Treating Insomnia: A Look at Some Treatment Options
If you are one of the millions of people with ]]>insomnia]]>, you might have ]]>difficulty falling asleep]]> or fall asleep easily only to wake up in the middle of the night. There are a variety of sleep aids to choose from, but many can leave you feeling groggy or "hungover" the next morning. Worse still, some can lead to dependence and affect memory and movement.
These side effects have been linked to a once commonly prescribed class of sleep aids called benzodiazepines, which help you fall asleep by depressing your central nervous system. Non-benzodiazepines, another class of sleep aids, work in a similar way, but are better able to target specific areas in your brain. Three prescription medications that fit this category are ]]>zaleplon]]> (Sonata),]]>zolpidem]]> (Ambien) and eszopiclone (Lunesta).
Zaleplon may end groggy mornings because it is designed to have a short "half-life," meaning that it stays active in the body for only a short time. Therefore, it helps promote sleepiness when you take it at night, but doesn't leave you feeling sedated many hours later when you're trying to get on with your day.
One of the most important points to remember about zaleplon is to take it right before going to bed and only when you will have four or more hours to sleep. If you take the medication without enough time for sleep, you may wake up feeling sleepy and have memory problems, side effects that can still accompany this class of drugs.
What Is Zaleplon Most Helpful for?
Studies have shown that Sonata is most effective in helping to initially fall asleep. But the medication does not increase how long you sleep or decrease how many times you awake during the night. "Some people go to sleep fine, but wake up and can't go back to sleep. For these people, I'm concerned that Sonata won't be as helpful," says David White, MD, Director of the Sleep Disorders Program at Boston's Brigham and Women's Hospital.
Zolpidem’s Two Versions
Zolpidem comes in two versions—regular and extended release. The first can help you fall asleep fast, while the latter can help you fall asleep and stay asleep. If you are older and struggling with insomnia, a study published in the American Journal of Geriatric Psychiatry found that the extended-release version (taken at a smaller dose) may improve the condition when taken for several weeks.
Strange Sleep-related Behaviors
There have been reports that people taking zolpidem engage in strange behavior. For example, there have been cases of people walking, eating, even driving while not fully awake, and then not being able to recall these activities in the morning. Why have these reports been linked to zolpidem, instead of other drugs in the same class, like zaleplon? Researchers believe this may be related to zolpidem’s half-life; it stays in the body longer than zaleplon. This means you have to set aside more time for sleep—at least 7-8 hours. This is true for both the regular and the extended-release versions.
Other non-benzodiazepines are also available, like eszopiclone (Lunesta ). With a half-life of about six hours, eszopiclone is designed to help you fall asleep and stay asleep, and it can be used to treat insomnia that occurs for prolonged periods of time, as well as insomnia that happens every night.
The FDA’s Warning
Compared to the older generation of sleep aids, non-benzodiazepines do offer advantages. You have less of a chance of feeling drowsy in the morning, having rebound insomnia (where you have a hard time falling asleep after stopping the medication), and becoming dependent. However, these are still possibilities with these medicines, and there are other risks as well.
The United States Food and Drug Administration (FDA) ordered that manufacturers of sleep aids include warnings about potential risks, like sleep-driving, ]]>anaphylactic shock]]> (a severe allergic reaction), and ]]>angioedema]]> (severe facial swelling) on their medication labels. In general, you should use caution when taking sleep aids and carefully follow the directions.
The Drugstore’s Options
Maybe you feel that options at your local drugstore would be a better alternative. Many popular over-the-counter (OTC) sleep medications, like ]]>Tylenol PM]]> and ]]>Nytol]]>, contain antihistamines. Labeled as diphenhydramine or doxylamine, antihistamines are used to treat allergies, but they can also induce sleep in some people. The American Academy of Sleep Medicine, though, reports that, “Most insomnia treatments that you can buy in stores have very little proof that they work and are safe.”
According to Dr. White, OTCs may have more potential side effects than some prescription sleep aids. Some of these side effects include drowsiness, forgetfulness, weakness, dry nose and eyes, and urinary retention. Avoid taking these if you have certain conditions, like ]]>glaucoma]]>, enlarged prostate gland, or breathing difficulties. Be sure to talk to your doctor before you take any OTC sleep aid (including ]]>herbs and supplements]]>) because there could be interactions with other medications that you are taking.
If you are interested in natural and alternative approaches for insomnia, ]]>valerian]]> and ]]>melatonin]]> are two of the most widely used treatments. Valerian is an herb commonly used to help treat intermittent insomnia. One study done on this herb found that it helped with improving sleep over the long-term (after taking the herb for four weeks). Overall, it is unclear whether valerian has an effect on insomnia. It has few side effects, including headache.
Melatonin is a hormone that is part of the sleep-wake cycle. Being in a dark room, for example, prompts your body to make melatonin. Results have been mixed as to whether this substance can help treat ordinary insomnia, but it does seem to help people who have insomnia related to jet lag. The safety of taking melatonin over the long-term has not been established, and it can decrease your mental and physical function.
Other natural treatments, like ]]>relaxation]]> and ]]>tai chi]]>, may offer some relief from insomnia. However, there is not enough evidence to recommend ]]>acupuncture]]> for insomnia. In addition, numerous other herbs and supplements (eg, ]]>St. John’s wort]]>, ]]>5-HTP]]>, among others) have been tried, but there is little evidence that these are helpful. ]]>Kava]]> may help if you also have ]]>anxiety]]> but there is concern that kava may cause severe liver problems.
What Should You Do?
With so many treatments available, how do you know what’s right for you?
Many experts, including Dr. White, suggest trying other methods before using medications. For example, the National Sleep Foundation recommends taking steps to promote sleep, like creating a bedtime routine and having a regular bedtime and wake time. Also regular exercise can improve sleep quality.
Check with your doctor to see if any medications you are taking may be causing the problem. Some drugs for ]]>high blood pressure]]> and ]]>asthma]]> are linked with sleep disturbance. Avoiding alcohol, caffeine, and ]]>nicotine]]> may also help.
It is important, too, that you get a proper diagnosis because, in some cases, the primary condition is not insomnia. Pain, ]]>digestive problems]]>, anxiety, and ]]>depression]]> can keep you from getting a full night’s sleep.
National Center on Sleep Disorders Research
National Sleep Foundation
Better Sleep Council Canada
The Canadian Sleep Society
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Last reviewed October 2010 by ]]>Brian Randall, MD]]>
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