Sleeping Pills in Japan: Prescription, Over the Counter, and What Is Recommended First
Sleeping pills are available in Japan by prescription, and the ones Japanese sleep specialists recommend first are newer medicines that are unlikely to cause dependence. Older sleeping pills are still prescribed, with their benefit weighed against a risk of dependence. Without a prescription, you can buy antihistamine sleep aids and, since July 2026, ramelteon from a pharmacist. Melatonin is not sold over the counter (why, and what to use instead). How prescribing works in general is in our guide to psychiatric medication in Japan.
Which sleep medicines are recommended first?
An orexin receptor antagonist. In a 2023 consensus of Japanese sleep specialists, lemborexant was the first-line choice for trouble falling asleep, lemborexant and suvorexant were first-line for trouble staying asleep, and the experts concluded that this group should be used first in most situations. The newer groups:
- Orexin receptor antagonists: suvorexant (Belsomra), lemborexant (Dayvigo), daridorexant (Quviviq), and vornorexant (Vorzzz, approved in 2025) turn down the brain's wake signal instead of sedating. They help with falling asleep and staying asleep, and dependence is unlikely, although the packaging carries Japan's standard habit-forming label.
- Ramelteon (Rozerem): ramelteon acts on melatonin receptors and helps with falling asleep. It is not habit-forming.
- Sedating antidepressants: trazodone and mirtazapine are sometimes chosen when insomnia comes with depression, so that one medicine treats both.
Each medicine's page covers how to take it and its side effects. Alcohol adds to the effect of sleeping pills, old and new: the Japanese labels for suvorexant, lemborexant and vornorexant say not to drink while taking them, and the zolpidem label says to refrain from drinking as far as possible (what the labels say about alcohol).
Are the older sleeping pills still prescribed?
Yes, when the benefit outweighs the risk of dependence. Z-drugs (zolpidem, zopiclone, and eszopiclone) and benzodiazepine sleeping pills such as brotizolam and triazolam act quickly, and for a short period, with an end point agreed in advance, the benefit can outweigh the risk. The risk is dependence: with regular use it can develop, and Japan's health ministry warns that this can happen even within the approved dose. Stopping suddenly can bring rebound insomnia and withdrawal symptoms such as anxiety, tremor, and in some cases seizures, so when one of these is used, it is for a limited period with a plan for stopping. Japan's insurance rules also discourage long-term and multi-drug prescribing of this group.
If you already take one of these every night, do not stop it suddenly. A gradual reduction is planned with your doctor, and our benzodiazepine guide explains how tapering works.
Which sleeping pills can be prescribed online?
Eszopiclone, the orexin receptor antagonists, and ramelteon can be prescribed from a first online visit when the doctor can confirm your medical background, for example from medical records, a referral letter, or your medication record. Benzodiazepine sleeping pills, zolpidem, and zopiclone are controlled psychotropics. They cannot be prescribed online, at a first visit or a follow-up, until a doctor has examined you in person for the sleep problem. Our guide to the online prescribing rules explains the rule.
What can you buy without a prescription?
Mainly antihistamine sleep aids and, since July 2026, ramelteon.
- Antihistamine sleep aids: "sleep improvement" products whose active ingredient is typically diphenhydramine, a sedating antihistamine. They are meant for occasional sleeplessness.
- Ramelteon (Rozerem S): the same ingredient as prescription Rozerem, sold at pharmacies and drugstores after an explanation from a pharmacist. The label limits it to temporary trouble falling asleep in people aged 15 and over, and says not to take it for more than two weeks without asking a doctor or pharmacist. It is not for people being treated for a sleep disorder or for a mental health condition that comes with insomnia, such as depression, or for people taking fluvoxamine.
Melatonin is not sold over the counter. If you are using a drugstore sleep aid more than occasionally, see a doctor about the insomnia itself.
Why is medication only part of the treatment?
Because guidelines put non-drug steps first. Japanese guidelines start with guidance on sleep habits, and US and European guidelines recommend CBT-I, a structured behavioral method, as the first treatment for chronic insomnia. Our insomnia treatment guide covers how CBT-I works and what happens at a first appointment.
Frequently asked questions
This article is general information, not medical advice for your individual situation. Decisions about medication belong in a consultation with a doctor who knows your history.
Medically reviewed by our psychiatrist (M.D.). Updated October 16, 2026.