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Sleep Medication and Insomnia

Sleep medication can help in the short term, but it isn't the long-term answer — the guidelines put it behind CBT-I (cognitive behavioral therapy for insomnia) and frame it as short-term use.

Written by George Wang
Medically reviewed by Gerardo Sison, PharmD
Reviewed
8articles
6 minper article
Oct 2026last reviewed article

What to know first

  • The AASM's 2017 guideline made recommendations on fourteen medications and supplements for chronic insomnia. It rated every recommendation weak, including the ones it suggests using. "Weak" is the guideline's own grade, and it means the benefits and the harms sit close enough together that the right answer depends on the person, not on the drug.
  • It suggests clinicians may recommend eszopiclone, zolpidem, temazepam, zaleplon, triazolam, ramelteon, low-dose doxepin, or suvorexant. Different ones are suggested for trouble falling asleep than for trouble staying asleep. The newer VA/DoD guideline (2025) suggests daridorexant, doxepin, eszopiclone, lemborexant, suvorexant, zaleplon, or zolpidem.
  • It suggests clinicians not recommend trazodone, tiagabine, diphenhydramine, melatonin, L-tryptophan, or valerian for insomnia. The 2025 VA/DoD guideline goes further. It suggests against benzodiazepines (a class of sedatives), including the temazepam and triazolam the AASM suggested in 2017. It also suggests against using antipsychotics.
  • Several drugs commonly taken for sleep, such as mirtazapine and quetiapine, are not approved for insomnia. They received no recommendation in the AASM's 2017 guideline.
  • The Beers Criteria advise avoiding benzodiazepines, Z-drugs (zolpidem and similar sleep drugs) and first-generation antihistamines in adults over 65. All three are strong recommendations.

AASM = American Academy of Sleep Medicine · VA = US Department of Veterans Affairs

For education only, and not a substitute for advice from your own doctor or prescriber.

Start here

  1. Sleep Medications: What the Guidelines Actually RecommendStart here

    There is no single safest sleeping pill. But US guidelines do say which medicines have evidence behind them, and which ones to avoid.

    7 min

Prescription drugs used for sleep

  1. Quviviq (Daridorexant) for Insomnia: What to Know

    Many medications people take for sleep are approved for something else. Quviviq is not one of them — insomnia is what it is approved for.

    6 min

  2. Mirtazapine for Sleep: What the Evidence Shows

    Mirtazapine is often prescribed off-label for sleep. To understand why, start with what it is actually approved to treat.

    5 min

  3. Seroquel for Sleep: Why It Is Rarely the Right Choice

    Quetiapine is sedating, which is why it sometimes gets prescribed for sleep. It is also an antipsychotic, not a sleep medicine, and it comes with real risks.

    6 min

  4. Does Zoloft Cause Insomnia? What the Evidence Shows

    Sertraline is one of the most prescribed antidepressants in the US, and trouble sleeping is one of its most reported side effects. The label puts a number on it.

    5 min

Over the counter

  1. Is It Bad to Take Melatonin Every Night?

    Melatonin is the supplement most people try first for insomnia. Sleep guidelines from the AASM and the VA/DoD suggest not using it for that.

    7 min

  2. Over-the-Counter Sleep Aids: Do They Work?

    Not needing a prescription tells you how a product is regulated, not how safe it is. Here is what the guidelines say about what is in the box.

    5 min

  3. Do Natural Sleep Supplements Work?

    An earlier version of this page ranked seven supplements. The evidence does not support a ranking, so here is what it does support.

    6 min

Do I have insomnia?

See if you have insomnia and learn how to sleep well again

2-min insomnia quiz

Common questions

What is the safest sleeping pill?
No guideline names one. Every medication recommendation in the AASM's 2017 guideline is graded weak, which means the balance of benefits and harms is close enough that the right answer depends on the person. Age matters too — the Beers Criteria advise adults 65 and over to avoid benzodiazepines, Z-drugs and older antihistamines.
Which sleep medications does the AASM recommend?
It suggests clinicians may use eszopiclone, zolpidem, and temazepam for both sleep onset and sleep maintenance insomnia. It suggests zaleplon, triazolam, and ramelteon for sleep onset, and low-dose doxepin and suvorexant for sleep maintenance. All are weak recommendations.
Which does it recommend against?
Trazodone, tiagabine, diphenhydramine, melatonin, L-tryptophan, and valerian. For each one, it recommends that clinicians not use it for sleep onset or sleep maintenance insomnia.
Why aren't drugs like mirtazapine and quetiapine on either list?
Because the guideline didn't make a recommendation on either one. Quetiapine is not among the fourteen agents it graded, though a trial of quetiapine for insomnia is cited in its references. Mirtazapine is not cited in the guideline at all. Both are approved for something else: mirtazapine for major depressive disorder, and quetiapine for schizophrenia and bipolar disorder. Both are used off-label (outside of their approved uses) for sleep.
Should I stop taking my sleep medication?
Not on your own. Some sleep medicines cause withdrawal symptoms or rebound insomnia if stopped abruptly, and some are treating something other than insomnia. Any change should go through your prescriber — though adding CBT-I alongside medication is always an option.

References

  1. Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults. Journal of Clinical Sleep Medicine. 2017;13(2):307-349.
  2. American Geriatrics Society. 2023 AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2023;71:2052-2081. doi:10.1111/jgs.18372
  3. Buysse DJ, et al. Combination treatment for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine. 2026;22(1):56. doi:10.1007/s44470-025-00038-8.
  4. Melatonin: What You Need To Know. National Center for Complementary and Integrative Health.
  5. VA/DoD Clinical Practice Guideline for the Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea. Version 3.0. US Department of Veterans Affairs and Department of Defense; 2025.