The active ingredient of the otc sleeping medications is either doxylamine or diphenhydramine. Both doxylamine and diphenhydramine are First Generation antihistamines. These antihistamines can cross the blood-brain barrier and have anticholinergic activity. Therefore, They can cause significant side effects.
The side effects include: Next-day drowsiness, constipation, dizziness, difficulty urinating, blurry vision, confusion, impaired coordination, paradoxical excitation, headache, dry mouth, nose, and/or throat etc.
Alcohol should be avoided when taking these medications because alcohol can aggravate the side effects of the medications. In addition, you should not combine OTC sleep drugs with other medications that contain 1st generation antihistamines such as Benadryl. Long-term use of diphenhydramine or benadryl has been associated with an increased risk of dementia.

The American Academy of Sleep Medicine does not recommend the use of diphenhydramine for insomnia. Similarly, doxylamine is not recommended for insomnia treatment either.
The American Geriatrics Society also advises against the use of these OTC sleep drugs in people 65 and older because of risks such as confusion, constipation, dry mouth, and cognitive decline.
The American Academy of Sleep Medicine does not recommend the use of melatonin, tryptophan or valerian as a treatment for insomnia in adults.

Cognitive behavioral therapy for insomnia provided by a counselor or a psychotherapist is recommended as a first-line treatment for insomnia.
OTC Sleeping medications may be used occasionally as adjunct treatment.
Routine use of otc sleeping medications for more than 2 weeks is not recommended

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