Sleep medicines (Z-drugs, suvorexant, melatonin) — patient guide

This page covers prescription sleep medicines — Z-drugs (zopiclone, zolpidem), suvorexant (Belsomra), and prolonged-release melatonin (Circadin). If your sleep medicine is temazepam (Normison), it belongs in the benzodiazepines family — see that page.

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Find your medicine

Generic name	Common brand names	Strengths	How often	Schedule
Zopiclone	Imovane, generics	7.5 mg (3.75 mg in older adults)	Once nightly, immediately before bed	Schedule 4 — prescription-only
Zolpidem	Stilnox, Stilnox CR, generics	5 / 10 mg (IR); 6.25 / 12.5 mg (CR)	Once nightly, immediately before bed	Schedule 4 — TGA boxed warning, SafeScript-captured (VIC)
Suvorexant	Belsomra	15 / 20 mg	Once nightly, 30 minutes before bed	Schedule 4 — prescription-only
Prolonged-release melatonin	Circadin	2 mg	1-2 hours before bed, after food	Schedule 4 — prescription-only (TGA-approved age 55 and over)

Looking for temazepam (Normison)? Temazepam is pharmacologically a benzodiazepine, not a Z-drug, and shares the benzodiazepine dependence and withdrawal profile. It is covered on the benzodiazepines page. Many people are sent here first because temazepam is often grouped with Z-drugs in everyday conversation — the cross-reference is deliberate.

Closely related families. Benzodiazepines (temazepam, diazepam, oxazepam) — combination risk warning runs both ways. Gabapentinoids (gabapentin, pregabalin) — combination risk warning runs both ways. Opioids — combination risk warning runs both ways. Sedating antihistamines (Restavit, Phenergan) — additive sedation, additive next-day impairment.

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What these medicines treat

Prescription sleep medicines have a narrow place. The on-label indications are:

• Short-term treatment of insomnia — difficulty falling asleep or staying asleep. Used when sleep hygiene and CBT-I have not been enough on their own.
• Situational or acute insomnia — bereavement, jet lag from a major time-zone shift, hospital admission, acute stress. A short bridging course is appropriate.
• Primary insomnia in adults aged 55 and over — prolonged-release melatonin (Circadin) is TGA-approved for this group as short-term therapy.
• Chronic insomnia where CBT-I is unavailable, declined, or has been tried and was inadequate — medication is an adjunct, not a stand-alone solution.

There are also off-label uses with some published evidence. Circadin for delayed sleep phase syndrome — usually specialist-initiated. Short-course immediate-release melatonin for jet lag — a different product. Sleep disturbance in autism spectrum disorder — specialist-paediatric initiation only. Off-label means “not the TGA-approved use”. The evidence base varies. The conversation about whether it suits an individual is one for the GP and (where appropriate) the sleep physician.

What these medicines are NOT for

• Routine first step in chronic insomnia. That is CBT-I. (Details below.)
• Long-term continuous use beyond the TGA 4-week ceiling for Z-drugs. Use past 4 weeks should be a planned exception, not the default.
• Routine treatment in adults under 55 for Circadin — outside the TGA indication.
• Adolescents and shift workers without specialist input — mis-timed melatonin can worsen circadian disruption.
• Anyone with untreated obstructive sleep apnoea — treat the apnoea first.

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The four-step approach for chronic insomnia

This is the framing that matters most. For chronic insomnia (insomnia present 3 or more nights per week for at least 3 months), the evidence-based hierarchy is:

1. CBT-I (cognitive behavioural therapy for insomnia) plus sleep hygiene. The gold-standard evidence-based intervention. Superior to medication on long-term outcomes per the 2012 Mitchell meta-analysis in BMC Family Practice, Edinger meta-analyses, the AASM 2017 clinical practice guideline, and NICE NG201. Durable improvement after treatment ends. No medication dependence. Available free as digital tools through the Sleep Health Foundation Australia and via psychologist referral under a Mental Health Care Plan (Better Access — ten Medicare-rebated sessions per calendar year).
2. Prolonged-release melatonin (Circadin) trial in adults aged 55 and over with an appropriate sleep-onset phenotype — TGA-approved for this group; low harm profile.
3. Short-term Z-drug or suvorexant for situational or acute insomnia — maximum 2-4 weeks, with the taper planned from the start rather than improvised at the end.
4. Specialist referral — sleep physician for treatment-resistant chronic insomnia or suspected sleep apnoea / circadian disorder, RANZCP psychiatrist where mental-health comorbidity is the dominant driver.

The order matters. The single most common pattern in general-practice insomnia is jumping straight to step 3 because CBT-I feels too slow. CBT-I does take 3-6 weeks to show benefit. The trade-off is durable improvement without medication dependence — and the medicine-first path often becomes a multi-year repeat-script habit that is harder to unwind than the original problem.

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The basics

1. Take it as planned, then go to bed. Z-drugs: take only when you are already in bed for the night, with at least 7-8 hours available before you need to be alert. Suvorexant: 30 minutes before bed, at least 7 hours before your planned wake time. Circadin: 1-2 hours before bed, after food.
2. Never combine without your prescriber’s knowledge with opioid painkillers, benzodiazepines (Valium-type medicines), other Z-drugs, or alcohol. The combination is the main cause of sleep-medicine-related deaths in Australia.
3. Never stop a Z-drug suddenly after more than 4 weeks of continuous use. Taper under medical supervision.
4. Call 000 for marked drowsiness with slow or shallow breathing, blue lips, or unresponsiveness — particularly after a combined dose with another sedating medicine or alcohol — or for sudden swelling of face, lips, tongue, or throat.

Everything else — side effects, complex sleep behaviour, the integrative angle, stopping safely — is below.

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The combination warning — read this section

This is the single most important safety conversation about prescription sleep medicines in Australia today.

Combining any of the medicines on this page with any of the following causes additive sedation and slowed breathing. Overdose deaths involving sleep medicines in combination with opioids and benzodiazepines have been rising in Australia since 2016, mirroring the gabapentinoid-plus-opioid pattern.

• Opioid painkillers — codeine (Panadeine Forte), tramadol (Tramal), tapentadol (Palexia), oxycodone (Endone, OxyContin), morphine (MS Contin), buprenorphine (Norspan, Subutex), fentanyl patches (Durogesic).
• Benzodiazepines — diazepam (Valium), oxazepam (Serepax), temazepam (Normison), alprazolam (Xanax), clonazepam (Rivotril).
• Other Z-drugs — never combine zopiclone with zolpidem, or with itself in a double-up.
• Alcohol — in any meaningful amount on a night a sleep medicine is taken.
• Sedating antihistamines — promethazine (Phenergan), doxylamine (Restavit), diphenhydramine.
• Sedating antidepressants — particularly mirtazapine (Avanza) at sleep-aid doses, amitriptyline, doxepin.
• Gabapentinoids — gabapentin, pregabalin (Lyrica). See the gabapentinoids page for the mirror-image warning.
• Muscle relaxants — orphenadrine (Norflex), baclofen.

Never combine without your prescriber’s explicit knowledge. Tell every doctor, dentist, surgeon, anaesthetist, and pharmacist what you are taking at bedtime. Check before buying any over-the-counter sleep aid or sedating cold-and-flu remedy.

If you live with someone, it is reasonable to tell them what marked drowsiness with slow or shallow breathing looks like — pale or blue lips, very slow or shallow breathing, hard to rouse — and that the response is to call 000 immediately.

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The zolpidem complex-sleep-behaviour warning

Zolpidem (Stilnox, Stilnox CR) carries a TGA boxed warning — the strongest safety alert the TGA issues — for complex sleep behaviour. After taking a dose, some people have:

• Driven cars
• Eaten or cooked
• Walked outside
• Shopped online
• Sent texts or emails
• Held conversations

— with no memory of the event the next morning. The TGA issued the boxed warning after multiple Australian reports. Risk rises with the 10 mg dose, with alcohol or other sedating medicines, and in people who do not go straight to bed after taking the tablet.

If this happens — even once — stop the medicine and contact your GP. Tell any bed partner, housemate, or family member you live with what to watch for, particularly in the first weeks. Zopiclone has a lower signal but is in the same class warning. Suvorexant and Circadin do not carry this signal.

Practical safety steps:

• Take the tablet only once you are already in bed for the night.
• Do not combine with alcohol, opioids, benzodiazepines, or other sedating medicines.
• For women — start at 5 mg, not 10 mg. The TGA recommends a 5 mg starting dose in women because of lower clearance.
• For adults aged 65 and over — start at 5 mg (zolpidem) or 3.75 mg (zopiclone).
• Do not take a Z-drug and then send important emails, sign documents, or drive.

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Tap any section below to expand the detail.

How do they work?

The medicines on this page reach the same patient-facing goal through three different biological routes.

Z-drugs (zopiclone, zolpidem) bind selectively to the alpha-1 subunit of the GABA-A receptor — the brain’s main inhibitory system. That binding enhances inhibitory signalling and slows neural activity, producing sedation and sleep induction. The selectivity for the alpha-1 subunit explains why Z-drugs are more sleep-focused and less anxiolytic than benzodiazepines, which bind across multiple GABA-A subtypes.

Suvorexant (Belsomra) blocks both orexin-1 and orexin-2 receptors. Orexin is the wake-promoting neuropeptide produced in the hypothalamus — it is what keeps you awake during the day. Blocking it removes the wake drive rather than depressing the central nervous system. This is closer to allowing natural sleep transition than to pushing the brain into sleep. The mechanism is why suvorexant has a lower dependence signal than Z-drugs in the SUNRISE 2 trial, and why its side-effect profile is distinct (vivid dreams, sleep paralysis, brief cataplexy-like episodes — these are predictable from blocking orexin, which is the same neurotransmitter system disrupted in narcolepsy).

Prolonged-release melatonin (Circadin) activates MT1 and MT2 melatonin receptors on the suprachiasmatic nucleus — the brain’s master clock. Endogenous melatonin production peaks in the early hours of darkness and falls with age. The prolonged-release formulation mimics the natural overnight melatonin profile, which is why it works best for sleep-onset complaints in adults aged 55 and over. The Wade 2007 and Lemoine 2007 trials established the over-55 indication.

The mechanism differences explain the safety differences. GABA enhancement (Z-drugs) brings the fall risk, the dependence signal, the complex-sleep-behaviour signal, and the respiratory depression on combination. Orexin block (suvorexant) brings the dream-related side effects but a lower dependence signal. Melatonin supplementation (Circadin) brings neither.

Side effects in detail

Z-drugs (zopiclone, zolpidem) — common (usually mild, often dose-related)

• Daytime sedation, dizziness, slowed reflexes — common in the first week and after every dose increase. Do not drive or operate machinery until you know how the medicine affects you. Zolpidem 10 mg in women has been linked with morning impairment severe enough that the TGA recommends a 5 mg starting dose in women.
• Bitter or metallic taste the morning after — characteristic of zopiclone (Imovane). Often the reason for discontinuation. Usually settles or persists but does not signal harm.
• Anterograde amnesia — Z-drugs can erase memory of conversations or events between taking the tablet and falling asleep. Do not take a Z-drug and then send important emails, sign documents, or drive.
• Headache, dry mouth, mild nausea — usually settle within the first week.
• Falls and unsteadiness — particularly important in adults aged 65 and over.

Z-drugs — uncommon or rare

• Complex sleep behaviour — TGA boxed warning for zolpidem; class warning for zopiclone. Sleep-driving, sleep-eating, sleep-walking, sleep-cooking, sleep-shopping, sleep-texting with no memory the next day. Stop the medicine and contact your GP if this happens, even once.
• Mood changes — new or worsening depression, low mood, or thoughts of self-harm. Tell your doctor immediately or contact Lifeline 13 11 14. Call 000 if safety is at risk right now.
• Rebound insomnia on discontinuation — sleep often temporarily worse in the first 1-2 weeks after stopping. This is the body re-learning to sleep without the medicine, not the original insomnia returning permanently.
• Unmasking of restless legs syndrome — zolpidem in particular.
• Rare but serious — angioedema (face, tongue, throat swelling), severe allergic reactions, marked confusion or delirium (particularly in older adults). Stop the medicine and seek urgent medical attention.

Suvorexant (Belsomra) — common

• Next-day somnolence — particularly at the 20 mg dose. Do not drive until you know how the medicine affects you.
• Vivid or unusual dreams — predictable from the mechanism (orexin block). Often transient.
• Dry mouth, headache, mild dizziness — usually settle.

Suvorexant — uncommon

• Sleep paralysis — waking with the inability to move for a few seconds. Frightening but transient.
• Brief cataplexy-like episodes on waking — legs feel weak or refuse to move for a few seconds. Predictable from the orexin mechanism (the same system is disrupted in narcolepsy). Tell your GP if persistent or distressing.
• Mood signal — rare but documented. Same advice as Z-drugs — tell your doctor; contact Lifeline 13 11 14 if needed.

Prolonged-release melatonin (Circadin) — common

• Mild headache or daytime drowsiness — uncommon, usually mild, often settles.
• Mild dizziness, nausea, or vivid dreams — uncommon.

Circadin — rare

• No meaningful dependence signal. No complex-sleep-behaviour signal. No respiratory depression. Very low overdose risk. The harm profile is genuinely low.

All — rare but call 000

• Marked drowsiness with slow or shallow breathing, blue lips, hard to rouse — particularly after a combined dose with an opioid, benzodiazepine, or alcohol.
• Sudden swelling of face, lips, tongue, or throat.

Drugs, food, and alcohol

The combination warning above is the most important interaction conversation for this class. This section covers the rest.

Suvorexant specifically — CYP3A4 interactions. Suvorexant is a strong substrate of the CYP3A4 liver enzyme. Anything that inhibits CYP3A4 raises suvorexant levels, sometimes sharply. Anything that induces CYP3A4 lowers them.

• Strong inhibitors that require dose reduction to 5 mg or a temporary switch — azole antifungals (fluconazole, itraconazole, voriconazole, ketoconazole), macrolide antibiotics (clarithromycin, erythromycin — azithromycin to a lesser extent), protease inhibitors (ritonavir).
• Grapefruit juice in large quantities — same effect, milder.
• Strong inducers that may render suvorexant ineffective — rifampicin, carbamazepine, phenytoin, St John’s wort.

Tell your GP and pharmacist about every new prescription, including short courses of antibiotics or antifungals. Z-drugs and Circadin are not strongly affected by CYP3A4 interactions, but other interactions exist:

• Circadin plus fluvoxamine — fluvoxamine strongly inhibits melatonin metabolism. Combination is not recommended.
• Circadin plus warfarin — weak signal for raised INR. Monitor INR more closely in the first few weeks of co-administration.
• Z-drugs plus opioid analgesia after surgery or trauma — markedly increased respiratory depression and falls risk in older patients. Tell every prescriber what you take at bedtime.

Food. Circadin should be taken after food (improves absorption profile). Z-drugs and suvorexant work best on an empty stomach — a heavy meal immediately before delays absorption and may push the peak sedation past the time you wanted to sleep.

Alcohol. Avoid completely on any night a sleep medicine is taken. Additive sedation, complex-sleep-behaviour amplification, respiratory-depression risk, and morning impairment.

Generic substitution at the pharmacy. Generic zopiclone and generic zolpidem are bioequivalent to the brand-name versions. If the pharmacist offers a generic, it is fine to take. The dose is the same.

Stopping safely — the taper

Never stop a Z-drug suddenly after more than 4 weeks of continuous use. Suvorexant has a lower dependence signal but the same principle applies for established use. Circadin can typically be stopped without a taper.

The withdrawal syndrome for Z-drugs after established use includes rebound insomnia (often worse than the original problem in the first 1-2 weeks), anxiety, irritability, sweating, restlessness, nausea, and — uncommonly — tremor or seizure.

A typical supervised taper for Z-drugs:

• Short-term users (under 4 weeks) — usually can stop without a formal taper, though some prefer a 1-week step-down to reduce rebound insomnia.
• Established users (months to years) — reduce the daily dose by 10-25% every 1-2 weeks. Slower for higher doses. Slower for longer duration of use. Slower in people with a history of withdrawal symptoms.

Rebound insomnia in the first 1-2 weeks is expected and is the body re-learning to sleep without the medicine — it is not the original insomnia returning permanently. Plan the taper around a low-stress period if possible. Run CBT-I behavioural strategies in parallel — consistent wake time, stimulus control, sleep restriction, screen taper before bed, caffeine cessation after midday.

The taper conversation typically covers: which dose drops are made when, what to expect during each drop, when to slow down or pause, what the off-medicine sleep plan looks like, and what the contingency plan is if rebound insomnia becomes marked.

This is a planned conversation, not an improvised one. Book a dedicated review with your GP before changing the dose.

Older adults — the fall conversation

Z-drugs cause a measurable rise in falls and fractures in people aged 65 and over — confirmed across Cochrane meta-analyses. The mechanism is the predictable sedation, dizziness, and unsteadiness of the class layered onto an age group with already-reduced balance reserve.

The defensible approach in people aged 65 and over:

• Lower starting dose. Zolpidem 5 mg (not 10 mg). Zopiclone 3.75 mg (not 7.5 mg).
• Slower-acting agents or non-medication strategies preferred. Circadin has a more favourable safety profile in this age group — no fall signal, no dependence signal, no respiratory depression — and is often considered first when the complaint is sleep onset.
• CBT-I as the primary plan. Effective at any age. No fall risk. No dependence signal.
• Home-hazard review. Loose rugs, poor lighting at night, bathroom rails, clear paths between bed and bathroom.
• Walking-aid review. If a stick or frame would help, this is the moment.
• Vitamin D check — supports bone strength if a fall does happen.
• Bone-density consideration — particularly in women over 65 and men over 70 with other risk factors.
• Avoid stacking sedating medicines. Sedating antihistamines (Restavit, Phenergan), sedating antidepressants (mirtazapine, amitriptyline), benzodiazepines, opioids — each adds to the fall risk.

If you have had a near-miss or a fall on a sleep medicine, that is a reason to review urgently rather than wait for the next routine appointment.

Pregnancy and breastfeeding

Z-drugs and suvorexant — limited safety data in pregnancy. Avoid where possible, particularly in the first trimester. If you become pregnant on one of these medicines, contact your GP as soon as possible — do not stop suddenly after established use without medical input. The plan is made together with your obstetric team.

Prolonged-release melatonin (Circadin) has some safety data in pregnancy but is not a routine pregnancy treatment. Decision is case by case with your prescriber.

Breastfeeding. Z-drugs and suvorexant transfer into breast milk. Risk-benefit discussion with your doctor before continuing. Circadin transfers in small amounts and is generally considered lower risk, but the decision is individual.

The CBT-I-first principle is particularly relevant in pregnancy and early postpartum — sleep disturbance is common, often situational, and CBT-I plus sleep hygiene plus practical changes (alternating night feeds where possible, daytime rest opportunities, light exposure timing) often produce meaningful improvement without medication exposure during a sensitive window.

Untreated sleep apnoea — the missed-diagnosis warning

This is the one to flag before reaching for any sleep medicine.

Obstructive sleep apnoea — repeated airway collapse during sleep, with oxygen drops and arousals — is common and frequently undiagnosed. The classic features are:

• Loud snoring (loud enough to disturb a bed partner)
• Witnessed pauses in breathing during sleep
• Waking unrefreshed despite an adequate sleep time
• Daytime sleepiness, particularly in sedentary moments (reading, in front of the TV)
• Morning headache
• High blood pressure that is hard to control

Z-drugs depress the arousal response and can worsen oxygen drops in untreated sleep apnoea. The combination of untreated sleep apnoea plus a Z-drug is a real safety concern.

If any of the features above are present, ask your GP about a sleep study before starting any prescription sleep medicine. The Better Health Channel and the Sleep Health Foundation have plain-English information on what the study involves — typically a home-based recording overnight.

Treating sleep apnoea — CPAP, mandibular advancement device, weight loss, positional therapy — is often more effective than any sleep medicine and removes the respiratory-depression risk. Many people on long-standing Z-drug scripts turn out to have undiagnosed sleep apnoea as the underlying problem.

Cost

From 1 January 2026, the PBS co-payment is:

• General patient — up to $25.00 per script.
• Concession card holder — up to $7.70 per script.

By medicine:

• Zopiclone (Imovane, generics) — PBS-listed without authority restrictions. Standard co-payment.
• Zolpidem (Stilnox, Stilnox CR, generics) — PBS-listed without authority restrictions. Standard co-payment.
• Suvorexant (Belsomra) — generally NOT PBS-listed as of 2026 (confirm at the pharmacy at the time you fill the script). Available privately at a higher cost — typically around $80-$120 per month depending on dose and pharmacy. The out-of-pocket cost is a real barrier for many people and is a legitimate factor in the prescribing conversation.
• Prolonged-release melatonin (Circadin) — PBS-listed with restrictions (TGA-approved indication: primary insomnia in adults aged 55 and over). Confirm restriction wording with your pharmacist at the time you fill the script.

Generic versions cost the same as brand-name versions at PBS pricing and work the same. Confirm with your pharmacist — they can show you the exact price for your script and tell you the cheapest option.

If a younger family member or housemate is curious about your tablets

Z-drugs and suvorexant carry a misuse signal — lower than benzodiazepines but real — and shared-household-access is a real route to harm.

• Store the medicine out of easy reach. Not on the kitchen counter, not in a handbag left on a hall table.
• Do not share your script. A Z-drug handed to a friend who has been “having trouble sleeping” can sedate, cause complex sleep behaviour, cause respiratory depression in combination with alcohol or another sedating drug, and — particularly with opioids — kill.
• If a tablet goes missing, tell your GP. It is a brief, non-judgemental conversation and is the right thing to do.
• If you have a young child in the home or visiting, a child-resistant container is worth it.

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The integrative view

The integrative angle on insomnia is substantial — arguably more substantial than for any other medication class on this site — because the foundational interventions (sleep hygiene, CBT-I, sleep apnoea workup, nutrient adequacy, circadian alignment) are often the primary therapy, with prescription medicine as a short-term bridge or adjunct.

Two principles. First — for chronic insomnia, the durable improvement comes from changes the medicine cannot make on its own. Second — many people on long-standing sleep medicine scripts are running on a workaround for an underlying issue (untreated sleep apnoea, restless legs syndrome with low ferritin, circadian misalignment, vitamin D deficiency, nutrient inadequacy, an unaddressed cognitive-behavioural pattern) that the medicine has masked rather than addressed.

Strong evidence — these reliably help

• Sleep hygiene foundation. Consistent wake time every day including weekends — the single most powerful lever for chronic insomnia. Dark, cool, quiet bedroom. Blue-light reduction from screens 2 hours before bed. Caffeine cessation after midday (half-life 5-7 hours; later cups are still in the system at bedtime). Alcohol moderation — alcohol sedates initially but fragments the second half of the night and worsens sleep apnoea. Morning rather than evening exercise where possible.
• CBT-I. Components include sleep restriction (counter-intuitive but powerful), stimulus control, cognitive reframing of unhelpful sleep beliefs, relaxation training, and sleep hygiene education. Available free as digital tools through the Sleep Health Foundation Australia and through psychologist referral under a Mental Health Care Plan (Better Access — ten Medicare-rebated sessions per calendar year).
• Sleep apnoea workup. Loud snoring, witnessed pauses, waking unrefreshed despite adequate sleep time, daytime sleepiness — ask the GP about a sleep study. Treating sleep apnoea (CPAP, mandibular advancement device, weight loss, positional therapy) is often more effective than any sleep medicine.
• Avoiding the obvious sleep disruptors. Heavy alcohol (fragments second-half sleep, worsens apnoea), late caffeine, large late meals, intense late exercise, blue-light exposure right up to bedtime.

Moderate evidence — likely helpful

• Magnesium glycinate 300-400 mg in the evening. Modest evidence for sleep architecture and smooth muscle relaxation. Glycinate form is better tolerated than oxide or citrate (less gut looseness). Cheap, low harm. Avoid in advanced kidney disease without medical advice.
• L-theanine 200 mg in the evening. Anxiolytic effect without sedation. Some evidence for reduced sleep latency and improved subjective sleep quality. Useful where racing thoughts are the dominant barrier to sleep onset.
• Glycine 3 g pre-bed. Modest evidence for reduced sleep latency and improved subjective sleep quality in small trials. Low harm profile.
• Mindfulness, body-scan meditation, and progressive muscle relaxation. Components of CBT-I that can be practised independently of formal therapy (Smiling Mind, Calm, Insight Timer apps). Reduce the cognitive arousal that maintains chronic insomnia.
• Iron and ferritin testing if restless-legs symptoms. Low ferritin (under 75 ng/mL, even within the lab-normal range) is associated with restless legs and can be addressed before reaching for a sleep medicine.
• Vitamin D adequacy. Emerging evidence for a relationship between vitamin D deficiency and sleep quality. If you fall in the deficient range (under 50 nmol/L) on a routine blood test, supplementation is reasonable.

Limited or emerging evidence

• Tart cherry juice (Montmorency). Modest evidence for sleep improvement, attributed partly to natural melatonin content. Sugar content is a consideration if metabolic health is in the picture; unsweetened concentrate (1-2 tablespoons in water) is an alternative.
• Valerian root and chamomile. Modest evidence for sleep onset; well tolerated. Valerian has more evidence than chamomile but the effect size is small. Tell your GP what you are taking — valerian can interact with sedating medicines.
• Lavender essential oil aromatherapy. Modest evidence for sleep quality in older adults and in hospital settings. Low harm; a reasonable addition to a sleep-routine bundle.

Things to avoid

• Avoid evening melatonin in shift workers and adolescents without specialist input — mis-timed melatonin can worsen circadian disruption rather than help.
• Avoid combining over-the-counter sedating antihistamines (doxylamine / Restavit, promethazine / Phenergan) with prescription sleep medicines — additive sedation, additive next-day impairment, additive anticholinergic burden (memory and falls in older adults). If you are using an over-the-counter sleep aid, tell your GP before adding a prescription.
• Avoid the assumption that more sleep medicine equals better sleep. Dose escalation typically does not reliably restore lost effect, and side effects (sedation, falls, complex sleep behaviour, dependence) rise with dose.

Specific to being on a prescription sleep medicine

• Run CBT-I in parallel from day one. Free digital tools through the Sleep Health Foundation. The medicine works better, and the eventual taper is easier, when CBT-I is the underpinning.
• Plan the taper from the start, not at the end. If a Z-drug or suvorexant is appropriate for a 2-4 week situational course, name the end date when the script is written, not when it runs out.
• Track what is working. A simple sleep diary (bedtime, lights out, sleep latency, wakings, wake time, morning grogginess) for 2 weeks tells the GP more than a verbal description and is the foundation for the next decision.
• Address the obvious underlying drivers. Sleep apnoea, low ferritin if restless legs, vitamin D deficiency, caffeine load, alcohol pattern, screen exposure, shift-work pattern.

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Track these between now and your next visit

• Sleep diary — bedtime, lights out, sleep latency (how long to fall asleep), number of wakings, time spent awake during the night, wake time, morning grogginess. Two weeks of diary entries make the next conversation specific rather than vague.
• Morning grogginess or next-day sedation — how marked, how long it lasts, any near-misses or falls.
• Any complex sleep behaviour — sleep-driving, sleep-eating, sleep-walking, sleep-cooking, sleep-shopping, sleep-texting. If any episode occurs, stop the medicine and contact the GP before the next dose.
• Mood — note any change, particularly any new low or any thought of self-harm. If safety is at risk, contact Lifeline 13 11 14 or call 000.
• Anything new you have started — over-the-counter medicines, supplements, alcohol changes, other prescribers’ prescriptions, particularly antibiotics or antifungals if you are on suvorexant.

Bring the diary and the list to the review appointment.

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This is general information, not personal medical advice. Every patient is different. Decisions about your sleep medicines — which one, what dose, when to stop, what to combine with, when to taper — are made with the doctor who prescribed them. If anything on this page appears to contradict advice from your treating doctor, follow your doctor; they have context about your situation that this page cannot.

Reading this page does not establish a doctor-patient relationship with Dr Hoebing Lo. If you are not a current patient, please discuss your medicines with your own GP, specialist, or pharmacist.

About the integrative content. The sleep hygiene, CBT-I, nutrient, and complementary recommendations on this page summarise current published research. Effect sizes are approximations from clinical studies — individual response varies, and real-world results are commonly smaller than trial results because day-to-day life differs from study conditions. Supplements and herbal products are not interchangeable with prescribed medication and can interact with it. Talk to your doctor and pharmacist before starting any new supplement, herbal product, or significant change in diet.

Currency. This page reflects clinical practice as of the last-reviewed date. Medicine evolves; specific details may date between reviews. Pricing shown is indicative; confirm with your pharmacist. PBS listings and authority restrictions change — confirm at the time you fill the script.

No commercial relationships. Dr Hoebing Lo has no financial or commercial relationship with the manufacturer of any medicine, brand, or supplement mentioned on this page.

Emergencies. If you have sudden swelling of face, lips, tongue, or throat; difficulty breathing; marked drowsiness with slow or shallow breathing; chest pain; thoughts of suicide or self-harm; or severe dizziness or fainting — call 000 or go to your nearest emergency department. For mental-health crisis support, Lifeline 13 11 14 is available 24 hours.