Medications to Treat Insomnia
Pharmacological therapy to treat insomnia may include over-the-counter sleep medications, antidepressants with sedative effects, benzodiazepines, and newer medicines (e.g., non-benzodiazepines). Some insomnia medications are used for a short period of time and some medications are indicated for longer use.
Over-the-counter Sleep Medications
Over-the-counter (OTC) sleep aids usually contain antihistamines, which are associated with drowsiness. Unfortunately, these medications also tend to cause side effects, such as decreased memory and concentration, dry mouth, morning sickness, blurred vision, extended sedation, and constipation. These drugs are generally not recommended for the treatment of insomnia that is severe enough to require attention of a physician. They should not be used to treat chronic insomnia, may provide only temporary relief, and can further disrupt sleep over the long term.
Many antidepressants have sedative side effects. These side effects may be utilized in patients with depression and insomnia. In fact, many widely used antidepressants, like Prozac®, actually regulate sleep onset and duration for patients who take them. Some antidepressants can cause significant sedation in the morning and others may affect rapid eye movement sleep (REM) and disrupt sleep quality. Generally, these medications are used to treat depression that causes insomnia; drowsiness as a side effect is used to an advantage in helping with difficulty sleeping. See more on antidepressants.
Benzodiazepines
Benzodiazepines also may be used to treat insomnia. There are several hypnotic drugs (commonly called sleeping pills) available. The primary difference among benzodiazepines is the length of effectiveness, or half life, of the medication in the body. Longer-acting benzodiazepines often result in carry-over morning sedation, and shorter-acting benzodiazepines cause a higher incidence of rebound insomnia after discontinuation. In some patients, these medications carry a risk for developing drug dependency with long-term use. Benzodiazepines can cause fatigue, dizziness, confusion, falls, and blurred vision, especially in older people. Operating a motor vehicle or heavy machinery while using this type of medication may be hazardous.
Non-benzodiazepines
Newer drugs (called non-benzodiazepines), such as zaleplon (Sonata®), zolpidem (Ambien CR®), eszopiclone (Lunesta®), and zopiclone (Imovane®), interact with benzodiazepine receptors on cells that induce sleep. These drugs have a rapid onset, result in a lower residual effect the next morning, and generally cause few mild side effects.
Side effects of these medications include the following:
- Constipation or diarrhea
- Dizziness
- Drowsiness
- Dry mouth
- Headache
Some patients experience more serious side effects while taking non-benzodiazepines. These side effects include allergic reactions, memory loss, and abnormal thoughts and behavior (e.g., performing various activities while unaware and not fully awake).
In November 2011, the U.S. Food and Drug Administration (FDA) approved the first medication to treat insomnia characterized by waking in the middle of the night and having difficulty falling back to sleep. This drug, called zolpidem tartrate sublingual tablets (Intermezzo) should not be used with other sleep aids or after consuming alcohol and should only be taken when at least 4 more hours of sleep are desired. Intermezzo can cause side effects that are similar to other non-benzodiazepines.
