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Sleep Medications
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Sleep Medications

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 (BzRAs)—These medications attach to special sites (benzodiazepine receptors) in the brain, causing relaxation. This class includes drugs in the benzodiazepine family and newer non-benzodiazepines drugs with similar effect. These drugs can be short-, intermediate-, or long-acting.

MedicationBrand names
Benzodiazepines
AlprazolamAlprazolam Intensol, Xanax
ChlordiazepoxideLibrium
ClonazepamKlonopin
ClorazepateTranxene
DiazepamDiastat, Diazepam Intensol, Dizac, Valium
EstazolamProSom
FlurazepamDalmane
HalazepamPaxipam
LorazepamAtivan, Lorazepam Intensol
OxazepamSerax
QuazepamDoral
TemazepamRestoril
TriazolamHalcion
Non-benzodiazepine-receptor agonists
ZaleplonSonata
ZolpidemAmbien
EszopicloneLunesta

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:

MedicationBrand names
NefazodoneSerzone
TrazodoneDesyrel, Trazon, Trialodine
AmitriptylineElavil

Nonprescription Drugs

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 cause drowsiness.

Pain relievers—These drugs are useful when insomnia is caused by minor pain. They do not cause daytime sleepiness.

  • Acetaminophen
  • Nonsteroidal anti-inflammatory agents (NSAIDs)

The information below relates to hypnotics, 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
  • As an interim measure until behavioral therapy fully takes effect
  • Insomnia occurs in association with:
    • Medical condition (eg, premenstrual syndrome)
    • Psychological condition (eg, anxiety)
    • Temporary changes in circadian rhythms (internal body 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 BzRA drugs 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, particularly for the longer-acting formulations. 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 following discontinuation of BzRAs 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
  • Trouble walking
  • Tremors
  • 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:
    • Alcohol
    • 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])
    • Lithium
    • Narcotic analgesics for pain relief and for surgery and obstetrics
    • Sedatives
    • 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 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 these drugs. These habits include the following:

  • Exercising regularly, at least four 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 (If concerns come to mind in bed, write them down in a "worry" book, then close the book until the morning.)
  • 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.

The non-benzodiazepine drugs have a very intense, rapid onset, and they should only be used when it is possible to go to sleep immediately after taking them.

Possible Side Effects

Elderly people are more susceptible to side effects and should usually start at half the dose prescribed for younger people. Also, they should not take long-acting forms.

Possible side effects of hypnotics include the following:

  • Clumsiness or unsteadiness
  • Dizziness or lightheadedness
  • Drowsiness (more common with long-acting than short-acting drugs)
  • Weakness
  • Slurred speech
  • Nausea
  • Nightmares
  • 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 antidepressants include the following:

  • Abnormal dreams
  • Agitation
  • Blurred vision or other changes in vision
  • Clumsiness or unsteadiness
  • Confusion
  • Constipation
  • Decreased sexual ability
  • Diarrhea
  • Dizziness, lightheadedness, or fainting
  • Drowsiness
  • Dryness of mouth
  • Fast or irregular heartbeat
  • Flushing, feeling of warmth, and/or increased sweating
  • Headache
  • Heartburn
  • 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
  • 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.

  • Acetaminophen
  • Antihistamines
  • Benzodiazepines
  • Nefazodone
  • Nonsteroidal anti-inflammatory agents (NSAIDs)
  • Paroxetine
  • Trazodone
  • Zaleplon
  • Zolpidem

RESOURCES:

National Center on Sleep Disorders Research
http://www.nhlbi.nih.gov

National Sleep Foundation
http://www.sleepfoundation.org

CANADIAN RESOURCES

The Canadian Sleep Society
http://www.css.to/

Better Sleep Council Canada
http://www.bettersleep.ca/default_main.aspx



Last reviewed August 2007 by J. Thomas Megerian, MD, PhD, FAAP

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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