Sleeping pills explained: Benzos to barbiturates to Z-drugs

If you can’t sleep, it’s as easy as going to the pharmacy or your doctor for some pills, right?

Well, it’s true that sleep medications are very accessible. They’re also very popular, according to a recent study which estimated around 4% of American adults used prescription sleep meds at least every month.

Some people might argue, though, that just because sleep aids are accessible and popular doesn’t make them the right solution.

People use sleeping pills for a variety of reasons. How many reasons? Well, the International Classification of Sleep Disorders (ICSD) has created eight categories of sleep disorders. There are dozens of sleep disorders on the ICSD list, including different kinds of insomnia, sleep apnea, and narcolepsy.

Doctors prescribe sleep medications to help their patients fall asleep, stay asleep, or deal with conditions that might interfere with their sleep, such as anxiety or bipolar disorder.

Just as there are different kinds of sleep disorders, there are different kinds of treatments for them. Medication is just one popular treatment for such disorders.

Not surprisingly, there are several different kinds of medications that address sleep disorders or the symptoms of such disorders.

For the purposes of this article, we’ll be discussing one broad type of sleep disorder, insomnia, which is the inability to fall asleep or stay asleep on a regular basis. (There are different kinds of insomnia, too, but we’ll be discussing insomnia in a general sense.)

Many people use medications to treat their insomnia. These medications have an effect on their users’ abilities to sleep and on other aspects of their lives.

That’s because most sleep medications have an impact on the brain. In this respect, sleep medications are like other types of drugs because they are psychoactive, which means they affect the brain or the way it functions.

The sleep medication-induced changes to the brain, though, can be quite intense or unusual. As with other decisions in life, the decision to use sleep medications requires some research and caution.

To help you compare types of sleep aids and what they can do, we’ve compiled a list of common sleep medications.

Benzodiazepines (Benzos)


Benzodiazepines, or benzos, are one type of sleep medication. Although the name benzodiazepine might sound like an exotic chemical, benzos are very common.

There’s a good chance that you or someone you know has used benzos, since this class of drugs includes Valium, Xanax, Ativan, Librium, Klonopin, and Halcion. In fact, doctors prescribe more benzodiazepines than any other type of sleep medication.

Benzodiazepines work by increasing the level of gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter, which means that it’s a substance that can stimulate or depress the brain.

In this case, people who use benzodiazepines trigger the brain to produce GABA, a chemical which depresses their brains and spinal cords (their central nervous systems). This helps promote feelings of sedation and relaxation and provides a release of tension.

Due to these effects, doctors also prescribe benzodiazepines to treat conditions such as anxiety or bipolar disorder. These depressive effects are also why drugs such as benzodiazepines are also known as hypnotics or hypnotic drugs.

Since they affect the brain so strongly, benzodiazepines can be highly addictive. People using the drugs could easily become dependent on them. The trouble is, the more benzodiazepines people take, the more they become accustomed to them.

They need more and more of the drugs to relieve their sleep or ease their anxiety. That’s why most medical professionals recommend prescribing benzodiazepines for a limited amount of time.

People taking benzodiazepines or similar sleep medications also shouldn’t drink alcohol, as both alcohol and benzodiazepines are depressants. Using the two substances together can produce severe, even fatal side effects.

Interestingly enough, though, drug and alcohol rehab facilities in California sometimes use benzodiazepines to help treat addictions to other benzodiazepines or to treat symptoms associated with alcohol withdrawal.

That’s because benzodiazepines and alcohol are depressants, and people can experience increased anxiety and other side effects when they stop using these depressants. Rehab facilities give their patients benzodiazepines to counter the anxiety and other side effects.



Barbiturates are another type of drug that has been used to treat insomnia and anxiety. Phenobarbital, secobarbital, amobarbital, and tuinal (a combination of amobarbital and secobarbital) are all kinds of barbiturates.

These drugs were common in the 1960s and 1970s, which seems to give them a Valley of the Dolls-type association. Doctors do not prescribe barbiturates to treat insomnia or anxiety much anymore.

Instead, they prescribe benzodiazepines for those purposes, although they still prescribe barbiturates to treat epilepsy.

Like benzodiazepines, barbiturates depress the brain and the spinal cord. While they are not positive, scientists believe that barbiturates might bind to spots on nerve cells and disrupt the movement of sodium ions, which disrupts the flow of information from the nerve cell.

Scientists also theorize that barbiturates might bind to spots on cells that are receptive to GABA, the neurotransmitter also instrumental in helping benzodiazepine produce its depressive effects.

When barbiturates bind to these spots, they increase the flow of chloride ions and prevent the flow of information from the nerve cells.

Because of these depressive effects, people who overdose on barbiturates might appear drunk or impaired. Like benzodiazepines, people can easily develop tolerances and addictions to barbiturates.

That’s partly why doctors stopped prescribing them. Despite that, people are still becoming hooked on barbiturates, even though the legal use of the drug has declined. Many people believe that barbiturates contributed to the death of iconic guitarist Jimi Hendrix in 1970.

Nonbenzodiazepines (Z-drugs)


Nonbenzodiazepines are yet another type of prescription sleep aid. Drugs in this category include Lunesta, Ambien, and Sonata. They are also known as the Z-drugs since their generic names often include the letter Z (eszopiclone for Lunesta, zolpidem for Ambien, and zaleplon for Sonata, for example).

Nonbenzodiazepines have different chemical compositions from benzodiazepines, although they behave in similar ways. Like benzodiazepines, nonbenzodiazepines boost the levels of GABA to calm activity in the brain.

Because of this calming effect, nonbenzodiazepines treat insomnia and depression, also like benzodiazepines.

In fact, the depressive nature of nonbenzodiazepines can cause people to feel drowsy, dizzy, and unstable. This is while the users are awake. While they’re asleep … let’s just say that the drugs can produce some odd behavior.

People have made phone calls, cooked and baked, eaten food, had sex, and even driven cars, all while asleep and under the influence of nonbenzodiazepines. The danger of this sleep activity eventually led the U.S. Food and Drug Administration (FDA) to issue warnings about these drugs.

These behaviors have also prompted doctors to be careful about prescribing specific doses of nonbenzodiazepines for limited amounts of time.

For all these weird behaviors, nonbenzodiazepines do seem to have some advantages over other sleep  medications.

These advantages stem from the fact that nonbenzodiazepines work more efficiently on certain areas of the brain that deal with sleep, instead of more general brain areas that perform multiple functions. Nonbenzodiazepines are thus more targeted types of medications.

This targeting also means that users are less likely to become tolerant to the drugs or addicted to them. Users also might experience less lingering tiredness and illness after they take them, a condition known as the hangover effect.

Over-the-counter (OTC) sleep medications

Over the counter sleeping aids

Over-the-counter (OTC) sleep medications are a traditional method many people use to induce sleep. Some drugs treat just insomnia. Other over-the-counter medications combine sleep aids with ingredients that reduce pain, fight colds, or suppress coughs.

There are a wide variety of over-the-counter substances in a variety of forms, some of the popular name brands including Nytol, ZzzQuil and Calms Forte.

The common denominator is that they all promote sleep (or claim to promote sleep) and that you can obtain all of them without prescriptions.

Many OTC sleep medications contain diphenhydramine, an antihistamine. An antihistamine is a substance that treats allergies. Antihistamines work by affecting the way that histamines affect the body.

Our bodies produce histamines when faced with allergens (allergy-producing substances) and other potential threats.

Histamines keep us alert, so it makes sense that using antihistamines can make us drowsy. Like prescription medications, over-the-counter medications might create the lingering tiredness and illness of the hangover effect.

The common occurrence of the hangover effect illustrates the similarities among different kinds of sleep aids. If manufactured, sold, and used properly, over-the-counter sleep medications seem to provide many of the same benefits and carry many of the same risks as their prescription counterparts.

One benefit of prescription medications is that they require people to visit medical professionals to obtain prescriptions. These professionals might be better at diagnosing medical conditions and finding appropriate treatments than people outside the medical field.

The dangers of sleep meds and alternatives

Sleep medications have helped many people find sleep and relieve anxiety. Other people have built tolerances to these sleep medications and have even developed addictions to them.

To counter these dangers, doctors usually prescribe sleep medications for short periods of time. Pharmaceutical companies have also been developing drugs with less potential for abuse.

People are also searching for ways to treat insomnia without the use of drugs entirely. Some people take supplements of melatonin, a hormone that helps control the body’s wake/sleep cycle.

Melatonin can make people drowsy and relaxed, so people use the substance to promote sleep and sedation. Other people use the herbal extract valerian to treat insomnia and anxiety because it sedates the brain.

Chamomile,  often used in tea, is still another herb that people to treat their insomnia and other conditions.

People are also turning to therapy to find sleep. Cognitive behavioral therapy (CBT) trains patients how to replace thoughts and actions that hinder sleep with thoughts and behaviors that promote it.

CBT often incorporates relaxation and meditation techniques, requires patients to leave their beds if they are not tired, asks patients to limit their caffeine and alcohol intake, and establishes consistent times for going to sleep and rising from sleep.

CBT also encourages patients to create the proper environment that will encourage sleep. This environment is typically cold, quiet, and dark. Electronic devices and other potential distractions are not allowed in these environments because of the light, noise, and stress that they could create.

Some people sleep with ceiling, floor, or table fans to create more sleep-friendly environments. These fans cool bedrooms and can provide a steady humming noise that some people find calming.

Speaking of noise, other people swear by white noise sleep solutions to help them drift off. These machines provide steady sounds that block out more distracting noises that might hamper sleep.

Other forms of technology can help the sleep impaired. If you have to work on the computer before bedtime, you might want to consider downloading f.lux.

This free app adjusts the color of your computer screen to match the light of the time of day or night. Studies have shown that the bright light of computer screens and other electronic devices could prevent the body from producing the normal amount of melatonin needed to help people sleep.

You can also buy sleep tracking devices or download an app to help you estimate how long you sleep and what kinds of sleep you’re experiencing. If you’re struggling with sleep conditions, also consider undergoing sleep study tests.

These tests can provide a detailed analysis of your sleep, which could help diagnose whether you have a sleep disorder. The tests could also help you determine how to treat your sleep issues.

Since so many people suffer from sleep problems, people are working on more techniques to solve them. The science of sleep is relatively new, so we’re still learning about sleep, disorders, and treatments. One wonders what dividends this research will pay in the future.

List of references

“Barbiturates,” howMed,

“Barbiturates,” Neuroscience for Kids, University of Washington,

Chong, Yinong, Cheryl D. Fryar, and Qiuping Gu, “Prescription Sleep Aid Use Among Adults: United States, 2005-2010,” Centers for Disease Control and Prevention (CDC),

“Insomnia Treatment: Cognitive Behavioral Therapy Instead of Sleeping Pills,” Mayo Clinic,

Pietrangelo, Ann, “Lunesta vs. Ambien: Two Short-term treatments for Insomnia,” Healthline,

“Prescription Sleeping Pills: What’s Right for You?,” Mayo Clinic,

Shaw, Gina, “When Counting Sheep Fails: The Latest Sleep Medications,” WebMD,

[about nonbenzos being less addictive, hangover effect, sleep cycles]

“Sleep Aids: Understand Over-the-Counter Options,” Mayo Clinic,

Soong, Jennifer, “Sleeping Pills: Prescription or OTC?,” WebMD,

Sutherland, Stephani, “Bright Screens Could Delay Bedtime,” Scientific American,

Watt, Anthony, “Benzodiazepines,” Healthline,

Pam Zuber has been a writer and editor for over 20 years, covering many topics including health, emotional wellness, and substance abuse.

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