The quick verdict
Strong consistent, high-quality evidence Situational helps specific people or uses Skip little benefit, or risky
| Option | Grade | Bottom line |
|---|---|---|
| CBT-I | Strong | First-line treatment for chronic insomnia, with benefits that last. |
| Melatonin | Situational | Good for jet lag and a body clock that runs late. Weak for general insomnia. |
| Prescription sleep medications | Situational | Useful short-term or alongside CBT-I, with real trade-offs. |
| Magnesium, glycine, L-theanine | Situational | Low risk, small or uncertain benefits. |
| Valerian, "sleep blends" | Skip | Inconsistent evidence, variable quality. |
| Diphenhydramine, doxylamine | Skip | Next-day grogginess, tolerance, and problems for the prostate. |
| Alcohol | Skip | Knocks you out, then wrecks the second half of the night. |
| Cannabis & CBD | Skip | Weak evidence, tolerance, and rebound insomnia. |
| Mouth taping | Skip | Little evidence, and risky with undiagnosed sleep apnea. |
Start here: CBT-I
Cognitive behavioral therapy for insomnia Strong
For chronic insomnia, the American College of Physicians recommends CBT-I as the first treatment for adults, ahead of any medication. In head-to-head studies, it works about as well as sleeping pills in the short term and better in the long term, because the improvement persists after the program ends. It has no side effects beyond a tough first week or two of sleep restriction.
It's available through sleep psychologists, many therapists, and digital programs. How CBT-I works →
Melatonin
Melatonin Situational
Melatonin is a hormone your brain releases in the evening to signal nighttime. As a supplement, it's better at shifting the timing of your body clock than at knocking you out. That makes it genuinely useful for some problems and weak for others.
- ✓Jet lag, taken around bedtime at your destination.
- ✓A body clock that runs late (delayed sleep phase), where you can't fall asleep until very late but sleep fine once you do. Here a small dose taken a few hours before your target bedtime works best.
- ✓Shift work, for some people, to help with daytime sleep.
- ?Ordinary chronic insomnia: the effect is small, typically helping you fall asleep only minutes sooner. The American Academy of Sleep Medicine suggests against it for this use.
Side effects are generally mild (headache, next-day grogginess, vivid dreams). Talk to your doctor if you take blood thinners, blood pressure medication, or immune-suppressing drugs.
Other supplements
Magnesium Situational
Popular, but the sleep evidence is limited to small studies, mostly in older adults. It's most plausibly helpful if your intake is low. It's low risk for most people, though it can cause digestive upset, and people with kidney disease should avoid it unless their doctor approves.
Glycine & L-theanine Situational
Small studies suggest glycine (about 3 g before bed) and L-theanine may modestly improve subjective sleep quality. They're low risk to try, but the evidence is thin.
Valerian & herbal "sleep blends" Skip
Valerian has been studied for decades with inconsistent results. Multi-ingredient sleep blends are often under-dosed and unstandardized, and they sometimes include ingredients (like kava) with liver risks. If you want to try an herb, try a single-ingredient, third-party-tested product rather than a proprietary blend.
Ashwagandha Situational
Some small trials suggest benefits for stress and sleep, but there have been rare reports of serious liver injury, and it's not appropriate for everyone. More in our supplements guide →
Over-the-counter sleeping pills
Diphenhydramine & doxylamine Skip
Most drugstore sleep aids (ZzzQuil, Unisom, Tylenol PM, Advil PM and similar "PM" products) rely on these older sedating antihistamines. The American Academy of Sleep Medicine recommends against diphenhydramine for chronic insomnia. The problems:
- ✕Tolerance develops within days, so the sleepy effect fades quickly.
- ✕Next-day grogginess and slowed reaction time, which matters for driving.
- ✕Urinary retention. These drugs can make it hard to urinate, and that's especially relevant for men with an enlarged prostate.
- ✕Long-term cognitive concerns. Observational studies link heavy, long-term use of this drug class (anticholinergics) with higher dementia risk, and it's on lists of medications older adults should avoid.
Prescription options
Prescription medications can help, especially short-term, during a crisis, or alongside CBT-I. The main types:
| Type | Examples | Worth knowing |
|---|---|---|
| Orexin receptor antagonists | Suvorexant (Belsomra), lemborexant (Dayvigo), daridorexant (Quviviq) | A newer class that blocks wake-promoting signals rather than sedating broadly. Can cause next-day drowsiness. |
| "Z-drugs" | Zolpidem (Ambien), eszopiclone (Lunesta), zaleplon | Effective at helping you fall asleep. They carry an FDA boxed warning for complex sleep behaviors like sleep-walking and sleep-driving. |
| Low-dose doxepin | Silenor | Very low-dose version of an older antidepressant, approved for trouble staying asleep. |
| Trazodone | Generic | Commonly prescribed off-label for sleep, though sleep medicine guidelines suggest against it for insomnia. A rare but serious risk for men is priapism, a prolonged erection that needs emergency care. |
| Benzodiazepines | Temazepam, lorazepam, and others | Effective short term, but dependence, falls, and withdrawal make them a poor long-term choice. |
Most sleep medications shouldn't be combined with alcohol or opioids, and several can worsen untreated sleep apnea. If you've been on one for a long time, don't stop suddenly. Taper with your doctor's guidance.
Alcohol, cannabis & CBD
Alcohol Skip
Alcohol is the most common self-prescribed sleep aid. It helps you fall asleep faster, then fragments the second half of the night, suppresses REM sleep, and relaxes the airway, which worsens snoring and sleep apnea. You sleep longer on paper and recover worse. More on alcohol and recovery →
Cannabis & CBD Skip
THC can shorten the time it takes to fall asleep in the short term, but tolerance builds, it suppresses REM, and stopping after regular use commonly causes weeks of rebound insomnia and vivid dreams. Evidence that CBD helps sleep is weak, and CBD product labeling is notoriously inaccurate. CBD can also interact with other medications.
Mouth taping & other trends
Mouth taping Skip
Taping your mouth shut to force nasal breathing is popular on social media. Recent reviews found little good evidence that it helps. It can be risky if your nose is congested, and it could mask the symptoms of, or worsen, undiagnosed sleep apnea. If you breathe through your mouth at night, get the underlying cause checked: nasal blockage, allergies, or apnea.
Weighted blankets, white noise & sleep headphones Situational
Low risk, and some people find them genuinely helpful for relaxation or blocking noise. Evidence is limited, but if it helps you and costs nothing but money, it's a reasonable comfort choice.