Medications and Their Commonly Used Names
There are several types of prescription and nonprescription medications that can be used to treat insomnia.
Benzodiazepine-receptor agonists—These medications attach to special sites in the brain, causing relaxation. This class includes drugs in the benzodiazepine family and newer non-benzodiazepine drugs with similar effects. These drugs can be short-, intermediate-, or long-acting.
|]]>Alprazolam]]>||Alprazolam Intensol, Xanax|
|]]>Diazepam]]>||Diastat, Diazepam Intensol, Dizac, Valium|
|]]>Lorazepam]]>||Ativan, Lorazepam Intensol|
Melatonin-receptor agonist (eg, ]]>ramelteon]]> [Rozerem])—This medication is used in the treatment of insomnia characterized by difficulty with falling asleep. It shortens the time to fall asleep in people with transient insomnia.
Antidepressants —For long-term treatment of insomnia or when insomnia is accompanied by ]]>depression]]> and/or caused by depression, antidepressants may be prescribed. Some of the more commonly used antidepressants include the following:
|]]>Trazodone]]>||Desyrel, Trazon, Trialodine|
Nonprescription sleeping aids can leave people feeling drowsy the next day and may not always be effective at providing restful sleep. But they are often recommended 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.
- Note: Only the older antihistamines are effective for this purpose. The newer antihistamines, such as ]]>Claritin]]>, do not typically cause drowsiness.
]]>Melatonin]]>—This is a hormone produced by the brain. Melatonin may be helpful for jet lag.
Pain relievers —These drugs are useful when insomnia is caused by minor pain.
- Note: ]]>Acetaminophen]]> does not cause drowsiness.
The information below relates to hypnotics (sleep medications), unless stated otherwise.
What These Medications Are Prescribed For
To promote sleep in someone who has insomnia, especially in these cases:
- Sleep difficulties cause problems in accomplishing daily activities
- Behavioral approaches have proven ineffective
Insomnia occurs in association with:
- Psychological condition (eg, ]]>anxiety]]> )
- Temporary changes in circadian rhythms (internal clock), such as jet lag or shift work
Hypnotics can help to do the following:
- Shorten the time it takes to fall asleep
- Increase total sleep time
- Decrease the number of awakenings during sleep
How These Medications Work
The benzodiazepine-receptor agonists work by enhancing the effect of a brain chemical responsible for reducing neuron excitability. Antidepressants may cause immediate drowsiness as well as alter brain chemistry in such a way as to improve sleep. Antihistamines of the older type cause immediate drowsiness.
Precautions While Using These Medications
Avoid overuse and dependence.—Benzodiazepines may become less effective over time, requiring higher doses to produce effects. This can lead to dependence. This does not seem to be as much of a problem for the non-benzodiazepine drugs. Antidepressants and antihistamines present a very low risk for dependency.
Don't 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:
- Blurred vision
- Impaired memory and concentration
- Muscle and abdominal cramps
- Decreased appetite
- Hallucinations or ]]>seizures]]> (in severe cases)
Do not combine with certain substances.—Be sure to tell your doctor about all of the medications, both prescription, nonprescription, and herbal supplements that you take. Hypnotics can have potentially dangerous interactions when combined with certain other substances, such as the following:
Central nervous system depressants, including:
- Anesthetics, including dental anesthetics
- Anticonvulsants (barbiturates, other benzodiazepines, hydantoins, succinimide, and others)
- Antidepressants (MAO inhibitors, tricyclics, ]]>fluoxetine]]> [Prozac], fluvoxamine [Luvox], ]]>paroxetine]]> [Paxil], ]]>sertraline]]> [Zoloft], ]]>trazodone]]> , ]]>venlafaxine]]> [Effexor], Nefazodone [Serzone])
- Narcotic analgesics for pain relief for surgery and obstetrics
- Antipsychotic tranquilizing agents (phenothiazine, ]]>clozapine]]> , ]]>haloperidol]]> , ]]>loxapine]]> , ]]>molindone]]> , ]]>pimozide]]> , ]]>risperidone]]> , thioxanthenes)
- ]]>Cimetidine]]> (Tagamet)
- ]]>Fluconazole]]> (Diflucan)
- ]]>Itraconazole]]> (Sporanox)
- ]]>Ketoconazole]]> (Nizoral)
Practice good sleep habits.—Due to 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 six hours before you want to sleep
- Avoiding naps
- Going to sleep and waking up at the same time every day
- 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 for sex
Proper Usage and Missed Dose
Your doctor will determine the appropriate dose and usage schedule for you. The drug ]]>eszopiclone]]> (Lunesta) is the only sleep medication that has been specifically studied for long-term usage, but other medications may be beneficial in the long-term, as well.
Some of the non-benzodiazepine drugs have a rapid onset and should only be used immediately before going to bed.
Possible Side Effects
Elderly people are more susceptible to side effects and therefore hypnotics aren’t recommended for them.
Possible side effects of hypnotics include the following:
- Clumsiness or unsteadiness
- Dizziness or lightheadedness
- Drowsiness (more common with long-acting than short-acting drugs)
- Slurred speech
- Memory loss
Rare side effects include the following:
- Odd moods and behavior
- Lack of usual inhibitions
Possible side effects of antidepressants include the following:
- Abnormal dreams
- Blurred vision or other changes in vision
- Clumsiness or unsteadiness
- Sexual dysfunction
- Dizziness, lightheadedness, or fainting
- Dryness of mouth
- Fast or irregular heartbeat
- Flushing, feeling of warmth, and/or increased sweating
- Increased or decreased appetite
- Memory problems
- Nausea and vomiting
- Problems urinating
- Ringing in the ears
- Skin rash, or itching, tingling, burning, or prickly sensations
- Suicidal thoughts
- Swelling of arms or legs
- Trembling or shaking
- Trouble sleeping
- Unpleasant taste
- Unusual tiredness or weakness
Possible side effects of antihistamines include the following:
- Dizziness or lightheadedness
- Drunken movements
- Blurred vision
- Dry mouth and throat
- Urinary retention
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.
National Center on Sleep Disorders Research
National Sleep Foundation
Better Sleep Council Canada
The Canadian Sleep Society
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Sleep hygiene—the healthy habits of good sleep. American Academy of Sleep Medicine website. Available at: http://www.sleepeducation.com/Hygiene.aspx. Accessed January 12, 2009.
Last reviewed January 2009 by ]]> Judy Chang, MD, FAASM]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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