Medications For Treating Insomnia - Insomnia: Sleep Disorders

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Medications for treating insomnia

A variety of products — including prescription medications and over-the-counter preparations — are available for treating insomnia (see Table 1). But their effectiveness varies, and some may carry unpleasant side effects, so talk to your doctor about which option is best for you.

Antihistamines. Antihistamines are the active ingredients in most over-the-counter sleep aids and in motion-sickness pills. Many different over-the-counter sleep remedies are available, but physicians don't usually encourage their use because they're often ineffective and may cause dizziness, blurred vision, constipation, nausea, and next-day grogginess. (For more on over-the-counter products, see "Nonprescription sleep aids".)

Barbiturates. Drugs in this class have been available for nearly a century and were a common ingredient in sleep medications until benzodiazepines became available in the 1960s. Today, sleep experts prescribe barbiturates only in very rare cases. Because these drugs suppress the activity of the entire central nervous system, barbiturate-induced sleep has a lower level of REM sleep than normal. More importantly, barbiturates are highly addictive, withdrawal can be painful and difficult, and an overdose is often fatal.

Benzodiazepines. These medications are frequently prescribed as sleeping pills. Drugs of this class work by enhancing the activity of the inhibitory neurotransmitter GABA, which calms brain activity. Many different benzodiazepines are available. They differ in how quickly they kick in and how long they remain active in the body. Benzodiazepines taken at night can lead to drowsiness and sedation the next day. If your main problem is getting to sleep, your doctor may prescribe a medication that begins working quickly and is short-acting, such as triazolam (Halcion). If your problem is staying asleep, a drug that lasts longer — such as lorazepam (Ativan), estazolam (ProSom), or temazepam (Restoril) — may be necessary. Some drugs in this class also act as muscle relaxants and may be prescribed for this purpose. Additionally, benzodiazepines are used to treat anxiety, so they tend to be useful for patients with anxiety and insomnia that results from it.

Many people who use benzodiazepines develop tolerance — the need for more and more of the drug to obtain the same effect — and after a few weeks, the drugs no longer promote sleep and instead may contribute to rebound insomnia when the medications are stopped. These medications should be discontinued under a doctor's supervision because withdrawal may also lead to muscle tension, restlessness, irritability, or, in rare cases, convulsions.

Imidazopyridines. The class of drugs called imidazopyridines became available in 1992, when the FDA approved zolpidem (Ambien). This medication begins to work after about 30 minutes and leaves the body within five hours. In 1999, zaleplon (Sonata), a shorter-acting imidazopyridine, was introduced. Imidazopyridines specifically enhance the sleep-inducing activity of the neurotransmitter GABA. Unlike benzodiazepines, they do not cause muscle relaxation. Treatment seems to promote a normal pattern of sleep. The most common side effects include headache, dizziness, nausea, and grogginess.

The newest drug in this class, eszopiclone (Lunesta), has just been approved for use in all types of insomnia. It has been shown to be safe and effective even when used for six months. Additional drugs in this class will be released in the near future.

Antidepressants. When depression interferes with sleep, an antidepressant may improve both sleep and mood. If depression is not the problem, a type of older antidepressant medication known as tricyclics is sometimes used because these drugs reduce the length of time it takes to fall asleep and improve the continuity of sleep. At the low doses used to treat sleep disturbance, tricyclic antidepressants seem to be less habit-forming than benzodiazepines and, therefore, less likely to contribute to rebound insomnia. When the tricyclic drug amitriptyline (Elavil, Endep) is used to treat insomnia in people with rheumatoid arthritis or other painful conditions, improved sleep seems to decrease aches and pains.

Other antidepressants, such as the sedative mirtazapine (Remeron), the serotonin-modulator trazodone (Desyrel), and those in the class known as SSRIs (selective serotonin reuptake inhibitors) may also be helpful in treating insomnia. SSRIs include fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil), and citalopram (Celexa).

Sedatives. Chloral hydrate is an older sedative that doctors sometimes prescribe before certain diagnostic tests. It is occasionally used to treat insomnia. Side effects include rash, nausea, stomach pain, dizziness, and headache.

Last updated:	January 23, 2007