January 12, 2026

Six Common Sleep Aids, Compared

Research data only — consult your doctor or pharmacist

These articles are for informational purposes only and should not substitute for your doctor's guidance.

Three supplements, one over-the-counter drug and two prescription drugs, set against the same criteria. Where a column is blank, the research is blank too. Every claim is numbered to a source below. Effect sizes are averages from trials; individual response varies. This is not medical advice. For a more personal look at how medications and supplements fit your profile, try our Zoimetrics Health Analysis.

Supplementnot reviewed by the FDA before saleOTC drugFDA-approved, no prescriptionPrescriptionstrength of the evidence that it improves sleep

Criterion	Melatoninhormone supplementSupplement	Magnesiummineral supplementSupplement	ValerianValeriana officinalis rootSupplement	DiphenhydramineBenadryl, ZzzQuil, the "PM" in Tylenol PMOTC drug	TrazodoneDesyrel, used off-labelPrescription	ZolpidemAmbien, Ambien CRPrescription
What it is	A hormone the pineal gland releases in darkness; the supplement is chemically identical.¹² Sold as a dietary supplement in the US, so the FDA does not review it before it reaches shelves.⁶ Use among US adults rose from 0.4% to 2.1% between 1999 and 2018.⁷	An essential mineral, sold in many salt forms. Reviews cannot yet say which form, dose or duration to prefer.¹⁴	An extract of valerian root, used as a sedative in Europe since antiquity.¹⁷ Often blended with hops, lemon balm or melatonin in "sleep formula" products, which are barely studied.¹⁶	A first-generation antihistamine that crosses into the brain and blocks histamine's wake-promoting signal. FDA-approved as an over-the-counter nighttime sleep aid, unlike the supplements here.²¹ Roughly 21% of US older adults report using OTC sleep aids.²⁰	An antidepressant (a serotonin antagonist and reuptake inhibitor) used off-label at low doses for sleep.²⁶ Not a controlled substance and very cheap, which is much of its appeal to prescribers.²⁶ At 25–150 mg it mainly blocks histamine and serotonin-2A receptors; antidepressant effects need far higher doses.²⁸	A "Z-drug": acts on the same GABA-A system as benzodiazepines but binds more selectively.³⁰ FDA-approved for insomnia since 1992; 39.4 million prescriptions dispensed in 2011 alone.³¹
Evidence it improves sleep	Small but real. About 7 minutes faster to fall asleep and 8 minutes more sleep than placebo across 19 trials and 1,683 people.¹ A quality review noted the extra sleep time showed up only in self-reports, not objective recordings, and that one large trial dominated the pooled result.²	Weak and thin. About 17 minutes faster to fall asleep, pooled from three small trials in 151 older adults; the 16-minute gain in total sleep was not statistically significant.¹³ Those trials were rated low to very low quality, at moderate-to-high risk of bias.¹³ A 2026 review found results inconsistent, with subjective measures looking better than device-recorded ones.¹⁴	Inconsistent. Trials have produced conflicting results and its value for insomnia has not been demonstrated.^15,16 Later literature leans toward no benefit for insomnia.¹⁸	Small and uncertain. In the trials the AASM reviewed (50 mg doses), sleep latency fell by about 8 minutes and total sleep rose by about 12 minutes, but the confidence intervals crossed zero in both cases.¹⁹ It makes most people drowsy; that is not the same as measurably better sleep.	Sparse, despite heavy use. It has not been properly studied for insomnia and is not FDA-approved for it; safety information is limited.²⁶ It is nonetheless the most prescribed insomnia drug: 130.9 prescriptions per 1,000 Medicaid enrollees in 2023, against 27.3 for zolpidem.²⁵	Best-evidenced of the six. FDA-approved, and the AASM suggests it for both sleep onset and sleep maintenance insomnia, though only as a weak recommendation.¹² In older adults specifically, the Beers panel judges the improvement in sleep latency and duration to be minimal.²⁴
Where it works best	Body-clock problems rather than ordinary insomnia. In delayed sleep-wake phase disorder, 0.5 mg an hour before the target bedtime moved sleep onset 34 minutes earlier.⁵ It works as a hypnotic mainly when your own levels are low: in young adults it lengthens sleep only when taken during the biological day.⁸	Nothing is well established. The strongest signal is self-reported insomnia severity in adults over 55.¹³ Current evidence cannot identify which populations benefit.¹⁴	No use is well supported. Evidence for anxiety, stress and other claimed uses is also insufficient.¹⁵	Occasional short-term sleeplessness, not chronic insomnia; tolerance makes nightly use self-defeating.^20,21	Patients with co-occurring depression or anxiety, where one drug can address both.²⁷ Sleep maintenance, since it is sedating through the night without acting on GABA.³⁰ Prescribers also reach for it when they want to avoid habit-forming drugs.²⁶	Short-term difficulty falling asleep (immediate release) or staying asleep (controlled release).³²
When to take it	Clinical practice is 2 mg about 30 minutes before bed, but a 2024 dose-response meta-analysis of 26 trials suggests 4 mg taken about 3 hours before bed works better.³ For shifting the body clock, roughly 3 hours before your own melatonin rise, at a small dose.⁴	Not a bedtime pill in the research: trials used 320–729 mg of elemental magnesium split into two or three daily doses for 20 days to 8 weeks.¹³	Taken before bed, but it appears to need two or more weeks of regular use, and the effective dose is unclear.¹⁸ Studied doses were 300–600 mg daily for up to six weeks.¹⁵	The usual adult dose for occasional sleeplessness is 50 mg at bedtime.²¹ It should not be taken every night.²¹	The real-world median dose is 50 mg a night, with a 30-day supply.²⁷ Its short half-life at low doses (3–6 hours) is why it is used for night-time sleep without a long hangover.²⁸	Immediate release: 5 mg for women, 5 or 10 mg for men. Controlled release: 6.25 mg for women, 6.25 or 12.5 mg for men.³² Taken right at bedtime, with a full night available before driving.³²
Next-morning effects	Generally mild at the doses studied. Dose changes what you get: in adults over 55, 5 mg raised sleep efficiency where 0.3 mg did not.⁸	Not meaningfully studied. Trials reported no serious adverse events but were short and small.¹³	Reported side effects include mental dullness, headache, dizziness, stomach upset and vivid dreams.¹⁵ Because it may be sedating, driving after taking it is discouraged.¹⁸	Anticholinergic effects are the concern; the Beers panel groups anticholinergics with the drugs that cause impaired psychomotor function and falls.²² Continued nightly use is linked to next-day cognitive impairment.²¹	Common complaints are drowsiness, dizziness, confusion, dry mouth and headaches.²⁶ Psychomotor impairment matters most for older patients.²⁹	The clearest morning impairment of the six. Eight hours after 10 mg immediate release, 15% of women and 3% of men still had blood levels associated with impaired driving; after 12.5 mg controlled release it was 33% and 25%.³⁴ The FDA advises against driving the day after taking the controlled-release form at all.³²
Age	Older adults may need more, not less, than the popular low doses.⁸ Children are the safety flashpoint: calls to US poison control centers for pediatric melatonin rose 530% from 2012 to 2021, with 4,097 hospitalizations and two deaths.⁹	The only pooled trial evidence is in adults aged 55 and over.¹³ No basis for pediatric use.	Not evaluated for children under 3, and safety in pregnancy and breastfeeding is unknown.^15,18 Long-term safety at any age is unknown.¹⁵	Cumulative use of strong anticholinergics like this one was linked to higher dementia risk in a 7-year study of 3,434 adults over 65, with more exposure carrying more risk.²³ The finding is observational, and at least one published letter argues it may be inflated by residual confounding.²³	In older adults the salient risks are dizziness, blood-pressure drops on standing, arrhythmias and psychomotor impairment; parkinsonism has also been reported.²⁹ Still often preferred over Z-drugs in this group because it has minimal effects on breathing.³⁰	The 2023 Beers Criteria say to avoid Z-drugs in adults 65 and over: their adverse effects resemble benzodiazepines.²² In nursing-home residents, Z-drugs were associated with hip fracture (odds ratio 1.66), rising to 2.20 in new users.²⁴ Blood levels run higher in older patients, and the male-female difference disappears with age.³³
Sex	No established difference in the trial literature.	No data; trials are too small to split by sex.	No data.	No established difference.	Priapism, a prolonged erection needing emergency care, is rare but is the one clearly sex-specific risk.²⁹	The only sleep drug here with a sex-specific label. Women had peak blood levels about 45% higher than men and cleared the drug more slowly, so in 2013 the FDA halved their recommended dose.^31,32 Not everyone agrees: a 2019 study found women no more impaired than men eight hours after a dose.³⁵
Body weight	No weight-based dosing in adult trials.	No data.	No data.	The adult OTC dose is not weight-adjusted.²¹	Not weight-adjusted; dosing is titrated by response and tolerability.²⁷	The FDA looked and found no relationship between blood levels and body weight or ethnicity.³³
Tolerance and dependence	The sleep effect did not fade with continued use across the pooled trials.¹ No withdrawal syndrome described.	None reported, though trials ran eight weeks or less.¹³	Stopping abruptly after long-term use can cause anxiety, irritability, insomnia and, rarely, hallucinations.¹⁵	The fastest tolerance of the six: it has been reported after just four days of use.²⁰ After about two weeks people may become reliant on it to fall asleep.²¹	Not a controlled substance and does not act on GABA, so it does not produce benzodiazepine-style physical dependence.³⁰ Stopping suddenly can still bring rebound insomnia.²⁶	People become dependent on it to fall asleep; stopping abruptly worsens insomnia, so it has to be tapered.²⁶ Withdrawal from Z-drugs can include delirium, which itself raises fall risk.²⁴
Main risks and interactions	You often do not get the dose on the label: of 25 gummy products tested, 22 were mislabelled, with actual content ranging from 74% to 347% of the declared amount and one containing no melatonin at all.⁶ An unpublished 2025 conference abstract found heart failure in 5% of long-term users versus 3% of matched non-users. It cannot show cause, and chronic insomnia itself affects heart health.^10,11	The main documented risk is the absence of evidence: reviewers judged the literature too weak to support recommendations.¹³	Rare liver injury, usually in products combining several herbs.¹⁷ Adds to alcohol, sedatives and anesthetics; guidance is to stop it two weeks before surgery.¹⁸	Anticholinergic load is the core issue, producing dry mouth, constipation and urinary retention alongside sedation.²³ Its presence in combination products means people take it without realizing.²⁰	QT prolongation and arrhythmias at higher doses; serotonin syndrome when combined with other serotonergic drugs.²⁹ Carries the antidepressant class warning about suicidal thoughts in children and young adults.²⁹	Carries the FDA's strongest warning for complex sleep behaviors, including sleepwalking and sleep-driving.²⁶ Combined with opioids, Z-drugs appear more hazardous than previously thought.³⁰
What the guidelines say	AASM: clinicians should not use it for sleep onset or maintenance insomnia (weak recommendation, based on 2 mg trials).^12,19	Not addressed by the 2017 AASM guideline.¹²	AASM: clinicians should not use it for sleep onset or maintenance insomnia (weak).^12,15	AASM: clinicians should not use it for sleep onset and maintenance insomnia (weak, based on 50 mg trials).¹⁹	AASM: clinicians should not use it; the task force judged its harms to outweigh its benefits.²⁹	AASM: suggested for both sleep onset and maintenance insomnia (weak).¹² Beers Criteria: avoid in adults 65 and over.²²

One thing missing from the grid

The AASM's own position is that drugs belong mainly to patients who cannot do cognitive behavioral therapy for insomnia, who still have symptoms after it, or who need a short-term addition to it.¹² None of the six columns above is the guideline's first choice.

About the AASM

The AASM is the American Academy of Sleep Medicine, the main professional body for sleep medicine in the US. It's the group behind most of the "not recommended" and "weak recommendation" verdicts in the grid — they're the ones who publish the clinical practice guidelines that doctors actually use when deciding what to prescribe (or not) for insomnia.

Noteworthy:
· They accredit sleep medicine physicians and sleep centers, and publish the Journal of Clinical Sleep Medicine, where the guideline that was cited (Sateia et al., 2017) appeared.
· Their insomnia drug guideline is built using GRADE, a standard method for grading how strong the evidence behind a recommendation actually is. That's why almost every verdict in the grid says "weak" — the panel is being explicit that the underlying trial evidence is thin, even when the direction (recommend or don't) is clear.
· Importantly, they don't rank drugs against each other. The guideline explicitly says there weren't enough head-to-head trials to say "drug A beats drug B" — each recommendation is drug-versus-no-treatment, not drug-versus-drug.
· Their bigger-picture stance, which is mentioned at the bottom of the article ("What the guidelines say"), is that CBT-I (cognitive behavioral therapy for insomnia) should usually come first, and drugs are for people who can't access CBT-I, didn't improve with it, or need a short-term bridge while doing it.

So when the grid says "AASM: not recommended," that's a professional medical society's guideline panel, not a regulatory body like the FDA. The FDA decides what's legal to sell and how it's labeled; the AASM decides what doctors are advised to prescribe.

Sources

Ferracioli-Oda E, Qawasmi A, Bloch MH. Meta-analysis: melatonin for the treatment of primary sleep disorders. PLoS ONE 2013. https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0063773
Database of Abstracts of Reviews of Effects: quality assessment of Ferracioli-Oda et al. https://www.ncbi.nlm.nih.gov/books/NBK143481/
Optimizing the time and dose of melatonin as a sleep-promoting drug: systematic review and dose-response meta-analysis. Journal of Pineal Research 2024. https://onlinelibrary.wiley.com/doi/10.1111/jpi.12985
Melatonergic agents influence the sleep-wake and circadian rhythms: systematic review and meta-analysis. Neuropsychopharmacology 2022. https://www.nature.com/articles/s41386-022-01278-5
Sletten TL et al. Efficacy of melatonin with behavioral sleep-wake scheduling for delayed sleep-wake phase disorder. PLoS Medicine 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005466/
Cohen PA et al. Quantity of melatonin and CBD in melatonin gummies sold in the US. JAMA 2023. https://jamanetwork.com/journals/jama/fullarticle/2804077
Li J et al. Trends in use of melatonin supplements among US adults, 1999-2018. JAMA 2022. https://pubmed.ncbi.nlm.nih.gov/35103775/
High-dose melatonin increases sleep duration during night-time and daytime sleep episodes in older adults. 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9288519/
Reporting on US poison-center data for pediatric melatonin ingestion, 2012-2021. ABC News / Good Morning America 2023. Secondary source; the underlying CDC and poison-center data should be cited directly for publication. https://www.goodmorningamerica.com/wellness/story/melatonin-gummies-claim-lab-analysis-shows-98864435
Nnadi E et al. Effect of long-term melatonin supplementation on incidence of heart failure in patients with insomnia. Abstract 4371606, Circulation (AHA Scientific Sessions 2025). Conference abstract, not peer-reviewed. https://www.ahajournals.org/doi/10.1161/circ.152.suppl_3.4371606
American College of Cardiology summary of the above abstract, with event counts and hazard ratios. https://www.acc.org/latest-in-cardiology/articles/2025/11/03/16/19/mon-melatonin-aha-2025
Sateia MJ et al. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults. Journal of Clinical Sleep Medicine 2017. https://jcsm.aasm.org/doi/10.5664/jcsm.6470
Mah J, Pitre T. Oral magnesium supplementation for insomnia in older adults: systematic review and meta-analysis. BMC Complementary Medicine and Therapies 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053283/
Magnesium supplementation for sleep in adults: a systematic review of randomized controlled trials. 2026. https://www.tandfonline.com/doi/full/10.1080/19390211.2026.2719670
National Center for Complementary and Integrative Health. Valerian: usefulness and safety. https://www.nccih.nih.gov/health/valerian
National Center for Complementary and Integrative Health. Sleep disorders and complementary health approaches. https://www.nccih.nih.gov/health/sleep-disorders-and-complementary-health-approaches
LiverTox: clinical and research information on drug-induced liver injury — valerian. NIH. https://www.ncbi.nlm.nih.gov/books/NBK548255/
MSD Manual, consumer version: valerian. https://www.msdmanuals.com/home/special-subjects/dietary-supplements-and-vitamins/valerian
AASM clinical practice guideline, full PDF, including the diphenhydramine recommendation and effect estimates. https://aasm.org/resources/pdf/pharmacologictreatmentofinsomnia.pdf
Randomized crossover trial background on diphenhydramine use and tolerance. 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10900002/
Drugs.com clinical answer: can diphenhydramine be used as a sleep aid? Secondary source; verify dosing details against the FDA OTC label. https://www.drugs.com/medical-answers/diphenhydramine-sleep-aid-3563518/
American Geriatrics Society 2023 updated Beers Criteria. https://health.uconn.edu/pharmacy/wp-content/uploads/sites/60/2023/11/2023-American-Geriatrics-Society-Beers-Criteria-1.pdf
Gray SL et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Internal Medicine 2015, with published correspondence on residual confounding. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2091745
Medscape reference: geriatric sleep disorder medication, summarizing Beers guidance and Z-drug fracture data. https://emedicine.medscape.com/article/292498-medication
National prescribing trends for insomnia medications in Medicaid patients, 2023 data. SLEEP 2025. https://academic.oup.com/sleep/article/48/Supplement_1/A241/8136022
Harvard Health Publishing. A popular alternative to a traditional sleeping pill. 2025. https://www.health.harvard.edu/healthy-aging-and-longevity/a-popular-alternative-to-a-traditional-sleeping-pill
Pochiero I et al. Real-world characteristics and treatment patterns of patients with insomnia prescribed trazodone in the US. Clinical Therapeutics 2022. https://www.sciencedirect.com/science/article/abs/pii/S0149291822002351
Effects of trazodone on sleep quality and cognitive function. 2020, on low-dose pharmacology and half-life. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344257/
ScienceDirect topic overview: trazodone, collating adverse-effect and guideline summaries. https://www.sciencedirect.com/topics/medicine-and-dentistry/trazodone
Mortality and concurrent use of opioids and hypnotics in older patients. PLoS Medicine 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8321368/
Impact of an FDA drug safety communication on zolpidem dosing. Primary Care Companion for CNS Disorders 2022. https://www.psychiatrist.com/pcc/zolpidem-dosing-change/
FDA drug safety communication: new label changes and dosing for zolpidem products. 2013. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-approves-new-label-changes-and-dosing-zolpidem-products-and
FDA questions and answers: risk of next-morning impairment after use of insomnia drugs. https://www.fda.gov/drugs/drug-safety-and-availability/questions-and-answers-risk-next-morning-impairment-after-use-insomnia-drugs-fda-requires-lower
Farkas RH et al. Zolpidem and driving impairment: identifying persons at risk. New England Journal of Medicine 2013. https://www.nejm.org/doi/full/10.1056/NEJMp1307972
The People's Pharmacy, citing a 2019 Journal of Clinical Psychopharmacology analysis disputing the sex-based impairment difference. Secondary source; cite the 2019 paper directly for publication. https://www.peoplespharmacy.com/articles/zolpidem-has-new-dose-for-women

General information for editorial use, not medical advice. Dosing figures are reported as they appear in trials, labels and guidelines; they are not recommendations. Anyone taking prescription sleep medication should talk to a prescriber before changing or stopping it.

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