Medications for sleep

When behavioral techniques don’t cure your insomnia, talk with your doctor about sleep-promoting medications. Although such medications can be helpful in the short term to break a pattern of insomnia, when used long-term, they may actually worsen your fatigue by leaving you groggy during the day.

Prescription sleep medications should be used cautiously because they can cause tolerance (the need for progressively larger doses over time to get the same effect). Over-the-counter sleep aids (which typically contain antihistamines) are often ineffective and, in some people, cause irritability, but when used occasionally they may work well for some individuals.

Melatonin. One over-the-counter supplement that many take as a sleep aid is a synthetic form of the hormone melatonin. Each day, the body releases melatonin in response to darkness, causing drowsiness. In the mid-1980s, researchers began investigating whether oral doses of natural melatonin might help people reset their biological clocks, which would particularly benefit travelers, shift workers, and people with insomnia. Melatonin supplements are not regulated by the FDA for purity and effectiveness.

In 2005, the FDA approved Rozerem (ramelteon), the first drug in a class known as melatonin receptor agonists. Rozerem can be used to help insomnia in people who have trouble falling asleep. It works by affecting the part of the brain that controls the circadian cycle of sleep and wakefulness. The most common side effect is dizziness, and Rozerem might exacerbate depression. People with liver problems and those taking the antidepressant fluvoxamine (Luvox) shouldn’t take it.

Benzodiazepines. These are prescription medications frequently used as sleeping pills. They include temazepam (Restoril), diazepam (Valium), and triazolam (Halcion). These medications work by enhancing the activity of the inhibitory neuro­transmitter GABA, which calms brain activity. The various benzodiazepines differ in how quickly they start working and how long they remain active. While effective at helping people fall asleep and stay asleep, benzodiazepines have several limitations. They can lead to drowsiness and sedation the next day. And people who use them may develop a tolerance for them, so that after a few weeks, the drug won’t promote sleep and might even contribute to rebound insomnia, in which discontinuation of the drug results in worse insomnia than before the drug was started. Finally, if taken regularly, these medications should be discontinued only under a doctor’s supervision because withdrawal can lead to muscle tension, restlessness, irritability, or — in rare cases — convulsions.

Imidazopyridines. This class of drugs, which first became available by prescription in the early 1990s, specifically enhances the sleep-inducing activity of the neurotransmitter GABA. One such drug, zolpidem (Ambien), begins to work after about 30 minutes, and its effect lasts about five hours. In 1999, zaleplon (Sonata), a shorter-acting imidazopyridine, became available. The newest drug in this class, eszopiclone (Lunesta), is approved for use in all types of insomnia. It has been shown to be safe and effective even when used for six months. The most common side effects of the imidazopyridines are headache, dizziness, nausea, and grogginess.

Antidepressants. When depression interferes with sleep, an antidepressant may improve both sleep and mood. If depression is not the problem, older anti­depressant medications known as tricyclics are sometimes used because these drugs reduce the length of time it takes to fall asleep, and they improve the continuity of sleep. At the low doses used to treat sleep disturbance, tricyclic antidepressants seem to be less habit-forming than benzodiazepines and, therefore, less likely to contribute to rebound insomnia. Tricyclic drugs should be used with caution in people over age 60 and in people with known heart disease. Another commonly prescribed antidepressant is trazodone (Desyrel). This medication increases levels of the neurotransmitter serotonin, which is involved in sleep regulation as well as mood.

Do you take any medications to help you sleep?

Boosting Your Energy, a Special Health Report from Harvard Medical School, provides you with the latest information about fatigue and offers strategies to help you regain the physical and mental energy you need to enjoy life to its fullest.

-----------------------------------------------------------------------------------

Are you Living With Insomnia? Connect with others with similar health concerns and issues. Click here to join the group.