Medication

OTC sleep aids have a place, but they also have drawbacks, according to the Royal College of Psychiatrists (RCP). 

Antihistamine-based products may cause next day drowsiness and tolerance, so restrictions should be carefully adhered to. Herbal remedies, such as those containing valerian, are best taken nightly for two to three weeks rather than occasionally, with warnings given about next day drowsiness and the risk of dependence. Anyone asking about these products should be signposted to resources about sleep hygiene, such as those available on the NHS website. 

There is little good quality evidence supporting the use of cannabidiol (CBD) products, although there is emerging evidence that they can help with anxiety, which can play a significant role in insomnia. 

The RCP discourages the use of hypnotics, saying they do not work for very long, can cause tiredness and irritability the next day, and are likely to cause dependence. This applies equally to the newer Z-drugs and to benzodiazepines. For this reason, the RCP advises using such medication at the lowest possible dose for less than two weeks (ideally, under a week) and only in situations of insomnia such as those due to acute distress which are severely impairing daytime functioning. 

Anyone who has been on long-term sleeping tablets should be assisted in gradual withdrawal. While antidepressants may be helpful to some, they are not without their own potential issues. Melatonin is often heralded as a sleep aid, but is only available on prescription in the UK, and pharmacists should be aware that it has licensing restrictions.