Insomnia Medications

Medications are used most often as treatment for insomnia. Annually, 25 percent of Americans take some type of medication to help them sleep. Taking medication for insomnia should only be done when:

A doctor has diagnosed the cause of insomnia and thinks it is best treated by medication
Problems with sleep cause difficulty with everyday activities
Behavior modification has failed to improve sleep
Behavior modification has begun but patient still suffers insomnia related stress
Short-term, or temporary insomnia is experienced
Insomnia is associated with a medical condition
Insomnia is expected (for example, travel across time zones, or an event)

Guidelines for Treatment

Lowest possible dosage given first
If used nightly, to be short-term
If used occasionally (medication), can be long-term
Only in combination with good sleep practices and behavior modification (if needed)

Hypnotics, Antidepressants and Anxiolytics

The patient's age, medical condition and history, diagnosis, use of drugs, psychological factors, and other issues are important for the doctor to know before deciding what medications to prescribe.

Hypnotics

Hypnotics are the most successful prescription medications available to promote sleep. In the mid 1800s, bromide was found to be an excellent sedative and tranquilizer. Serious adverse effects and toxicity from bromide became known, and was withdrawn from the marketplace many years ago. Chloral hydrate, urethane, sulfonal, and paralehyde were introduced after bromide's introduction. In the early 20th century, a new class of sleep medications were introduced. This class of drugs are known as barbiturates, which includes pentobarbital, amobarbital, secobarbital,and phenobarbital. The barbiturate class of drugs were very successful, and frequently prescribed until the 1960s. Many adverse side effects on the body were associated with barbiturates, and when overdosed, could prove harmful or lethal to the patient.

In the 1960s, a new class of sleep aids were developed, called benzodiazepines. Adverse side effects were greatly reduced over the barbiturate class, and was much less likely to be lethal when taken in overdose quantities. Today there are five benzodiazepine class drugs approved by the FDA (Food and Drug Administration) for treatment of insomnia. These Valium-like drugs are thought to work on specific neurotransmitter receptor sites in the brain (a section of the GABA receptor complex), and are quickly absorbed after introduction into the body. Different variants of the benzodiazepine class differ in time of effectiveness, and absorption rates. How long the drug is effective in the body is called the half-life. A shorter half-life is favored, because a shorter half-life has less chance of being drowsy, or groggy (hangover-like feeling) the next day. Benzodiazepines can be habit forming, and persons with a history of substance abuse should not take them. Flurzepam (Dalmane) has a half-life of 48 to 120 hours, and should be taken in 15-30 mg (milligram) doses. Quazepam (Doral) also has a 48 to 120 hour half-life, and recommended dosage is  7.5 to 15 mg. Triazolam (Halcion) has only a 2-6 hour half-life, with a dosage of .125-.25 mg. Estazolam (ProSom) has an 8-24 hour half-life, and a 1-2 mg dosage. Temazepam (Restoril) has a half-life of 8-20 hours, with a 15-30 mg dosage.

The 1990s, a new class of sleep aid medications were introduced, called non-benzodiazepines. Non-benzodiapzepines have much less adverse effects on the body than benzodiapines, and much lower risk of dependence. Three drugs of this class are currently approved by the Food and Drug Administration for insomnia treatment. In the brain, they work on one of the subtypes of the GABA-benzodiazepine receptors. Considered safe and effective, one of these drugs (eszopicione) is thought to work safely when taken nightly for a period of up to six months. Zolpidem tartrate (Ambien) has a half-life of 1.5 to 2.4 hours, and recommended dosage is  5-20 mg. Zaleplon (Sonata) has a half-life of 1 hour, with a dosage of 5-10 mg recommended. Eszopicione (Lunestra) has a 5 to 7 hour half-life, and a 1-3 mg dosage is recommended. 

Studies are needed on the long-term effects of sleep aids, and the recommended time limit is four weeks. Alcohol intensifies both itself and the hypnotics, so should not be used. Lower doses should be given to the elderly, because increased risk of falls is present. Those who operate machinery soon after awakening should not use hypnotics, because of morning drowsiness associated with their use.  Sleep apnea sufferers can have breathing impaired worse when taking hypnotics.

Antidepressants

Antidepressants are used when depression is the cause of the patient's insomnia. Some antidepressants can actually cause more insomnia, and some can worsen symptoms of restless leg syndrome. Some antidepressants have been prescribed in low dosage for insomnia, but their success is doubtful for patients without clinical depression.

Anxiolytics

Anxiolytics are prescribed if anxiety is the cause of insomnia.

Over the Counter (OTC) Sleep Aids

Many over the counter sleep aids are available today. When used as directed, they can be safe, but caution should be used. Many include antihistamines, which have side effects, including impaired psychomotor skills, visual processing, thinking performance, dry mouth, dry eyes, confusion, and urinary retention. Reduced effectiveness over time, and many contain diphenhydramine, which causes morning-after drowsiness, and difficulty urinating. Other drugs and alcohol should not be used with over the counter sleep aids, and those glaucoma, breathing problems, chronic bronchitis, pregnant or nursing women, and those with problems urinating due to an enlarged prostate gland.

There are other medications available and new developments are always on the rise. especially to find medications thta are not dependants. There is a nonschedule drug on the market today to help people with sleeping disorders called Rozerm. Other Home Remedies include:

Melatonin

Produced in the pineal gland by the brain, from the amino acid tryptophan, melatonin is a neurohormone. Darkness is reported to trigger the release of melatonin by the brain. Very few clinical trials have yet to be performed, so much more research is needed. Speaking to your doctor is recommended before trying any home remedy.

Small trials and studies have only been done so far on melatonin. Inadequate randomization and blinding in these trials and studies for the results to be sure. But, it seems the weight of scientific evidence does show at least  decrease in the time it takes to fall asleep (sleep latency). In healthy people, it is suggested that a dosage of .1 to 6 mg of melatonin taken 30 to 60 minutes before bedtime will help sleep latency. According to studies, .1 to .3 mg of melatonin taken before bedtime should put melatonin levels to nighttime range the body should have. Some say that quick-release melatonin will work better than the sustained-release melatonin. It is not known conclusively if melatonin increases the time a person stays asleep, and no studies or trials have been done to suggest this.

This document is for informational use only, and should not be used in place of the advice of a doctor or healthcare professional. This document is also not a recommendation for any particular treatment plans. The advice of a doctor or healthcare professional is important for your particular condition or disorder.