Bonnie Procter, a 39-year old mother of four, was first prescribed a sleep aid by her endocrinologist following a surgery in 2015. “You need to get some sleep so you can heal,” she remembers her doctor telling her.
At first it was great, Procter says. “I’d take the pill and I’d go to sleep. But before long, I would take it and then wake up after a few hours and not be able to go back to sleep.” Any sleep she did manage to snag was poor quality, and she could feel her mental health deteriorating. “I’d be hysterical with tiredness,” Procter wrote on Facebook of her experience.
Back to the doctor Procter went, desperate for a solution. More prescriptions, including for a benzodiazepine (a class of sedative drugs that includes Xanax, Klonopin, and Valium), followed. Procter says the cycle continued for years: The meds would work for a time, and then they’d stop. Sleepless nights would lead to more doctors and more meds.
Procter’s sleep-aid flywheel dramatically came to a stop in November of 2022 when medications she was taking—some prescribed for sleep and others for pain-management following a severe accident—had an interaction that landed her in the hospital’s Intensive Care Unit. “I almost died,” Procter says. “After that I was like, ‘No way.’” No more sleep meds; she tapered off her medication and began to seek alternative sleep solutions.
Procter’s story is an extreme version of an all-too-common narrative: Patient needs sleep, patient tries a sleeping pill (maybe prescribed by a doctor, maybe not), patient sees diminishing returns from said sleep aid, stress and anxiety regarding sleep increase, and the cycle continues.
The urgency and frequency with which people, particularly older and middle-aged women, seek sleep solutions show that they’re aware of just how important sleep is.
“Sleep is necessary to function optimally in every domain of life, both mentally and physically,” says sleep specialist Angela Holliday-Bell, MD. But what they might not realize is that these drugs are little more than Band-Aid solutions—ones that are quick to fall off, at that.
Over-the-counter and prescription sleep medications may help you fall asleep, says preventative neurologist Kellyann Niotis, MD, but for various reasons, many related to cognitive function, “in the long term, they’re doing more harm than good.”
Sleep issues are more common in women—and get worse with age
While all demographics suffer from sleep disturbances, women are more prone to insomnia than men, are at greater risk of experiencing restless leg syndrome, and are more likely to “report difficulty maintaining sleep, feeling unrefreshed in the morning, and excessive daytime sleepiness,” according to a review article published in Frontiers of Neuroscience in 2021. This over-indexing of sleep issues for women is partly because when hormones that cis women have in greater quantities than cis men fluctuate—such as during a person’s monthly menstrual cycle or at life stages such as pregnancy and menopause—it can impact sleep.
“Progesterone plays a big role in sleep and in maintaining sleep. For instance, oftentimes women will experience bouts of insomnia with sleep disruption surrounding their periods [due to progesterone drops during this time of the month],” says Dr. Holliday-Bell. “Then as [women] get older, shifts in progesterone and estrogen that happen—especially that come with menopause—significantly increase rates [of insomnia].”
Dr. Holliday-Bell points out that during menopause, rates of obstructive sleep apnea (a sleep disorder that is, on average, more common in men) for women are equal to those seen in men. Because of this, “there are more disruptions in sleep, pauses in breathing while sleeping, decreased oxygen to the tissues while sleeping” for menopausal women.
Shelby Harris, PsyD, who is board-certified in behavioral sleep medicine and the director of sleep health at Sleepopolis, adds, “Sleep issues are common among women, and age-related factors can contribute to specific sleep problems. Hormonal changes during perimenopause and menopause can lead to hot flashes, night sweats, and mood swings, which can cause sleep disruptions and worsen sleep quality.”
And those are just the biological forces behind poor sleep. What are some of the driving reasons behind poor sleep in women? “Well, life in general!” says integrative sleep medicine physician Valerie Cacho, MD, founder of the sleep education platform Sleephoria. “Take a look at the role women play within their family circles—maybe they’re still caregiving for children and have elderly parents. Sometimes there can be a lot of work stress on top of that…Women do a lot for everybody and then put themselves last as we get older.”
This pressure to be everything, everywhere, all at once is so pervasive for women in midlife, Dr. Cacho says, that it can perpetuate the myth that it’s a fact of life to be tired all the time. “When women discuss poor sleep and how tired they are [online or with their friends], it seems like it’s the norm: You get to a certain age in your life and you’re just supposed to be tired,” she says.
Because this run-down and sleepless feeling has been normalized, Dr. Cacho says, she thinks many women don’t take the important step of seeing a specialist to find relief. Instead, they turn to what feels like a simple, accessible solution: sleep meds.
Older women use sleep medication more than anyone else
According to a data brief released by the National Center for Health Statistics (a unit of the Centers for Disease Prevention and Control) in January 2023, over 18 percent of U.S. adults over the age of 18 take either an over-the-counter (OTC) or prescription medication to fall asleep. Women were more likely than men to take sleep medication and usage increased with age (for both genders): 7 percent of men aged 45 to 64 reported using sleep meds in the past 30 days, compared to 13 percent of women in the same age group.
Often, as was the case for Bonnie Procter, these sleeping pills are prescribed by doctors. “I think even well-intentioned medical professionals tend to prescribe [sleep meds] more than they actually should,” says Dr. Holliday-Bell, who says it can be difficult to address the underlying causes behind poor sleep. “We want this quick fix. Everyone’s used to having a medication for something.”
Alleged quick fixes have also never been easier to access. The market for sleep medications of all types swelled during the COVID-19 pandemic, and market research projects it will continue to grow through 2029.
The risks associated with sleep medications
“People often have some misconceptions about sleep aids. They may think sleep aids are a cure-all, or that over-the-counter ones are always safe,” says Dr. Harris. “Some believe taking more sleep aids will work better, or that they don’t need to consult a healthcare professional before using them. However, sleep aids can have side effects and risks, and it’s important to talk to a sleep specialist or your doctor before trying them.”
No sleep drug is 100-percent risk-free, and sleep experts say that each type comes with its own set of red flags. With prescription sleep meds (such as Ambien or Lunesta), side effects such as grogginess, headaches, and nausea are common. Rarer but still possible—and potentially life-threatening—are parasomnias, or unusual behaviors performed while falling asleep, while sleeping, or soon after waking. “There have been instances where people have gone driving while sleeping on Ambien, and [behaviors] like sleep walking are a lot more common” while under the influence of a sleep drug, says Dr. Holliday-Bell. “It can be very dangerous.”
Dr. Niotis adds that benzodiazepines, anxiety medications that are sometimes prescribed as sleep aids, can be addictive and “have an association with cognitive decline and dementia.”
Besides, Dr. Holliday-Bell says, the sleep you get after you’ve popped an Ambien isn’t always what she would call quality sleep. “People end up sleeping, but it’s more of this sedative state,” she says. “I like to compare it to anyone who’s ever had a major surgery and has been put to sleep or gone under anesthesia: You’re sleeping, but you don’t necessarily wake up feeling so refreshed and amazing after that sleep. It’s a technical sleep, but it doesn’t necessarily recreate the sleep stages that you would go through naturally.”
Dr. Holliday-Bell also cautions against sleep aids because it’s easy to quickly develop a tolerance to them. “Then, people will need higher and higher doses to achieve the same effect as what they were initially seeing with the smaller dose,” she says.
This is true, too, for natural supplements—including Miss Popularity, melatonin, which Dr. Holliday-Bell says she only recommends to patients for short-term use, such as for acclimating your circadian rhythm after traveling.
“Melatonin is a slippery slope because melatonin is a hormone,” adds Dr. Niotis. “Anytime you take an exogenous hormone, you are suppressing your body’s ability to produce that hormone itself. I wouldn’t rely on melatonin nightly.”
It’s also important to keep in mind that the quality of alternative remedies can vary. “Many natural sleep aids, such as melatonin, are not regulated by the FDA in the U.S., so there can be a lot of variability in each bottle and there’s no guarantee that the label accurately reflects the dosage or ingredients,” says Dr. Harris.
“There’s a lot of misinformation out there,” echoes Dr. Holliday-Bell. While some sleep supplements and products that are marketed as sleep aids do have well-studied ingredients, “the problem is there’s not a lot of research surrounding those things, so it can be difficult to really determine how true the effect is and, in addition, the amounts necessary to achieve those effects without risky side effects.”
How to get help for sleep issues
Instead of self-medicating, anyone suffering from sleep issues should reach out to their health care provider or consider seeing a sleep specialist.
Medical sleep aids are sort of like pain medications, says Dr. Cacho. “When you fall and you break your arm, we’re definitely going to give you medications for the symptoms that you’re having, but it doesn’t do anything to fix the broken bone, right? That’s basically how sleeping pills are working. They help slow down your brainwaves to help induce sleep. But at the end of the day, if you don’t figure out what caused you to have poor sleep, are you really doing yourself any benefit from just taking a pill?”
In her practice as an integrative sleep specialist, Dr. Cacho says she takes stock of each patient as a whole person. “What’s going on in their brain that can keep them from sleeping? Are they anxious? Are they overly depressed?” she says. Or is it something physical: Do they have sleep apnea? Do they have vitamin deficiencies, pain, or other medical issues that are contributing to their sleep issues?
For people going through menopause in particular, Dr. Holliday-Bell urges you to seek treatment for your specific symptoms. “Oftentimes, women will assume, ‘There’s nothing I can do about this…And while that’s true, it is a change that’s happening, there are things you can do to mitigate the symptoms in a way that’s going to be more conducive to sleep,” she says.
For instance, there are medications (such as menopausal hormone replacement therapy or the recently approved drug to treat vasomotor symptoms of menopause) or alternative therapies available that could help ease sleep-disrupting hot flashes. Working with your provider to address the symptoms of menopause can also benefit your sleep.
After switching from sleep meds to holistic, behavioral methods of achieving sleep—such as breathing exercises and tapping, or the emotional freedom technique (EFT)—Procter says she now consistently gets seven hours of sleep a night. A happy ending, but not one that was easy to come by.
Behavioral changes take effort, says Dr. Cacho. “Give yourself time and space to try to figure out what’s going on before grabbing that pill.”