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Medications for Insomnia

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your healthcare provider if you need to take any special precautions. Use each of these medications as recommended by your healthcare provider, or according to the instructions provided. If you have further questions about usage or side effects, contact your healthcare provider.

If you have chronic insomnia, medication may be prescribed to help you sleep. Medication should be used only in combination with good sleep practices and/or behavioral changes. Consult with your healthcare provider before taking over-the-counter medications, to make sure they will not interfere with sleep or interact with other medications you take.

Prescription Medications

Hypnotics

  • Zaleplon (Sonata)
  • Zolpidem (Ambien)
  • Triazolam (Halcion)
  • Estazolam (ProSom)
  • Temazepam (Restoril)
  • Eszopiclone (Lunesta)
  • Ramelteon (Rozerem)

Sedating antidepressants

  • Amitriptyline (Elavil)
  • Doxepin (Sinequan)
  • Trimipramine (Surmontil)
  • Nefazodone
  • Trazodone (Desyrel)
  • Mirtazapine (Remeron)

Over-the-Counter Medications

Antihistamines

  • Diphenhydramine (Benadryl)
  • Doxylamine (Unisom)

Prescription Medications

Hypnotics

Common names include:

  • Zaleplon (Sonata)
  • Zolpidem (Ambien)
  • Triazolam (Halcion)
  • Estazolam (ProSom)
  • Temazepam (Restoril)
  • Eszopiclone (Lunesta)
  • Ramelteon (Rozerem)

Hypnotics, or sedatives, are drugs that cause relaxation and help induce and maintain sleep. They affect chemicals in the brain that may be out of balance and causing the insomnia. These drugs are for short-term use. In any situation where long-term use is required, such use should be closely monitored by your healthcare provider. These drugs can react with other drugs you may be taking. Before starting a hypnotic, you should tell your healthcare provider about any and all drugs (including herbs and natural supplements) you are taking, and do not take any drugs unless he or she approves.

Before using these drugs, you should tell your healthcare provider if you have any of the following conditions:

These medications will make you sleepy and perhaps dizzy. When taking one of these drugs, use the following guidelines:

  • Use caution while driving, operating machinery, or doing any hazardous activities.
  • Take the medication with a full glass of water and just before going to bed.
  • Do not drink alcohol while taking hypnotics.
  • Do not take this medication unless you are able to get adequate rest before you must become active again.
  • Do not stop taking the drug suddenly if you have been taking it for several days or longer.

Possible side effects include:

  • Allergic reaction (swelling of the face or mouth, difficulty breathing, rash)
  • Hallucinations, strange behavior, or severe confusion
  • Suicidal thoughts
  • Changes in your vision
  • Drowsiness, dizziness, or clumsiness
  • Amnesia (loss of memory)
  • Sores in the mouth and throat
  • Yellowing of the skin and eyes
  • Depression
  • Fatigue
  • Nausea, vomiting, diarrhea , or constipation
  • Vivid dreams
  • Headache
  • Unpleasant taste
  • Rebound insomnia on abrupt discontinuation (except ramelteon)

Sedating Antidepressants

Common names include:

  • Amitriptyline (Elavil)
  • Doxepin (Sinequan)
  • Trimipramine (Surmontil)
  • Nefazodone
  • Trazodone (Desyrel)
  • Mirtazapine (Remeron)

Sedating antidepressants work by treating the underlying depression that may be the cause of the insomnia, while at the same time having a sedative effect. They have not been found to be effective in people with insomnia who are not depressed. While there are many medications for depression, sedating antidepressants are effective in treating people who have both insomnia and depression.

Before starting an antidepressant, tell your healthcare provider about any and all drugs (including herbs and natural supplements) you are taking, and do not take any medications unless he or she approves.

Before using these drugs, you should tell your healthcare provider if you have any of the following conditions:

  • Any drug allergies
  • Liver disease
  • Kidney disease
  • Asthma
  • Glaucoma , or pressure inside the eye
  • Diabetes
  • Enlarged prostate, bladder problems, or difficulty urinating
  • Thyroid disease
  • High or low blood pressure or any heart problems
  • Stomach or intestinal problems
  • Pregnancy or breastfeeding
  • Manic-depressive disorder
  • Blood problems

Take these medications with a full glass of water. Some of these medications may take four weeks or more before you feel its full therapeutic effect.

Possible side effects include:

  • Allergic reaction (swelling of the face or mouth, difficulty breathing, rash)
  • Seizures
  • Fast or irregular heart beat
  • Heart attack
  • High blood pressure
  • Painful or inappropriate erections (trazadone)
  • Yellowing of the skin and eyes
  • Dry mouth and eyes
  • Mild tremor or agitation
  • Difficulty urinating
  • Fever, with muscle stiffness or weakness
  • Drowsiness, dizziness, or clumsiness
  • Nausea or constipation

Over-the-Counter Medications

Antihistamine

Common medications include:

  • Diphenhydramine (Benadryl)
  • Doxylamine (Unisom)

An antihistamine is a medication that blocks an allergic reaction in the body. One of its side effects is drowsiness, and therefore, it is sometimes used to induce sleep. This and any other over-the-counter sleep aid should be taken only with the approval of your healthcare provider. It can be taken with or without food, and with a full glass of water. These drugs can react with other drugs you may be taking. Before starting an antihistamine, you should tell your healthcare provider about any and all drugs you are taking, and do not take any drugs unless he or she approves.

Before using these drugs, you should tell your healthcare provider if you have any of the following conditions:

Possible side effects include:

  • Dry mouth
  • Sleepiness, fatigue, or dizziness
  • Headache
  • Difficulty urinating
  • Constipation
  • Blurred vision
  • Delirium

Special Considerations

Whenever you are taking a prescription medication, take the following precautions:

  • Take them as directed—not more, not less, not at a different time.
  • Do not stop taking them without consulting your healthcare provider.
  • Don’t share them with anyone else.
  • Know what effects and side effects to expect, and report them to your healthcare provider.
  • If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
  • Plan ahead for refills so you don’t run out.

Note: On March 14, 2007, the Food and Drug Administration requested that all manufacturers of drugs used to induce or maintain sleep strengthen product labeling regarding potential risks of taking these medications. The risks include severe allergic reactions and complex sleep-related behaviors, which may include sleep-driving, making phone calls, and preparing and eating food while asleep. For more information, click here .

When to Contact Your Healthcare Provider

Hypnotics and sedating antidepressants can have side effects. Call your healthcare provider immediately if you experience side effects such as these:

  • Fast or irregular heart beat
  • Chest pain or pressure
  • Trouble breathing
  • High blood pressure
  • Yellowing of the skin and eyes
  • Difficulty urinating

Many of these medications need to be tapered off when stopping them. Stopping your medication abruptly can lead to “rebound insomnia,” which worsens your condition. Consult your healthcare provider before stopping your medication.

References:

Conn’s Current Therapy. 54th ed. WB Saunders; 2002.

FDA requests label change for all sleep disorder drug products. FDA News. March 14, 2007. Food and Drug Administration website. Available at: http://www.fda.gov/bbs/topics/NEWS/2007/NEW01587.html . Accessed May 6, 2007.

Morin AK, Jarvis CI, Lynch AM. Therapeutic options for sleep-maintenance and sleep-onset insomnia. Pharmacotherapy. 2007;27:89-110.

National Sleep Foundation website. Available at: http://www.sleepfoundation.org/ .

PDR Nurse’s Drug Handbook. Delmar; 2002.

Silber MH. Chronic insomnia. N Engl J Med. 2005;353:803-810.



Last reviewed May 2007 by Janet H. Greenhut, MD, MPH

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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