the same time each night to allow your body to get in sync with this natural pattern.
  • Avoid caffeine, nicotine, and alcohol.—Caffeine and nicotine are stimulants. Nicotine can also cause nightmares. Caffeine-containing products such as coffee, tea, and chocolate remain in the body on average from three to five hours, but some people are affected for up to 12 hours. Alcohol causes sleep disturbances throughout the night. While alcohol may help you to relax and fall asleep, it can lead to a night of less restful and shallow sleep.
  • Don't eat or drink too close to bedtime.—It's best to avoid a heavy meal too close to bedtime. Spicy foods may cause heartburn, which leads to difficulty falling asleep and discomfort during the night. A light snack is often best before bed and may help you sleep better.
  • Exercise at the Right Time to Promote Sleep.—Exercising right before bedtime will make falling asleep difficult. Besides making us alert, exercise causes a rise in body temperature, which can take approximately six hours to begin to drop. A cooler body temperature signals the body that it's time for sleep.
  • Use relaxing bedtime rituals.—This may include taking a bath, reading a book, meditating, or listening to relaxing music. Use techniques that work best for you and your bed partner.
  • Create a sleep-promoting environment.—The best sleep environment is a cool, quiet, and dark room. Be sure to check your room for noise or other distractions. Make sure that your mattress is comfortable and supportive for your body.

If you suffer from chronic insomnia, see your doctor. You may be experiencing a symptom of a larger problem such as clinical depression or a sleep disorder. Your physician will help you find the treatment plan or medication that's best for you.