Sleeping Pills Side Effects in Men: OTC and Prescription Risks

Short answer: The most common sleeping pills side effects are next-day grogginess, dizziness, dry mouth and slowed reaction time. The serious ones depend on the drug class: sedating antihistamines can cause urinary retention and are generally not advised for older adults, z-drugs such as zolpidem carry an FDA boxed warning for complex sleep behaviors like sleep driving, benzodiazepines carry a boxed warning for dependence and withdrawal, and trazodone can cause erection problems or, rarely, a prolonged erection that needs emergency care. For long-lasting insomnia, cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment, so talk to a doctor before relying on any pill.

Key Takeaways

• Every class has trade-offs: over-the-counter (OTC) and prescription sleep aids all carry some risk of next-morning impairment, even when you feel fully awake.
• OTC is not automatically safer: MedlinePlus states diphenhydramine generally should not be used in older adults except for serious allergic reactions, and Mayo Clinic flags urinary retention as a caution for men.
• Z-drugs have a boxed warning: in 2019 the FDA added complex sleep behaviors (sleepwalking, sleep driving) to the boxed warning for zolpidem, eszopiclone and zaleplon.
• Sexual side effects are drug specific: trazodone lists decreased sex drive, erection problems and priapism; the MedlinePlus zolpidem page does not list sexual side effects.
• Melatonin labels can be inaccurate: NCCIH reports most tested products did not contain the amount on the label.
• CBT-I comes first: the American College of Physicians strongly recommends CBT-I as first-line treatment for chronic insomnia.

What Counts as a Sleeping Pill?

“Sleeping pill” is a loose term. It covers products you can buy off the shelf and drugs that require a prescription, and they work in very different ways. That matters, because the side effect profile follows the mechanism, not the marketing.

Over-the-counter sleep aids

Most OTC “PM” and “nighttime” products rely on a sedating antihistamine, usually diphenhydramine (the drug in Benadryl) or doxylamine (Unisom). Melatonin and valerian are sold as dietary supplements and are often shelved next to them. Mayo Clinic notes that antihistamines can lose their effect quickly as tolerance builds, and that all of these products are meant for temporary use.^[1]

Prescription sleep medications

Prescription options include the “z-drugs” (zolpidem, eszopiclone, zaleplon), benzodiazepines, and drugs used off label for sleep such as trazodone, an antidepressant that MedlinePlus says is sometimes used for insomnia.^[5] Newer prescription classes also exist. Your clinician chooses among them based on whether you struggle to fall asleep, stay asleep, or both, along with your age, other medicines and breathing during sleep.

Sleeping Pills Side Effects by Drug Class

The table below summarizes what the sources we reviewed list for each class. It is not a complete list. Always read the Medication Guide that comes with a prescription.

Sources: Mayo Clinic,^[1] NCCIH,^[2] FDA,^[3][6] MedlinePlus.^[4][5][7]

OTC Sleep Aids: The Antihistamine Problem

Because diphenhydramine and doxylamine are cheap and easy to buy, many men assume they are harmless. The evidence says otherwise, especially with age.

Urinary retention and prostate concerns

Mayo Clinic lists urinary retention among the side effects of diphenhydramine and says these products are not recommended for people with closed-angle glaucoma, peptic ulcer or urinary retention.^[1] MedlinePlus lists difficulty urinating or painful urination as a serious side effect that warrants a call to your doctor.^[7] For a man with an enlarged prostate, that is a practical risk, not a theoretical one. If you already get up at night to urinate or have a weak stream, read our guide to enlarged prostate symptoms and mention them before choosing a nighttime product.

Older adults and memory

MedlinePlus states that “generally diphenhydramine should not be used in older adults, except to manage serious allergic reactions,” because it is not as safe or effective as other options.^[7] Mayo Clinic adds that sleep aids might pose risks for people over age 65, including an increased risk of dementia.^[1] Next-day grogginess, which Mayo Clinic calls the hangover effect, is another reason to avoid driving after a dose.

Melatonin and quality control

Melatonin is a hormone that helps regulate the sleep and wake cycle. NCCIH says short-term use appears safe for most people, but long-term safety data are lacking, and it may stay active longer in older people, which can cause daytime drowsiness.^[2] The bigger issue is what is in the bottle. In a 2017 study of 31 supplements described by NCCIH, the amount of melatonin in most products did not match the label, and serotonin was found in 26 percent of them. A 2023 study of 25 gummy products found 22 were mislabeled, with contents ranging from 74 to 347 percent of the labeled amount.^[2]

Prescription Sleeping Pills: Boxed Warnings

Z-drugs and complex sleep behaviors

On April 30, 2019, the FDA required a boxed warning, its most prominent warning, for eszopiclone, zaleplon and zolpidem after reviewing 66 cases of complex sleep behaviors that led to serious injuries, including 20 deaths.^[3] Complex sleep behaviors include sleepwalking, sleep driving and other activities while not fully awake. The FDA says these drugs should not be used by anyone who has had such an episode before, and that patients should stop the drug and call their clinician if one happens.^[3]

The MedlinePlus zolpidem page adds that your ability to drive the day after a dose “may be impaired even if you feel fully awake,” that zolpidem may be habit forming, and that you should not drink alcohol during treatment.^[4] Stopping suddenly can cause withdrawal symptoms, so any change should go through your prescriber.

Benzodiazepines and dependence

In September 2020 the FDA required the benzodiazepine boxed warning to cover abuse, misuse, addiction, physical dependence and withdrawal reactions.^[6] The agency singled out the combination with opioids, which has caused severe breathing problems and death, and said there is no standard tapering schedule that fits everyone. If you take a benzodiazepine for sleep, do not stop on your own. Ask for an individualized taper plan.

Sleeping Pills and Sexual Side Effects in Men

Many men first notice a sleep medication through changes in drive, firmness or next-day energy. The honest answer is that the data differ by drug:

• Trazodone lists sexual problems in males among its common side effects, including decreased sex drive, “inability to get or keep an erection,” and delayed or absent ejaculation. It also lists priapism, an erection lasting more than 6 hours, as a serious side effect that needs immediate medical care.^[5]
• Zolpidem does not list sexual side effects or libido changes on its MedlinePlus page.^[4] Its one mention of sex is a complex sleep behavior: people have had sex while not fully awake and had no memory of it.
• Sedating drugs in general can leave you groggy the next day, and that fatigue alone can lower interest and confidence.

Poor sleep itself is part of the picture. Untreated insomnia and sleep apnea can drain energy and mood with or without a pill, which is why a medication review should include the sleep diagnosis. Read more about insomnia in men and the link between sleep apnea and testosterone. If a change in sexual function started soon after a new sleep medicine or a dose change, tell your prescriber rather than stopping the drug abruptly.

CBT-I and Habits Come First

For chronic insomnia, defined as symptoms lasting a month or longer, the American College of Physicians strongly recommends cognitive behavioral therapy for insomnia (CBT-I) as first-line treatment, according to NCCIH.^[2] Mayo Clinic also says lifestyle changes are usually the best approach for chronic insomnia, with behavioral therapy to build better sleep habits and short-term prescription sleep aids in some cases.^[1]

CBT-I is a structured program, usually delivered by a trained clinician or a validated digital program, that works on the thoughts and habits keeping you awake. It typically includes a consistent wake time, limiting time in bed to actual sleep, and getting out of bed when you cannot sleep. Our guide to the best sleep routines for men covers the daily habits that support it. If you work nights, see our page on shift work sleep disorder.

Who Should Talk to a Doctor First

Do not start, stop or combine sleep medicines on your own if any of the following apply:

• You are 65 or older, or you already have memory problems.
• You have an enlarged prostate, trouble urinating or closed-angle glaucoma.
• You snore loudly, stop breathing during sleep or wake up gasping (possible sleep apnea).
• You take opioids, other sedatives, antidepressants or blood thinners, or you drink alcohol regularly.
• You have ever sleepwalked, sleep driven or done things at night you do not remember.
• You notice changes in erections, drive or ejaculation after starting a sleep medicine.

Tell your doctor about every supplement, too

Supplements count as part of your medication list. Some herbs can affect sleep on their own. For example, NCCIH says insomnia is the most common side effect of Asian ginseng (Panax ginseng), and that it might interact with certain medications.^[8] If you take Ultra Bann, which contains 110 mg of Panax ginseng per capsule among its seven botanicals, list it for your doctor or pharmacist along with your sleep medicine. The full label is on our ingredients page. Ultra Bann is not a sleep aid and is not a substitute for medical evaluation of insomnia.

Related reading: for a detailed look at one common prescription sleep medicine, see our guide to zolpidem side effects.

Frequently Asked Questions

What are the most common side effects of sleeping pills?

Next-day drowsiness, dizziness, headache, dry mouth and slowed reaction time are the most common across classes. Antihistamine products can also cause constipation and urinary retention. Your exact risk depends on the drug, the dose and your age.

Can sleeping pills cause erectile dysfunction?

Some can. Trazodone lists decreased sex drive, trouble getting or keeping an erection and delayed ejaculation among its side effects, plus a rare risk of priapism. Zolpidem’s MedlinePlus page does not list sexual side effects. Grogginess and untreated sleep problems can also affect sexual function, so ask your doctor to review the whole picture.

Are over the counter sleep aids safe for older men?

Often not as first choice. MedlinePlus says diphenhydramine generally should not be used in older adults except for serious allergic reactions, and Mayo Clinic notes possible risks over 65, including an increased risk of dementia, plus urinary retention.

Is it safe to drive the morning after a sleeping pill?

Not always. The FDA notes that all insomnia medicines can impair driving and alertness the next morning, and MedlinePlus warns that impairment after zolpidem can occur even if you feel fully awake.

What is the safest first step for insomnia?

See a clinician to check for causes such as sleep apnea, pain, depression or medication effects, and ask about CBT-I, which the American College of Physicians recommends as first-line treatment for chronic insomnia.

References

1. Mayo Clinic Staff. Sleep aids: Understand options sold without a prescription. Mayo Clinic. mayoclinic.org
2. National Center for Complementary and Integrative Health. Melatonin: What You Need To Know. NCCIH. nccih.nih.gov
3. U.S. Food and Drug Administration. FDA adds Boxed Warning for risk of serious injuries caused by sleepwalking with certain prescription insomnia medicines. Drug Safety Communication, April 30, 2019. fda.gov
4. MedlinePlus. Zolpidem. U.S. National Library of Medicine. medlineplus.gov
5. MedlinePlus. Trazodone. U.S. National Library of Medicine. medlineplus.gov
6. U.S. Food and Drug Administration. FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. Drug Safety Communication, September 23, 2020. fda.gov
7. MedlinePlus. Diphenhydramine. U.S. National Library of Medicine. medlineplus.gov
8. National Center for Complementary and Integrative Health. Asian Ginseng. NCCIH. nccih.nih.gov

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. This article is for information only and is not medical advice.