Alternatives for Ambien Compared

What Is Ambien & What Is It Used For?

Ambien, containing the active ingredient zolpidem, is part of a class of medications called nonbenzodiazepine hypnotics. Ambien is FDA-approved for the short-term treatment of insomnia characterized by difficulties with falling asleep.

Ambien’s primary function is to promote sleep by affecting the activity of a neurotransmitter (brain chemical) called GABA. This action may have a sedative effect on the brain, aiding individuals in falling asleep more quickly.²

Ambien is also available in an extended release version called Ambien CR and as generic zolpidem in both immediate release and extended-release. Zolpidem is also available as another brand name called Edluar which is a tablet that dissolves in your mouth.

Reasons to Consider an Alternative for Ambien

Individuals may seek alternatives to Ambien for several reasons, often due to the side effects associated with its use. These may include complex sleep behaviors like sleep-walking or sleep-driving, as well as next-day drowsiness.

Additionally, Ambien may not be suitable for individuals with certain medical conditions, such as severe liver impairment and respiratory depression. Due to its potential for dependence and withdrawal, it may also not be recommended for those with a history of substance misuse. The risk of these adverse effects, coupled with the importance of matching treatment to individual health profiles and responses, makes considering alternatives essential for some patients.

Nonbenzodiazepine Hypnotics

Nonbenzodiazepine hypnotics, such as Ambien, are prescription medications used to treat insomnia. For some patients, these may be considered as alternatives to benzodiazepines due to different side effects or individual responses. Other medications of this type include eszopiclone (Lunesta), and zaleplon (Sonata). Notably, zopiclone (brand name Imovane) has been discontinued.

Other Prescription Medications Used for Insomnia

Other prescription medications that may serve as alternatives to Ambien for insomnia include sedative antidepressants and benzodiazepines. While these medications may help some individuals with sleep, their responses can vary significantly and are unique to each person.

Other prescription medications that may be used for insomnia include:

• Antidepressants: Some antidepressants, such as trazodone and doxepin (Silenor) are FDA approved to treat insomnia. However, potential risks associated with these medications may include dizziness, dry mouth, and weight gain.
• Benzodiazepines: Benzodiazepines such as temazepam, diazepam, and triazolam work by enhancing the effects of a neurotransmitter in the brain to promote relaxation and sleep. Common side effects may include drowsiness, dizziness, and the potential for dependence or tolerance.

Comparing Efficacy & Side Effects

When comparing the efficacy and side effect profiles of different medications for insomnia, it is essential to consider individual variability in response. Personalized treatment choices are crucial as medication responses can differ widely among individuals.

The table below compares prescription alternatives to Ambien:*

*All medications can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and understand the potential side effects and benefits of any medication.

How to Get a Prescription for Ambien Alternative Medications

To obtain a prescription for Ambien alternative medications, you will need to consult with a healthcare provider who is authorized to prescribe medications. This can include primary care physicians, psychiatrists, or other healthcare professionals with prescribing privileges.

Before prescribing antidepressants as an alternative to Ambien, your healthcare provider will typically conduct a thorough evaluation, which may include a physical examination, a review of your medical history, and an assessment of your symptoms. They will consider factors such as the severity of your insomnia, any underlying medical conditions, potential drug interactions, and your preferences. This medical evaluation will help determine which medication, if any, may be a suitable and beneficial treatment for your sleep issues.

Over-the-Counter Alternatives for Ambien

When looking for options that do not require a prescription, over-the-counter alternatives to Ambien can be considered. Antihistamines are a common choice for managing insomnia, as they can induce drowsiness. Additionally, cannabidiol (CBD) has gained popularity for its potential to promote relaxation and improve sleep quality.

Over-the-counter Ambien alternatives may include:

• Antihistamines: Antihistamines are commonly used to relieve allergy symptoms but can also cause drowsiness, making them helpful for managing insomnia. They work by affecting levels of histamine, a neurotransmitter that plays a role in wakefulness, thus promoting drowsiness and aiding sleep. Examples of these include diphenhydrame and doxylamine. Diphenhydramine is an antihistamine commonly found in over-the-counter sleep aids. It affects histamine levels in the brain, leading to sedation and drowsiness. Doxylamine is another antihistamine that is often used in sleep aids due to its sedative effects¹
• Cannabidiol (CBD): CBD, a compound derived from the cannabis plant, may promote relaxation and potentially improve sleep quality for some who use it. It interacts with the endocannabinoid system in the body, which regulates various physiological processes, including sleep.¹²

*All medications, including OTC sleep aids, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

How Effective Are Over-the-Counter (OTC) Alternatives to Ambien?

Over-the-counter alternatives (OTC) to Ambien, such as antihistamines like diphenhydramine and doxylamine, have shown limited effectiveness in treating insomnia. For example, a randomized, double-blind, crossover study demonstrated that tolerance to diphenhydramine’s sedative effect was complete within three days of administration.

Additionally, antihistamines are associated with potent anticholinergic effects, particularly in older individuals, and are generally not recommended for use in treating chronic insomnia. The study involved fifteen healthy men aged 18 to 50 years receiving diphenhydramine 50 mg or placebo twice a day for four days, showing significantly higher levels of sleepiness on day 1 compared to placebo, with tolerance complete by day 4.¹

Natural Supplement Alternatives for Ambien

For some who use them, natural supplement alternatives for Ambien may promote relaxation and support healthy sleep patterns. Some popular choices may include melatonin, valerian root, chamomile, and lavender. Melatonin is a hormone that regulates sleep-wake cycles and can be taken as a supplement to improve sleep quality.

Valerian root is an herb known for its calming effects and potential to reduce anxiety, which may aid in falling asleep. Passionflower and L-theanine are herbs with soothing properties that can help promote relaxation before bedtime.

Natural supplement Ambien alternatives may include:

• Melatonin: Melatonin is a hormone that regulates sleep-wake cycles. It is commonly used as a natural remedy for insomnia because it promotes relaxation and sleep. Research suggests that melatonin supplements may help improve sleep quality and reduce the time it takes to fall asleep.¹
• Valerian root: Valerian root is an herb used for centuries to treat sleep problems. It is believed to work by increasing levels of a neurotransmitter that helps regulate sleep. Valerian root may help improve sleep quality and reduce the time it takes to fall asleep, making it a potential alternative to Ambien.¹
• Kava: Kava, derived from the shrub Piper methysticum, is known for its sedative and muscle-relaxant properties. It acts on GABA and benzodiazepine binding sites, potentially helping with anxiety and stress, which are common contributors to insomnia.¹
• Passionflower: Passionflower is a plant often used as a natural remedy for anxiety and insomnia. It is thought to have calming effects on the brain, which can help promote relaxation and improve sleep quality. Some studies suggest that passionflower may be effective in reducing insomnia symptoms.¹³
• L-theanine: L-theanine is an amino acid found in tea leaves that has been studied for its potential sleep-promoting effects. It is known to induce relaxation without causing drowsiness. L-theanine may help improve sleep quality and reduce anxiety, making it a possible alternative to Ambien.¹⁴

*Dietary supplements (including vitamins, supplements, herbs, and natural medicines) are not regulated the same way as medications by the FDA. Before being sold to the public, these products do not have the same clinical trials to determine their safety and efficacy. You should consult your doctor or pharmacist before starting any new dietary supplement.

How Effective Are Over-the-Counter Alternatives to Ambien?

Natural herbs and over-the-counter (OTC) alternatives to Ambien, such as melatonin and valerian root, may be effective in improving sleep quality and duration for some individuals with insomnia. However, According to a study, caution should be exercised with substances like kava. The FDA has warned about the potential for severe liver injury associated with its use due to the lack of clinical efficacy and safety data.¹

The Role of Therapy & Lifestyle Changes in Managing Insomnia

Psychotherapy and lifestyle modifications are essential elements of a treatment plan for insomnia. These non-medication therapies offer a holistic way to address the root causes and symptoms of insomnia, either as standalone treatments or with medication.

It’s also beneficial to focus on more than short-term symptom management. Underlying psychological and lifestyle factors often contribute to sleep disturbances. Addressing these issues can help patients achieve more sustainable and long-term improvements in sleep quality and overall mental health.

Effective therapy options for conditions with insomnia as a symptom may include:¹⁵

• Cognitive behavioral therapy for insomnia (CBT-I): CBT for insomnia helps individuals change the thoughts and behaviors that disrupt sleep. It includes techniques such as stimulus control and sleep restriction, effectively reducing insomnia symptoms.
• Hypnosis for sleep: Hypnosis for sleep involves guided techniques to induce deep relaxation and suggestibility. Hypnosis can help reduce anxious thoughts that often hinder sleep, promoting a more restful state.
• Mindfulness and meditation: These practices focus on being present and fully engaged in the moment without judgment. Regular mindfulness and meditation can reduce stress levels, thus improving sleep quality.
• Relaxation techniques: Techniques such as progressive muscle relaxation and deep breathing exercises can help ease the body and mind into sleep by reducing physical tension and calming the mind.

Important lifestyle changes for conditions with insomnia as a symptom include:

• Getting regular exercise: The impact of regular exercise on mental health can improve both the quality and duration of sleep by reducing stress and anxiety levels. However, it’s best to avoid vigorous exercise close to bedtime as it may interfere with the ability to fall asleep.
• Avoiding alcohol, caffeine, and nicotine: These substances can disrupt sleep patterns. Alcohol may help with falling asleep but often leads to fragmented sleep, while caffeine and nicotine can make it difficult to fall asleep.
• Establishing a regular sleep schedule: Going to bed and waking up at the same time every day, even on weekends, can help regulate your body’s internal clock and improve sleep quality.
• Creating a comfortable sleep environment: Ensuring the bedroom is quiet, dark, and comfortable can significantly improve sleep quality. Investing in a comfortable mattress and pillows can also make a big difference.
• Limiting screen time before bed: The blue light emitted by screens can interfere with the body’s production of melatonin, the hormone that regulates sleep. Turning off electronic devices at least an hour before bed can help avoid this issue.

Mindful eating close to bedtime: Eating heavy or large meals within a few hours of bedtime can cause discomfort or indigestion, making it harder to fall asleep. Opt for light snacks if needed.

Questions to Ask Your Healthcare Team About Ambien Alternatives

When considering alternatives to Ambien, consider your whole health and well-being in your decision. Seeking alternatives might stem from various reasons, including side effects, concerns about dependency, or simply a desire for a different approach to managing insomnia.

Questions to ask your care team about Ambien alternatives include:

1. Is it safe to take Ambien alternative sleep aids with my other medications?
2. Am I at risk for side effects from Ambien alternative sleep aids or supplements if I am already taking other medications, such as anti-anxiety medication?
3. What Ambien alternatives sleep aids should I consider for fewer side effects?
4. Will my symptoms get better without medication?
5. Can I make any lifestyle changes to improve my sleep without medication?
6. How long should I try an Ambien alternative before determining its effectiveness?
7. Are there any non-medication treatments I should consider for my sleep issues?
8. What are the potential risks of long-term Ambien use, and how do alternatives compare in terms of safety?
9. Are there any specific dietary changes I should make to support better sleep?
10. Can you provide information on the efficacy and safety of melatonin as an alternative to Ambien?
11. Are there any underlying health conditions contributing to my sleep difficulties that must be addressed?
12. How can I gradually taper off Ambien if I decide to switch to an alternative sleep aid?