Potential Side Effects and Adverse Events of Prescription Sleep Medications

The potential side effects and risks of sleep aids are mainly related to the sedating effects of these medications and their impact on the body’s natural sleep architecture (the multiple stages of sleep that make up a complete sleep cycle). 

For most people, the side effects are mild and do not pose a major risk to daily activities, and serious adverse events are rare. The health benefits of improved sleep from short-term use of sleep medication may outweigh these risks for many people. 

Common Side Effects of Prescription Sleep Medications

The common side effects of all types of prescription sleep aids include some combination of:

• Drowsiness
• Dizziness
• Headache
• Gastrointestinal upset
• Dry mouth

This list is not exhaustive, and additional side effects may occur depending on the type of sleep aid and its mechanism of action. 

Potential nervous system side effects of sleep medications

Benzodiazepines (Restoril and Halcion), Z-drugs (Ambien, Lunesta, and Sonata), and trazodone are more commonly associated with cognitive and motor impairment side effects than other sleep aids.¹Restoril. Package Insert. SpecGx LLC; 2023^,2Ambien. Package Insert. Sanofi-Aventis U.S. LLC; 2019^,3Trazodone. Package Insert. Apotex Corp; 2023

Common symptoms and signs include confusion, poor physical or mental coordination, difficulty maintaining balance, and reduced attention and concentration. This risk is increased in older adults and people with liver disease.

Z-drugs are associated with a “drugged feeling” or feelings of euphoria.²Ambien. Package Insert. Sanofi-Aventis U.S. LLC; 2019

Potential psychiatric side effects of sleep medications

Benzodiazepines, Z-drugs, and dual orexin receptor antagonists (Belsomra and Quviviq) may cause abnormal dreams or nightmares.¹Restoril. Package Insert. SpecGx LLC; 2023^,2Ambien. Package Insert. Sanofi-Aventis U.S. LLC; 2019^,4Belsomra. Package Insert. Merck Sharp & Dohme LLC; 2023

Benzodiazepines and Z-drugs may cause or increase anxiety.¹Restoril. Package Insert. SpecGx LLC; 2023^,2Ambien. Package Insert. Sanofi-Aventis U.S. LLC; 2019

Potential cardiovascular side effects of sleep medications

Antidepressants used off-label (Trazodone and Remeron) may cause cardiovascular side effects, including orthostatic hypotension (reduced blood pressure when standing up), changes in heart rate, and fainting.³Trazodone. Package Insert. Apotex Corp; 2023^,5Mirtazapine. Package Insert. Apotex Corp.; 2023

Other potential unique side effects of sleep medications

Mirtazapine is associated with a risk of increased appetite and weight gain.⁵Mirtazapine. Package Insert. Apotex Corp.; 2023

Z-drugs, trazodone, and amitriptyline may cause blurred vision in rare cases.²Ambien. Package Insert. Sanofi-Aventis U.S. LLC; 2019^,3Trazodone. Package Insert. Apotex Corp; 2023^,6Amitriptyline. Package Insert. Advanced Rx Pharmacy of Tennessee, LLC; 2023

Serious Risks of Prescription Sleep Medications

All prescription medications indicated for insomnia have warnings for:

• Complex sleep behaviors. These are behaviors that people engage in while not fully awake. Complex sleep behaviors include: 
  • Sleepwalking
  • Sleep-driving
  • Preparing and/or eating food at odd hours
  • Making phone calls
  • Online shopping

These symptoms are rare and individuals who experience complex sleep behaviors usually do not remember these events.

• Next-day impairment. All sleep medications have the potential to cause symptoms of impairment the next day. Impairment symptoms can include drowsiness, reduced attention or concentration, slowed reaction times, and difficulty performing everyday activities like driving. 
• Behavior changes and abnormal thinking, including agitation, depersonalization, and bizarre behavior
• Worsening depression in individuals diagnosed with depressive disorders

It is advisable to discuss these risks and the potential benefits of using a sleep aid with the doctor.

Sleep-wake transition risks

Dual orexin receptor antagonists (Belsomra, Quviviq, and Dayvigo) have risk warnings for abnormal events that can occur during the brain’s transition between sleeping and waking up,⁴Belsomra. Package Insert. Merck Sharp & Dohme LLC; 2023including: 

• Sleep paralysis. This symptom is described as an inability to move or speak for up to several minutes when falling asleep or waking up. People may or may not be fully aware of their surroundings during these events. 
• Hallucinations. Hallucinations may include vivid and disturbing perceptions or waking dreams. Hallucinations may occur when falling asleep and when waking up from sleep.
• Cataplexy-like symptoms. These symptoms are characterized by sudden muscle weakness that occurs when a person is awake and can last for several seconds to minutes. The leg muscles are most commonly affected.

These events are rare and do not pose any health risks but may be disturbing or stressful if they are experienced. People with a history of experiencing similar events or other sleep-related behaviors (such as sleepwalking or sleep talking) may be at a higher risk for these events. 

Abnormal heart rhythm risks

The off-label use of some antidepressants (trazodone, mirtazapine, and amitriptyline) has risk warnings for severe heart rhythm abnormalities. These medications are used cautiously in people with known cardiovascular disease.³Trazodone. Package Insert. Apotex Corp; 2023^,5Mirtazapine. Package Insert. Apotex Corp.; 2023^,6Amitriptyline. Package Insert. Advanced Rx Pharmacy of Tennessee, LLC; 2023

Psychiatric disorder risks 

The off-label use of some antidepressants may potentially impact people with bipolar disorder by activating a state of mania or hypomania. Mania and hypomania are two related mental states that are characterized by a significant increase in energy, activity, and mood.³Trazodone. Package Insert. Apotex Corp; 2023^,5Mirtazapine. Package Insert. Apotex Corp.; 2023  

How to Manage the Side Effects of Sleep Medications

Every person responds differently to medication, and some people may experience more side effects than others. 

Communicating with healthcare providers

Engaging in open discussions with a healthcare provider regarding troublesome side effects or adverse events is crucial. They can evaluate potential medication interactions, make necessary dose adjustments, switch to a different sleep aid, or suggest alternative non-drug therapies to address the concerns effectively.  

Taking medications on time

Some side effects of sleep medications may continue into the next day and interrupt daily activities. Taking a sleep aid too late in the evening, with food, or with other sedating medications can increase the likelihood of these side effects. 

It may be helpful to consult with a doctor or healthcare professional about the best time to take a medication dose or what to avoid when taking a dose.

Following dose instructions

Following the dosage of a sleep medication as instructed can help reduce the risk of side effects and adverse reactions. Taking more than the prescribed dose of any sleep aid or abruptly stopping certain medications may increase the risk of complications.

Avoiding alcohol

Alcohol could be a contributing factor to sleep problems. Although it may initially induce drowsiness, it later disrupts sleep during the night, resulting in poor sleep quality.

Adopting a sleep hygiene routine 

Sleep hygiene refers to habits and behaviors that aim to help people fall asleep and improve the quality of sleep. Sleep hygiene typically includes:

• Limiting caffeine and stimulant intake, especially later in the day
• Avoiding the use of computers, smartphones, or other screens before bed
• Creating a soothing sleep environment (eg, a quiet, dark room and cooler temperature)
• Creating and sticking to a sleep schedule by going to bed and waking up at the same time every day
• Establishing relaxing bedtime routings (eg, reading a book or taking a bath)
• It may be helpful to combine these sleep hygiene habits with non-drug therapies to help manage insomnia and reduce the need for prescription medications.

Considering non-drug therapies

Alternative therapies to manage insomnia include:

• Cognitive behavioral therapy (CBT)
• Relaxation and meditation techniques
• White noise machines or relaxing sounds
• Natural electromagnetic frequencies (Schumann resonance)
• Light physical exercises (eg, yoga or gentle stretching) 
• Managing stress

The effectiveness of these therapies can vary from person to person. A combination of these therapies with good sleep hygiene is generally recommended.