Are sleeping pills safe to take?

You've probably tried a lot already: cutting the caffeine, a bedtime routine, a podcast in the dark. So reaching for a pill can feel like failure and relief at once, and knowing the pack is there in the drawer may be half the comfort. If you've taken one for a long time, you may have a worry behind all the other questions. What is it doing to you, and could you sleep without it? For tonight, though, it comes down to some sleep, and a clear head when the alarm goes tomorrow.

What most people hope for from a pill is simple enough: to fall asleep sooner, and to sleep longer once they do. The prescription pills you're most likely to be holding, zolpidem or an older benzodiazepinebenzodiazepine A family of sedative medicines, such as diazepam and temazepam, prescribed for anxiety and sometimes for sleep. Taken for a long time, they can lead to dependence. such as temazepam, work through the brain's own braking system³⁵3 US Food and Drug Administration, 20205 Huedo-Medina et al., 2012 to slow the brain and bring on drowsiness.

Researchers once gathered the trials that the makers of zolpidem and its relatives had sent to the FDA: thirteen of them, with more than 4,000 adults with insomnia sleeping in a lab. On the drug, people fell asleep about forty-two minutes sooner⁵ than they had before. People on a dummy pill fell asleep sooner too. Set side by side, about twenty-two of those minutes came from the drug itself⁵, and about twenty came on the dummy pill as well.

What, then, does the pill itself add to your night? The American Academy of Sleep Medicine pooled the zolpidem trials for its guideline. Taken together, they showed zolpidem cut about twelve minutes from falling asleep and added about half an hour of sleep²2 Sateia et al., 2017. The academy rates the evidence behind those numbers as very low in quality, so they're best read as a rough guide. Why twelve minutes here and twenty-two in the FDA trials? The two figures come from different sets of trials. For the older benzodiazepines, the trials are thinner still². Newer pills that act on the brain's orexinorexin A messenger made by a small group of brain cells that helps keep us awake through the day and holds sleep and waking steady. It's also called hypocretin. system, such as daridorexant, do modestly better than a dummy pill⁶6 Kishi et al., 2025, with no evidence so far of tolerance or rebound²⁶ when they're stopped. Those trials ran only one to three months, though, which is too short to know for sure.

So on a hard night a pill can give you something real: somewhere between twelve and twenty-two minutes sooner asleep from the drug itself, and about half an hour more sleep. A good part of the ease you feel on it comes from you.

In many PM boxes, among them Advil PM, Aleve PM and Excedrin PM, the sleep ingredient is diphenhydramine, the same antihistamine sold for allergies as Benadryl⁷7 MedlinePlus, 2026d. That makes it easy to take twice in one evening without knowing: once in a painkiller, and again in an allergy tablet. Some PM boxes use a different ingredient, so you could turn yours over and check the label. What follows is about diphenhydramine alone.

On a hard night, a PM pill is likely to add only minutes of sleep²2 Sateia et al., 2017, too few for the sleep medicine guideline to count as a real difference. Your body also seems to get used to it within days. In a small trial, fifteen healthy men took it twice a day, and the sleepiness it caused had faded by the fourth day⁴4 Richardson et al., 2002. That was sleepiness by day; the trial didn't look at anyone's nights. If you have glaucoma, lung disease or trouble passing urine because of an enlarged prostate, you'd want a doctor to hear about it before you take it⁷.

Taken now and then, a pill is a visitor your body barely adjusts to, because dependence builds with steady use³3 US Food and Drug Administration, 2020. So on an occasional night, what matters most is how and when you take it. Zolpidem's label says to take it right at bedtime, with seven to eight hours still ahead of you in bed¹1 MedlinePlus, 2019. If you get up sooner, you can be drowsy, unsteady and forgetful, and it can impair your driving the next morning even when you feel wide awake¹. The guideline found this morning-after sleepiness was the main exception to zolpidem's otherwise mild side effects²2 Sateia et al., 2017, most of all with fewer than eight hours before waking. That's why a pill taken at 3am with the alarm set for 7 is the one most likely to follow you into the day.

The serious danger lies in combinations, when a pill meets other things that slow the brain and breathing. Benzodiazepines taken with opioids, alcohol or other sedativessedative Something that slows activity in the brain and makes you feel drowsy. have caused breathing so slow that people have died³. Alcohol adds to the effects of zolpidem and diphenhydramine¹⁷7 MedlinePlus, 2026d as well. So please don't take a sleeping pill on a night you've been drinking, or alongside another sleep aid. And if you wake at 2am with the pill already in you, please leave the pack where it is rather than reach for a second one¹.

A few people on zolpidem have got up and driven, cooked and eaten, made phone calls or sleepwalked without being fully awake¹, and remembered none of it the next day. Trials are too small to say how often this happens, so what's known comes mostly from clinical experience². If you find it has happened to you, please call your doctor straight away. The label says to stop the pill. If you've been taking it every night, your doctor can tell you how to stop safely, since stopping all at once can bring withdrawal.

If you're older, or helping a parent decide, the pills work differently in an older body. Here the evidence comes from trials in people over 60, who took a pill for at least five nights. Sleeping pills gave them about twenty-five more minutes of sleep a night⁸8 Glass et al., 2005. Memory loss, confusion and daytime tiredness, meanwhile, came far more often than on a dummy pill. For every thirteen people treated, one slept better, while for every six, one had a side effect⁸.

That's why the American Geriatrics Society advises older adults to avoid benzodiazepines for sleep and keep z-drugs to under ninety days²2 Sateia et al., 2017, because of falls, confusion and car crashes. Zolpidem can leave someone unsteady in the night and the next day, so getting up to the bathroom at night and the first hours of the morning both need extra care¹1 MedlinePlus, 2019. PM pills matter here too. A box on an open shelf isn't a sign that it suits an older body: diphenhydramine is generally not advised for people 65 and over⁷7 MedlinePlus, 2026d except for a serious allergic reaction.

If you've taken a pill most nights for months or years, nothing here asks you to stop tonight. Long-term use can be reasonable. The guideline notes that newer z-type drugs can stay safe and effective over the long term²2 Sateia et al., 2017 for some people: those for whom CBT for insomnia hasn't worked or isn't available, who keep benefiting and who see their doctor regularly.

Taken every night, though, a pill changes how your body responds to it. Zolpidem may not help as well after two weeks or more¹1 MedlinePlus, 2019 as it did at first. With a benzodiazepine, a few days to a few weeks of steady use, even exactly as prescribed, is enough for the body to adapt to the drug³3 US Food and Drug Administration, 2020. Then stopping suddenly brings withdrawalwithdrawal The body’s reaction when a drug it has adjusted to, such as a sleeping pill, another sedative or alcohol, is cut down or stopped too quickly. It can bring anxiety, shaking and sleeplessness, and at its most severe seizures, so stopping is planned with medical support.. This is physical dependence, and it's a different thing from addiction: your body has rearranged itself around a pill that arrives every night. How often either happens with sleeping pills isn't well known²³. The risk of dependence is greatest with benzodiazepines taken for a long time, at rising doses, with no one keeping an eye on them.

If the pill you take every night is a PM one, the evidence is a separate and thinner story. The sleep medicine guideline suggests not using diphenhydramine for long-running insomnia, because in trials it added only minutes of sleep²2 Sateia et al., 2017. In that small trial, the daytime sleepiness it caused in healthy men had faded by the fourth day⁴4 Richardson et al., 2002, a hint rather than a measure of anyone's nights. And heavy use over many years⁹9 Gray et al., 2015 is where the early dementia link you'll read about below comes from.

If you're 65 or over, diphenhydramine is generally not advised⁷7 MedlinePlus, 2026d, and your doctor would want to know you take it. Whatever your age, a pharmacist is someone you could talk it over with, or your doctor if you have one.

Please don't stop a nightly benzodiazepine or z-drugz-drug A group of prescription sleeping pills, such as zolpidem, that act on the same calming system in the brain as older sedatives like benzodiazepines. all at once. Stopping suddenly, or cutting down too fast, can bring withdrawal: with zolpidem, shakiness, nausea, sweating, panic, bad nights and, rarely, seizures¹1 MedlinePlus, 2019, and with benzodiazepines, seizures that can be life-threatening³3 US Food and Drug Administration, 2020. The way off is a gradual taper you plan with your doctor³, stepping the dose down over time. No single schedule suits everyone. If withdrawal shows up along the way, the two of you can pause the taper or step it back, then carry on more slowly.

In Québec, researchers worked with seventy-six older adults who had taken a benzodiazepine for sleep for an average of nineteen years. Over ten weeks, some tapered under a doctor's supervision, some had CBT for insomnia alongside the same taper, and some had CBT for insomnia alone. By the end, eighty-five percent of those who had both were off the drug¹⁰10 Morin et al., 2004, against forty-eight percent with the taper alone and fifty-four percent with CBT alone. A year later, they had kept those reductions. They had no significant withdrawal symptoms, and their sleep went on improving for months.

So if you're looking for a way off, what helps most? When researchers pooled eight trials like this one, people who added CBT for insomniaCBT for insomnia Cognitive behavioral therapy for insomnia: a short course of practical, talking-based techniques that help retrain sleep. It’s the first treatment doctors recommend for long-term insomnia. to their taper were more likely to be off their benzodiazepine sleeping pills¹¹11 Takaesu et al., 2019 in the first few months. By a year, the difference was no longer clear. A 2025 review found low-certainty evidence that simpler help may count too: explaining the pills and the taper, a look through someone's medicines, or a pharmacist's program may help more people stop¹²12 Zeraatkar et al., 2025. That same review didn't find compelling evidence for CBT on its own¹² as a way off. The two reviews asked different questions: one compared CBT added to a taper with the taper alone, and the other looked at CBT by itself. Neither settles which kind of extra help works best. A reasonable way to go, then, is a slow taper planned with your doctor, with CBT for insomnia alongside it if you can get it.

Guidelines put CBT for insomnia first²¹³2 Sateia et al., 201713 Qaseem et al., 2016 for long-running insomnia, because its gains last after the sessions end, while a pill's tend to fade once you stop. If you'd like a next step, you could read what it would ask of you, whether or not you're ready to come off.

It's a frightening thing to read, and researchers don't agree yet. When studies that followed people over time were pooled, those who took benzodiazepines were about 1.4 times as likely to be diagnosed with dementia¹⁴14 Penninkilampi & Eslick, 2018. But which came first, the pill or the dementia? Insomnia and anxiety can be early signs of dementia¹⁵15 Gray et al., 2016, so some people may reach for a pill in its first years, before anyone knows it's there.

A team in Seattle tried to pull those apart. They followed 3,434 people aged 65 and over, and they left out each person's most recent year of pill use, so that early signs of dementia would be less likely to muddy things. If the pills caused dementia, you'd expect the risk to climb with heavier use. It didn't. The risk was slightly higher at the lowest use and not at the highest¹⁵, and the researchers said that pattern doesn't support cause and effect.

The PM pills raise a different question. The same Seattle researchers looked at anticholinergic medicines, a group that includes diphenhydramine. Dementia risk was about 1.5 times higher⁹9 Gray et al., 2015 in people who'd taken the equivalent of more than three years of daily use over a decade, with no clear rise at lower amounts. That study pooled every kind of anticholinergic medicine, sleep aids among many. It watched people over time without testing a drug, so it's an early finding.

So where does that leave you? There is a link, and researchers are still arguing over it. So far, though, the evidence doesn't show that the pills cause dementia, and the most careful study didn't find the pattern you'd expect if they did. Studies of whole populations have also tied sleeping pills to infection, depression and earlier death in older people, but the guideline calls that evidence scant and inconsistent²2 Sateia et al., 2017. If the worry stays with you, your doctor is a good person to talk it through with. And if you decide to come off, the slow taper above is the way to do it, since stopping all at once can bring withdrawal.

On an odd hard night, with a full night in bed ahead and no alcohol, a pill asks very little of you. Every night, it asks more. The way back takes time, but people do find it, even after many years on the pills, as the older adults in Québec¹⁰10 Morin et al., 2004 did.