Medications That Can Help Insomnia

According to a 1999 survey, about 30% of American women and 20% of men reported taking a medication to help them sleep at some time during the course of a year. Over half of these drugs were over the counter medications.

It should be stressed that only behavioral or psychological techniques can actually cure insomnia, whereas prolonged use of sleeping pills can only result in dependency. In addition, a 2002 study reported lower survival rates in people who took sleeping pills, although more research is needed to clarify this association.

Why do so many people want to take sleeping pills for their insomnia? Many people experiencing sleep problems want a quick fix for their problems. Several of the treatments that are often successful are time intensive and require a lot of work on the part of the person experiencing insomnia.

The thought of a pill or medication that can solve the problem quickly and easily is very appealing. Unfortunately, the reality behind the use of sleep medications is that they don’t solve the problem, and can often exacerbate insomnia over the long term.

If you want to take medications to help you sleep because you are in a great deal of pain, are traveling or just need to get some sleep, pay attention to the type of medication you choose and try to use the medication only when you really need it. Additionally, if you can commit to making your sleep habits and sleep environment better and more conducive to sleep, you have a greater chance of limiting the effects of insomnia on your life.

Drugs used specifically for improving sleeping are called hypnotics. Benzodiazepines are the ones most commonly prescribed, but others are available that may be better tolerated and have less risk of dependency. They should generally be used only to prevent the vicious cycle of psychophysiological insomnia in people with transient or short-term insomnia when non-medical treatments have failed.

Originally developed to treat anxiety, these drugs reinforce a chemical in the brain that inhibits neuron excitability. Commonly prescribed benzodiazepines include the following:

  • Long acting benzodiazepines include flurazepam (Dalmane) and clonazepam (Klonopin), quazepam (Doral).
  • Medium- to short-acting benzodiazepines include triazolam (Halcion), lorazepam (Ativan), alprazolam (Xanax), temazepam (Restoril), oxazepam (Serax), prazepam (Centrax), estazolam (ProSom), and flunitrazepam (Rohypnol). Short-acting benzodiazepines are particularly useful for air travelers who want to reduce the effects of jet lag.

Of course, as with any medication, side effects are to be expected. When taking benzodiazepines, be mindful of what could happen when you take them. Common side effects of these drugs include:

  • The drugs may increase depression, a common co-condition in any case in many people with insomnia.
  • Respiratory depression may occur with overuse or with people with pre-existing respiratory illness.
  • Long-acting agents have a very high rate of residual daytime drowsiness compared to others. They have been associated with a significantly increased risk for automobile accidents and falls in the elderly particularly in the first week after taking them. Shorter-acting benzodiazepines do not appear to pose as high a risk.
  • Memory loss (so-called traveler's amnesia), sleepwalking, and odd mood states have been reported after taking Halcyon and other short-acting benzodiazepines. These effects are rare and probably enhanced by alcohol.
  • Because these drugs cross the placenta and enter breast milk, pregnant women or nursing mothers should not use them. An association was reported between the use of benzodiazepines in the first trimester of pregnancy and the development of cleft lip in newborns.
  • In rare cases, overdoses have been fatal.

Elderly people are more susceptible to side effects and should usually start at half the dose prescribed for younger people and should not take long-acting forms. Side effects may differ depending on whether the benzodiazepine is long- or shorting acting. Benzodiazepines are potentially dangerous when used in combination with alcohol, and some medications, like the ulcer medication cimetidine, can slow the metabolism of the benzodiazepine. This type of medication can be highly addictive.

When you stop taking this medication, you will probably have some withdrawl symptoms. Withdrawal symptoms usually occur after prolonged use and indicate dependence. They can last one to three weeks after stopping the drug and may include the following:

  • Gastrointestinal distress.
  • Sweating.
  • Disturbed heart rhythm.

In severe cases, patients might hallucinate or experience seizures, even a week or more after the drug has been stopped. Rebound insomnia, which often occurs after withdrawal, typically includes one to two nights of sleep disturbance, daytime sleepiness, and anxiety.

In some cases patients may experience the return of original severe insomnia. The chances for rebound are higher with the short-acting benzodiazepines than with the longer-acting ones. In addition, the following precautions are important in taking sleeping pills:

  • Start with non-prescription medication.
  • If prescription hypnotics are required, start with as low a dose as possible.
  • In general, do not take either prescription nor non-prescription sleeping pills on consecutive days or for more than two to four days a week.
  • If insomnia is still a problem after stopping the drug and continuing with good sleep hygiene, this pattern can be repeated again, but for no longer than four weeks.
  • Medication should be withdrawn gradually and the patient should be aware of the possibility of rebound insomnia when stopping medication.
  • Alcohol intensifies the side effects of all sleeping medication and should be avoided.

If chronic insomnia is a companion to depression or anxiety, treating these problems first may be the best approach. Some newer antidepressants may be effective at treating both depression and insomnia at once. Over-the-counter and prescription sleeping medications are very commonly used medications.

Antihistamines cause drowsiness and many over-the-counter preparations are available that might help transient insomnia. Most over the counter sleep aids use antihistamines ingredients, most commonly diphenhydramine. They may simply contain diphenhydramine alone (Nytol, Sleep-Eez, Sominex) or contain combinations of diphenhydramine with pain relievers (Anacin P.M., Exedrin P.M., Tylenol P.M.). Doxylamine (Unison) is another antihistamine used in sleep medications.

Unfortunately, most of these drugs can leave patients drowsy the next day and may not be very effective in providing restful sleep. Side effects include daytime sleepiness, dizziness, drunken movement, blurred vision, and dry mouth and throat.

In general, these types of medications should be avoided by people with angina, heart arrhythmias, glaucoma, problems urinating, or while taking medications to prevent nausea or motion sickness. Some, such as those containing doxylamine should also be avoided by patients with chronic lung disease.

Actually, for most people, over-the-counter (OTC) sleep medications are not a good choice. These medications are not intended for long-term use and rely on the sedating side effects of antihistamine to facilitate sleep. While taking an OTC sleep medication, avoid driving and other tasks where mental alertness is required. The sedative effects of antihistamines may increase your risk of falling as well.

Sleep experienced while taking OTC sleep medications is not of the same quality as normal sleep. Some people who take OTC sleep medications spend as little as 5% of their total sleep time in deep sleep (compared to approximately 10-25% for healthy sleepers). Only use OTC sleep medications for transient or short-term insomnia and in conjunction with changes to your sleeping habits. Be sure to pay attention to your body’s physical response to them.

Immediately discontinue use if you experience any severe adverse effects such as forgetfulness, constipation, urinary retention, and dizziness. There are some medications on the market that do not contain benzodiazepine. These pills are shorter acting and can induce sleep with fewer side effects than the benzodiazepines. These hypnotics include zolpidem (Ambien), zaleplon (Sonata), and zopiclone (Imovane).

The brands have some differences, such as the following:

  • Zaleplon (Sonata) is the shortest-acting hypnotic available. It can be taken even in the middle of the night and if a patient needs to awaken in only four hours. In such cases, the medication is effective and still does not leave the person overly sedated in the morning. It appears to have a better safety record than other hypnotics and may be particularly useful for patients in the younger and older age groups.
  • Zolpidem (Ambien) may be useful for people who take it as soon as they go to bed, since it is longer acting than Sonata. A 2002 study suggested that the drug might be used on an as-needed basis, with up to five tablets taken a week. After three weeks, two-thirds of the patients taking zolpidem in this way were able to reduce their tablet intake by more than 25% without losing improvements in sleep.

These agents can be particularly helpful for preventing jet lag. They also may be beneficial for people who also have accompanying mood disorders, such as depression or post-traumatic stress disorder. They also appear to be safe and effective for elderly patients, even possibly those with chronic lung problems, but research is needed to confirm this. They are expensive, however.

Of course, there will be some possible side effects that can come about even with these types of pills. They have fewer morning side effects than the benzodiazepines, including morning sedation and memory loss (although they can occur to some degree). Ambien's record of adverse effects is similar to that of triazolam (Halcyon), the short-acting benzodiazepine. Sonata appears to have less severe side effects. In general, for both drugs, the side effects are mild but can include the following:

  • Nausea.
  • Dizziness.
  • Nightmares.
  • Agitation or antagonistic mood in the morning.
  • Amnesia (in high doses).
  • Headache.
  • Rare fatal overdoses have been reported.

As with any hypnotics, alcohol poses a danger with these drugs. The risk for rebound, dependence, and tolerance is lower with these agents than with benzodiazapine, particularly with Sonata. In one study, people who took this hypnotic every night for one year had no evidence of dependency or withdrawal symptoms, but more large studies are needed to confirm long-term safety. These agents are still subject to abuse.

In any case, no hypnotic should be taken for more than a few days or at higher than the recommended dose. A combination of newer antidepressants and structured psychotherapy is proving to be very effective for improving both depression and insomnia in patients with both conditions.

Chloral hydrate is relatively reliable and has been in use since 1832. Many physicians prescribe it for short-term use if other hypnotics cannot be used. It has significant adverse effects, however, and some experts believe it no longer has a role in the treatment of insomnia.

In any case it does not appear to be effective in the elderly. Chloral hydrate poses a risk for addiction and it can be fatal in overdose. It also has carcinogenic properties and can harm genetic material. Potential side effects also include irritation of the skin, mucous membranes, and stomach.

People with stomach, heart, kidney, or liver disorders should not take this drug at all. If a child is given it (usually for minor surgery), then that child should never be given chloral hydrate again in his or her lifetime. Since most of these drugs are available by prescription only, a thorough consultation with your physician is necessary.

When under the care of a doctor, he or she can make sure that the medication is working for you and they can even assist you with any withdrawal symptoms should you stop taking the medicine. The most significant concern about the use of medications for treating insomnia is that medication does not address the root cause of the problem, and instead becomes a crutch to lean on rather than a cure.

Just as you would not leave a cast on a broken bone indefinitely because it would cause the muscle to atrophy, sleep medication should be seen as a temporary aid for sleep problems and not a long term one. Other concerns about the use of over-the-counter and prescription sleep medications include:

  • development of drug tolerance and/or dependence
  • reduced effectiveness of drug
  • physical side effects
  • interactions with other drugs or chemicals in the body
  • withdrawal symptoms
  • rebound insomnia

There are obviously some natural ways to help you sleep. Let’s take a look at those non-prescription methods of sleep inducement.