Insomnia affects 20-30% of adults in Romania at least occasionally. The causes are many — stress, anxiety, hormonal disturbances, physical illness, bad habits before bedtime. Here are the OTC and Rx options, ordered from the mildest to the most powerful.
First — sleep hygiene
No medication makes up for bad habits. Before taking any supplement or medicine, try at least 2 weeks of strict sleep hygiene:
- A constant bedtime and wake-up time (weekends included).
- No blue-light screens in the last hour before bed (phone, TV, laptop).
- No caffeine after 2 pm.
- A cool (18-19°C), dark, quiet room.
- Avoid afternoon naps.
- Regular exercise, but not in the last 3 hours before bed.
OTC remedies (without a prescription)
Melatonin
A natural hormone secreted by the pineal gland, the signal for sleep. Supplementation helps with sleep-onset insomnia (difficulty falling asleep) and jet lag. It is less effective for sleep-maintenance insomnia (waking at 3 in the morning).
- Dose: 0.5-3 mg 30 min before bed. More is NOT better — high doses (5-10 mg) can cause confusion, headaches and fragmented sleep.
- Preparations: Melaxose, Melatonin Solgar, Circadin (Rx, prolonged release), ZzzQuil.
Valerian
A plant with a mild sedative effect. The studies are mixed — some positive, others neutral. Typically 300-600 mg of extract in the evening. Preparations: Persen, Relaxane, Nervodyl.
Chamomile, passionflower, lemon balm
Traditional plants with a mild calming effect. Useful for mild anxiety associated with insomnia, not for severe insomnia. As a tea, a tincture or capsules.
L-theanine
An amino acid from green tea, 200-400 mg in the evening. It reduces anxiety without sedation, useful for people with a “racing” mind at bedtime.
Magnesium
Magnesium deficiency is associated with poor sleep. Supplement 200-400 mg in the evening (bisglycinate or citrate, NOT oxide, which is poorly absorbed). A subtle effect, but useful in the medium term.
OTC antihistamines (diphenhydramine, doxylamine)
A short-term benefit, but with residual drowsiness the next morning as a side effect. NOT for regular use — tolerance develops within 3-7 days. Preparations: ZzzQuil, Unisom, Dormeasan.
Prescription medicines (Rx)
Non-benzodiazepines (“Z-drugs”)
Zopiclone, zolpidem, eszopiclone. The most prescribed in Romania for short-term insomnia. Effective, but with a risk of dependence and tolerance with prolonged use.
- Zopiclone 7.5 mg — duration of action 6-8 hours. Side effects: a bitter taste in the morning, dizziness.
- Zolpidem 10 mg — shorter action (4-6 hours). Better for sleep-onset insomnia.
The standard recommendation: at most 4 weeks continuously. Beyond that — tolerance and dependence.
Benzodiazepines
Alprazolam, diazepam, lorazepam, bromazepam. Effective but with a marked risk of dependence, residual sedation and falls in older people. Reserved for special situations (associated severe anxiety, a history of dependence).
Antidepressants with a sedative effect
Trazodone 25-100 mg, mirtazapine 7.5-30 mg, amitriptyline 10-25 mg. The first choice when insomnia coexists with depression or chronic anxiety. They do NOT cause dependence like benzodiazepines or Z-drugs. A safe long-term effect.
Rx melatonergic agents
Ramelteon, agomelatine (Valdoxan). They act on the melatonin receptors, with a stronger effect than the OTC supplement. No dependence.
When to see a doctor
- The insomnia lasts more than 3 weeks.
- It affects your daily activities (drowsiness, irritability, lower performance at work).
- The insomnia is associated with breathing symptoms (loud snoring, pauses in breathing) — it may be sleep apnoea.
- There is associated anxiety or depression.
- Supplements and OTC medication are not effective.
Cognitive Behavioral Therapy for Insomnia (CBT-I)
Cognitive behavioural therapy is, in large studies, more effective than medication in the long term. It is done with a specialised psychologist, over 6-8 sessions, and teaches techniques for changing anxious thoughts and sleep-related behaviours. In Romania, it is increasingly accessible through online platforms.
Indicative prices
- Melatonin 3 mg x 30 tablets: 25-50 RON
- Persen x 40 tablets: 25-35 RON
- Zopiclone 7.5 mg x 20 tablets (Rx): 10-20 RON
- Trazodone 100 mg x 30 tablets (Rx): 30-50 RON
Check the current prices in HartaFarmacii — Sleep.
Hidden causes of chronic insomnia
Before escalating the medication, check for possible treatable causes:
- Sleep apnoea — loud snoring with pauses in breathing, daytime sleepiness. Polysomnography for the diagnosis. CPAP solves it.
- Restless legs syndrome — an unpleasant sensation in the legs at night. Low serum iron is common; dopaminergic medicines help.
- Gastro-oesophageal reflux — night-time heartburn. PPIs (omeprazole, pantoprazole) in the evening help.
- Hyperthyroidism — low TSH, a faster metabolism.
- Depression and anxiety — often masked, but real. Antidepressants with a sedative effect also treat the insomnia.
- Menopause — night-time hot flushes, hormonal insomnia. Hormone replacement therapy or alternatives (venlafaxine, gabapentin).
- Medication — beta-blockers, decongestants, corticosteroids and stimulants can cause insomnia.
Melatonin side effects — the less well-known facts
- Sleep that is too deep and difficulty waking up at high doses (over 5 mg).
- Vivid dreams or nightmares in some users.
- An interaction with anticoagulants (it potentiates warfarin).
- It is not recommended in pregnancy without medical advice.
- It does not slow sexual maturation in adolescents — a myth based on incomplete studies in animals.
Conclusion
For occasional insomnia, try melatonin 0.5-3 mg and sleep hygiene. For chronic insomnia, see a doctor — do not self-medicate with Z-drugs in the long term. CBT-I is the best treatment, but it requires patience and commitment. Choose medication as support, not as a permanent solution. Compare prices in the HartaFarmacii Sleep category.
Frequently asked questions
- What dose of melatonin should I take?
- 0.5-3 mg 30 minutes before bed. Higher doses (5-10 mg) are NOT more effective and can cause side effects (confusion, headaches, fragmented sleep). Start with a low dose and go up only if it does not work.
- Zopiclone or zolpidem — which is better?
- Zolpidem (4-6 hours) is better for sleep-onset insomnia (difficulty falling asleep). Zopiclone (6-8 hours) is better for sleep-maintenance insomnia (waking early). Both are prescription-only, at most 4 weeks continuously to avoid dependence.
- Do natural supplements work?
- With a modest effect. Melatonin is the best studied. Valerian, chamomile and L-theanine have a mild effect. Magnesium helps with insomnia associated with a deficiency. Severe insomnia needs prescription medication or CBT-I.
- Can I take sleeping medication for the rest of my life?
- It is not recommended for Z-drugs and benzodiazepines (tolerance, dependence). Sedating antidepressants (trazodone, mirtazapine) can be used safely in the long term. CBT-I is the best solution for chronic insomnia.
- Is CBT-I really more effective than medication?
- Yes, studies show greater long-term effectiveness (6+ months) compared with medication. It requires 6-8 sessions with a specialised psychologist, increasingly accessible in Romania through online platforms.