Sleep and medication
Many people working on insomnia already take something for sleep, or take medicines for other reasons that affect it. This article explains how medication and CBT-I fit together. It isn’t advice about your own prescriptions.
Never stop, start, or change a prescribed medicine without talking to the person who prescribed it. Some sleep medicines need to be reduced slowly, and stopping suddenly can bring a few nights of worse sleep, or for some medicines, more serious withdrawal effects.
Sleep medicine and CBT-I together
CBT-I can be used while someone takes sleep medication. Guidelines in the United States and Europe recommend CBT-I first for chronic insomnia, with medication as an option for some people, usually for a shorter time. Many people later work with their prescriber on a plan to taper, and some programs pair CBT-I with a gradual reduction.
If you use the sleep window while taking something that makes you drowsy, the daytime sleepiness of the first weeks can add up. Talk with your prescriber before you start the window.
Things that can affect sleep
Some medicines and substances can make it harder to fall or stay asleep, or make the day sleepier. A few examples:
- Decongestants and some cold medicines
- Steroids, such as prednisone
- Some antidepressants, which can either keep people awake or make them drowsy
- Some blood pressure medicines
- Medicines for ADHD
- Caffeine, nicotine, and alcohol
If your sleep changed around the time you started or changed a medicine, mention it to your prescriber or pharmacist. Don’t stop it on your own.
Over the counter
Many over-the-counter sleep aids contain an antihistamine, like diphenhydramine or doxylamine. Insomnia guidelines in the United States and Europe don’t recommend them for chronic insomnia. They can leave a hangover feeling the next day, and in older adults they can raise the risk of confusion and falls. Don’t mix sleep medicines with alcohol.
Melatonin is sold as a supplement in the United States, so doses vary from bottle to bottle. It affects timing more than it knocks people out. It can help with jet lag and some body clock problems, and its effect on chronic insomnia is small.
In the diary
The diary’s About yesterday section asks whether you took anything to help you sleep. That’s for your own notes and for a clinician, if you share your diary. Nothing judges that answer, and it never changes your sleep window.
References
- Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(2), 307–349. doi.org/10.5664/jcsm.6470
- Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., & Denberg, T. D. (2016). Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 165(2), 125–133. doi.org/10.7326/M15-2175
- Riemann, D., Espie, C. A., Altena, E., et al. (2023). The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. Journal of Sleep Research, 32(6), e14035. doi.org/10.1111/jsr.14035
Helpful links
Everyday Insight’s tools are for education and personal reflection. They are not therapy or medical care, and they are not for emergencies. In an emergency, call 911. If you are in crisis in the United States, call or text 988.