Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.
What Is Sleep Aid Tolerance? | Is Tolerance Related to Addiction?
How Do You Spot Sleep Aid Tolerance? | What are the Other Available Options?
Overview
Insomnia can be very annoying, especially after a long day. Unsurprisingly, about 60 million prescriptions are filled in the US for sleep every year.[1]
Prescriptions aren’t the only way to get help for poor sleep. Many over-the-counter (OTC) sleep aids are safe enough to use without a doctor’s supervision.
However, they may not always be helpful, and they may not always be safe. OTC Sleep aids can lose effectiveness over time, and this may lead to more serious issues.
If you find that your OTC sleep aid no longer works like before, or you often need to up the dose to find sleep, you should read this article to the end.
What Is Sleep Aid Tolerance?
Drug tolerance is a natural occurrence that happens due to repeated exposure. It’s not because the drug got less effective, but because you’re used to it now. At first, one tablet of Benadryl knocked you out as fast as lightning. Now, you need to take two pills to sleep without interruption.
The more you use certain drugs, the less your body reacts to them. Thus, you need more of the drug to get that same effect. In other words, you’ve developed a tolerance for Benadryl.
The exact tolerance mechanism is unclear, but it may be due to a decrease in your receptor’s affinity for that drug. It may also be due to a metabolic issue or decreased available receptors.
People experience tolerance differently. Some people experience tolerance after their first or second use, while it takes others weeks or months before tolerance sets in. Age, weight, genetics, comorbidities, and metabolic rate affect how quickly tolerance sets in.
Is Tolerance Related to Addiction?
Both tolerance and addiction are unwanted drug events and share some similarities. However, addiction is a more serious condition, and its symptoms are on a larger scale.
In drug tolerance, excessive exposure to a drug causes you to need more to get the same effect you once obtained.
Addiction occurs when the cessation of a drug or chemical agent causes undesired effects, called withdrawal symptoms.[2] When the drug or chemical agent is consumed again, these symptoms vanish.
In tolerance cases, discontinuing the drug causes mild withdrawal symptoms related to the initial condition. For example, discontinuing a sleep aid after tolerance causes rebound insomnia, which typically fades after a while. Nonetheless, it is advisable to discontinue sleep aids gradually if ineffective.
How Do You Spot Sleep Aid Tolerance?
1) You Need to Increase the Dose
The first sign of tolerance is upping the dose. You may have developed a tolerance if you started with one pill but now need to take two or three pills to get the same effect. Increasing your dose also increases the risks of side effects, which may be dangerous.
2) You Can’t Sleep When You Don’t Take Them
Ironically, overusing sleep aids can make it harder for you to fall asleep. Sleep aid tolerance may cause rebound insomnia, where stopping the drug makes your sleep worse than originally, making you more irritable and anxious the following day.
Sleep aids, like melatonin, increase the concentration of natural sleep chemicals, causing your body to produce less and less to balance the steady increase. Thus, abruptly stopping the sleep aid leaves you deficient in these sleep chemicals.
3) You’re Switching Sleep Aids
When one sleep aid stops working, you go to the pharmacy and ask for another one, which is a sign that you’re becoming tolerant. This switch may make it harder for your physician to treat your insomnia. If OTC sleep medicines aren’t working, visit your doctor instead.
4) What Happens if You Overuse Sleep Aids?
As mentioned earlier, OTC sleep aids are safe enough to use without a prescription. However, as tolerance sets in, people tend to increase their doses. Increasing your sleep aid dose predisposes you to side effects like:[3]
What are the Other Management Options?
Simple, safe, and free ways exist to fight insomnia without risking tolerance. Many behavioral or lifestyle modifications can distinguish between bad and good nights. Here are a few suggestions:
- Cognitive Behavioral Therapy for Insomnia
Cognitive behavioral therapy for insomnia (CBTi) involves learning what habits promote sleep and which make it harder for you to fall asleep.
CBT-I is a treatment for insomnia grounded in the science of behavioral change, psychological theories, and the science of sleep.
Empirical evidence supports the effectiveness of CBT-I, indicating lasting results and no adverse side effects.
This treatment can benefit nearly anyone with sleep problems, helping people with primary insomnia and those with medical issues, such as chronic pain, or mental health disorders, such as depression and anxiety.[4]
- Exercise
Exercise raises core body temperature. It also relieves stress and tension. Approximately 30 to 90 minutes after exercising, your body temperature falls, helping to facilitate sleep.
- Melatonin Supplements
Melatonin is the body’s primary sleep-regulation hormone. Melatonin helps you wind down and fall asleep naturally. Taking a melatonin pill about 30 minutes before bedtime can make it easier to fall asleep.[5] They are effective and can keep you asleep for about five hours. Keep in mind that supplementing with melatonin should be a short-term solution to sleeplessness.
- Magnesium Supplements
Like melatonin, magnesium is another compound you need to fall asleep naturally. Research shows that taking 500 milligrams of magnesium prompts sleep in people with insomnia.[6] This effect occurs because, in the right amounts, magnesium slows down the brain and facilitates peaceful rest. Magnesium supplements should always be taken cautiously, as too much can cause a stomach upset.
The link between smell and sleep is not clearly defined, but certain calming aromas, such as a lavender essential oil, have been known to induce sleep.
What’s the Takeaway?
Using sleep aids regularly may make you become tolerant faster than you expect. When your sleep aids stop working like they used to, instead of increasing the dose every night, you can try other alternative approaches to fighting insomnia.
These alternatives may be as simple as drinking a cup of tea or may require more serious lifestyle modifications. One thing is sure; there’s no risk of tolerance and no side effects to watch out for if you use them right.
References:
- Insomnia: When sleeping pills don’t work. MentalHelp.net. (n.d.). Retrieved March 29, 2023, from https://www.mentalhelp.net/blogs/insomnia-when-sleeping-pills-don-t-work/
- Greenblatt, D. J., & Shader, R. I. (1978). Dependence, tolerance, and addiction to benzodiazepines: clinical and pharmacokinetic considerations. Drug metabolism reviews, 8(1), 13–28. https://doi.org/10.3109/03602537808993775
- Viukari, M., Linnoila, M., & Aalto, U. (1978). Efficacy and side effects of flurazepam, fosazepam, and nitrazepam as sleeping aids in psychogeriatric patients. Acta psychiatrica Scandinavica, 57(1), 27–35. https://doi.org/10.1111/j.1600-0447.1978.tb06871.x
- Harsora, P., & Kessmann, J. (2009). Nonpharmacologic management of chronic insomnia. American family physician, 79(2), 125–130.
- Van der Heijden, K. B., Smits, M. G., Van Someren, E. J., Ridderinkhof, K. R., & Gunning, W. B. (2007). Effect of melatonin on sleep, behavior, and cognition in ADHD and chronic sleep-onset insomnia. Journal of the American Academy of Child and Adolescent Psychiatry, 46(2), 233–241. https://doi.org/10.1097/01.chi.0000246055.76167.0d
- Abbasi, B., Kimiagar, M., Sadeghniiat, K., Shirazi, M. M., Hedayati, M., & Rashidkhani, B. (2012). The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences, 17(12), 1161-1169. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3703169/
- Karadag, E., Samancioglu, S., Ozden, D., & Bakir, E. (2017). Effects of aromatherapy on sleep quality and anxiety of patients. Nursing in critical care, 22(2), 105–112. https://doi.org/10.1111/nicc.12198
