Sleep Medications
En Español (Spanish Version)

Medications and Their Commonly Used Names

There are several types of prescription and nonprescription medications that can be used to treat insomnia.

Prescription Drugs
Benzodiazepine-receptor agonists —These are hypnotic drugs that have a sedative effect. This class includes:

  • Benzodiazepines, which are also used to treat depression, anxiety, or seizure disorder.
  • Nonbenzodiazepines, which have similar effects to traditional benzodiazepines and mainly used to treat mild insomnia.
Melatonin-receptor agonist—This medication is used to treat insomnia characterized by difficulty with falling asleep. It shortens the time it takes to fall asleep in people with transient insomnia.

Sedating antidepressants—For long-term treatment of insomnia or when insomnia is accompanied by depression and/or caused by depression. These antidepressants are different other classes of antidepressants.

Nonprescription Drugs
Nonprescription sleeping aids can leave people feeling drowsy the next day and may not always be effective at providing restful sleep. However, they are often used as the first line of treatment for short-term insomnia because they are not addictive and a fatal overdose is extremely rare. These include the following:

Antihistamines—There are many antihistamines available over-the-counter. Diphenhydramine is a commonly used antihistamine for insomnia. Not all antihistamines are effective for this purpose, especially the newer, nondrowsy antihistamines.

Melatonin—A natural hormone produced in the brain. Melatonin triggers sleep and is more active at night. Your body produces more melatonin in a completely dark room than in a dimly lit one. Melatonin may be useful when your normal sleep cycle has been disturbed, such as during travel-induced jet lag.

Pain relievers—Can be useful when insomnia is caused by minor pain.

The information below relates to prescription sleep medications unless stated otherwise.

What These Medications Are Prescribed For
To promote sleep in someone who has insomnia, especially in these cases:

  • When sleep difficulties cause problems in accomplishing daily activities
  • When behavioral approaches have proven ineffective
  • Insomnia associated with:
    • Psychological condition, such as anxiety
    • Temporary changes in normal sleep cycles
Hypnotics may help to do the following:

  • Shorten the time it takes to fall asleep
  • Increase total sleep time
  • Decrease the number of wakings during sleep
How These Medications Work
Hypnotic drugs alter brain chemistry in different ways:

  • Benzodiazepine receptor agonists work by enhancing the effect of a brain chemical responsible for reducing neuron excitability.
  • Melatonin receptor agonists may enhance the properties of melatonin's sleep-inducing properties.
  • Antidepressants block the absorption of certain brain chemicals leaving them in the blood stream. This helps produce a feeling of drowsiness.
Precautions While Using These Medications
Avoid overuse and dependence —Benzodiazepines and other sleep medications may become less effective over time, requiring higher doses to produce effects. This can lead to dependence. Antidepressants and antihistamines present a lower risk for dependency. There is no current evidence that melatonin receptor agonists lead to overuse or dependence.

Do not stop suddenly —When you are discontinuing regular use of a prescription sleep aid, your doctor may gradually lower your dose. Stopping abruptly can cause withdrawal.

Mild withdrawal of benzodiazepines is common. The usual symptom is several nights of poor sleep. More serious withdrawal may occur with higher doses of benzodiazepines and may include the following symptoms:

  • Anxiety
  • Irritability
  • Depression
  • Insomnia
  • Sweating
  • Vomiting
  • Diarrhea
  • Blurred vision
  • Impaired memory and concentration
  • Tremor
  • Muscle and abdominal cramps
  • Decreased appetite
  • Hallucinations or seizures (in severe cases)
Melatonin receptor agonists are not associated with returning insomnia or withdrawal symptoms.

Do not combine with certain substances —Be sure to tell your doctor about all of the medications, both prescription and nonprescription and any herbal supplements you take. Hypnotics can have potentially dangerous interactions when combined with certain other substances, such as the following:

  • Alcohol
  • Anesthetics, including dental anesthetics
  • Antiseizure medications
  • Tricyclic antidepressants
  • Opioid pain relievers
  • Sedatives
  • Antipsychotics, such as lithium or tranquilizers
  • H2 blockers for gastrointestinal disorders
  • Antifungal medications
Practice good sleep habits —Because of the risks of overuse and withdrawal, sleep medications should not be considered a long-term or first solution to insomnia. While using these medications, it is essential to adopt good sleep habits in order to establish normal sleeping patterns that can be maintained without the use of drugs. These habits include the following:

  • Exercising regularly, at least 3 hours before you want to sleep
  • Avoiding naps, especially longer than 30 minutes and after 3 pm
  • Going to sleep and waking up at the same time every day (even on days off)
  • Saving your worries for daytime (schedule time during the day to write down concerns.)
  • Practicing a relaxing bedtime ritual, like a hot bath or listening to calming music
  • Using your bed only for sleeping and sex
Proper Usage
Your doctor will determine the appropriate dose and usage schedule for you.

Possible Side Effects
Elderly people are more susceptible to side effects and therefore hypnotics are not recommended for them.

Possible side effects of hypnotics include the following:

  • Clumsiness or unsteadiness
  • Lightheadedness
  • Drowsiness—more common with long-acting than short-acting drugs
  • Weakness
  • Slurred speech
  • Agitation
  • Headache
  • Depression
  • Memory loss
Rare side effects include the following:

  • Sleepwalking
  • Odd moods and behavior
  • Hallucinations
  • Lack of usual inhibitions
  • Confusion
Possible side effects of antihistamines include the following:

  • Lightheadedness
  • Drunken movements
  • Blurred vision
  • Dry mouth and throat
  • Urinary retention
  • Constipation
With every medication, there are important precautions to consider. These include allergies, interactions with other drugs and medical conditions, and safety during pregnancy, lactation, and other stages of life. If you have insomnia, talk to your doctor about treatment options.




RESOURCES:
National Heart, Lung, and Blood Institute

National Sleep Foundation

CANADIAN RESOURCES:
Better Sleep Council Canada


References:
Benzodiazepine withdrawal syndrome. Benzodiazepines Cooperation Not Confrontation website. Available at: http://www.bcnc.org.uk/symptoms.html. Accessed December 28, 2012.

Insomnia in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 8, 2014. Accessed November 25, 2014.

Proctor A, Bianchi MT. Clinical pharmacology in sleep medicine. ISRN Pharmacol. 2012 Nov [epub ahead of print].

Ramelteon. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 18, 2013. Accessed November 25, 2014.

Sack RL, Auckley D, Auger RR, et al. Circadian rhythm sleep disorders: Part I, basic principles, shift work and jet lag disorders. Sleep. 2007;30:1460-1483.

Sleep aids and insomnia. National Sleep Foundation website. Available at: http://www.sleepfoundation.org/article/sleep-related-problems/sleep-aids-and-insomnia. Accessed November 25, 2014.

Last Reviewed November 2014



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