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Insomnia (Sleepless Nights)

Can Medication Help Insomnia?

Last modified: 
11/04/2012 - 10:15

Contributing Author: Guy Slowik FRCS

Sleep medications should not be taken lightly. Low-dose sleep medication can help short-term insomnia but is rarely helpful for long-term sleep problems. Many experts today recommend only trying medications as a last resort, after other treatments for insomnia have failed, because they can be addictive and can have serious side effects.

Hypnotics (sedatives, minor tranquilizers, and antianxiety drugs) are among the most commonly used medications for insomnia.

  • Most hypnotics require a doctor's prescription because they may be habit-forming or addictive, and overdose is possible.
  • Many hypnotics can lose their effectiveness once a person has become accustomed to them.
  • Hypnotics also may produce withdrawal symptoms, and this can make the insomnia return. For this reason, doctor's recommend reducing the dose slowly; complete withdrawal can take several weeks.

Sleep medications are available as:

Over-The-Counter Medications

Two inexpensive medications available without a prescription that can relieve mild or occasional sleeping problems are diphenhydramine anddimenhydrinate.

  • These medications can leave you drowsy the next day, but they are not addictive.
  • Side effects include dizziness, blurred vision, and dry mouth.
  • They should not be used be used by people with angina, heart arrhythmias, glaucoma, prostate problems, or urinary problems.

Over-the-counter medications for insomnia are purchased more than any other type of drug.

  • Commonly used over-the-counter sleep medications include Nytol, Sleep-Eez, and Sominex.
  • When sleeplessness is caused by minor pain, over-the-counter pain relievers such as acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (Advil, Motrin) can be very helpful.
  • Some newer medicines (such as Anacin P.M., Excedrin P.M., and Tylenol P.M.) contain both a sleeping medication and a pain reliever.
  • Antihistamines have a sedating effect and may be used as mild sleep inducers. They include chlorpheniramine (Chlor-Trimeton)and diphenhydramine (Benadryl).

Need To Know:

About melatonin supplements

You may have heard about the treatment of insomnia with melatonin supplements. Despite its widespread use, little is actually known about the long-term safety of melatonin supplements. The U.S. Food and Drug Administration does not monitor melatonin, and many of the melatonin products sold in health food and supplement stores contain unknown substances.

Prescription Medications

Prescription medications for insomnia should be taken at the lowest dose possible. Various types of prescription medication include:

  • Benzodiazepines. These are the most common and safest hypnotics. They include lorazepam (Ativan), alprazolam (Xanax), triazolam (Halcion), and temazepam (Restoril), among others. Side effects include respiratory symptoms, daytime drowsiness, memory loss, and odd mood states. Benzodiazepines are potentially dangerous when combined with alcohol and should not be taken by people who use the ulcer medication cimetidine (Tagamet).
  • Non-benzodiazephines. These hypnotics may pose less of a risk of dependence. They include zolpidem (Ambien), zopiclone, and zaleplon. Side effects include nausea, dizziness, nightmares, agitation, and headache.
  • Antidepressants. These can relieve insomnia associated with depression or early morning awakening. Newer antidepressants include trazodone (Desyrel), nefazodone (Serzone), andparoxetine (Paxil). These medications have far fewer side effects, and much less danger for overdose, than other anti-insomnia drugs.

Need To Know:

What are the ground rules for being prescribed sleeping medication for insomnia?

Simply put, the focus should be on what's causing the insomnia and not simply on giving treatment to help someone sleep. For example, is the insomnia due to a brief short-lasting worry, or is it a symptom of an underlying disorder such as depression? Sleeping pills do not relieve such an underlying disorder, whereas antidepressants usually do.

For more detailed information about depression, go to Depression: How To Overcome It

Many experts suggest the following ground rules:

  • Try to avoid benzodiazepine sleeping pills and use a nonaddictive one instead.
  • Try to take them only occasionally and not make a habit of it.
  • Accept that the course of treatment will be short (no more than two weeks) and the prescription will not be repeated.

Nice To Know:

For women who have reached menopause, hormone replacement therapy (HRT) helps prevent insomnia caused by hot flashes, a common symptom of menopause. Studies have shown that women who take HRT seem to fall asleep faster, have fewer wakeful periods, and sleep longer than those not taking estrogen.

For more detailed information about hormorne replacement therapy, go to Hormone Replacement Therapy.

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.