Sleep Medications

There are several types of prescription and nonprescription medicines that can be used to treat insomnia.

To promote sleep in someone who has insomnia, especially in these cases:

• Insomnia associated with:
  • Psychological condition (eg, anxiety)
  • Temporary changes in circadian rhythms (internal clock), such as those due to jet lag or shift work
• Behavioral approaches have proven ineffective
• Sleep difficulties cause problems in accomplishing daily activities

Hypnotics can help to do the following:

• Decrease the number of wakings during sleep
• Increase total sleep time
• Shorten the time it takes to fall asleep

Benzodiazepine-receptor agonists work by enhancing the effect of a brain chemical responsible for reducing neuron excitability. Antidepressants may cause immediate drowsiness as well as alter brain chemistry in such a way as to improve sleep. Some antihistamines cause immediate drowsiness.

Avoid overuse and dependence—Benzodiazepines and other sleep medicines may become less effective over time, requiring higher doses to produce effects. This can lead to dependence. Antidepressants and antihistamines present a lower risk for dependency.

Do not stop suddenly—When you are discontinuing regular use of a prescription sleep aid, your doctor may gradually lower your dose. Stopping abruptly can cause withdrawal.

Mild withdrawal of benzodiazepines is common. The usual symptom is several nights of poor sleep. More serious withdrawal may occur with higher doses of benzodiazepines and may include the following symptoms:

• Hallucinations or seizures (in severe cases)
• Anxiety
• Blurred vision
• Decreased appetite
• Depression
• Diarrhea
• Impaired memory and concentration
• Insomnia
• Irritability
• Muscle and abdominal cramps
• Sweating
• Tremor
• Vomiting

Do not combine with certain substances—Be sure to tell your doctor about all of the medicines, both prescription and nonprescription and any herbal supplements you take. Hypnotics can have potentially dangerous interactions when combined with certain other substances, such as the following:

• Antidepressants (MAO inhibitors, tricyclics, fluoxetine [Prozac], fluvoxamine [Luvox], paroxetine [Paxil], sertraline [Zoloft], trazodone, venlafaxine [Effexor], Nefazodone [Serzone])
• Antipsychotic tranquilizing agents (phenothiazine, clozapine, haloperidol, loxapine, molindone, pimozide, risperidone, thioxanthenes)
• Alcohol
• Anesthetics, including dental anesthetics
• Anticonvulsants (barbiturates, other benzodiazepines, hydantoins, succinimide, and others)
• Cimetidine (Tagamet)
• Fluconazole (Diflucan)
• Itraconazole (Sporanox)
• Ketoconazole (Nizoral)
• Lithium
• Narcotic analgesics for pain relief for surgery and obstetrics
• Sedatives

Practice good sleep habits—Due to the risks of overuse and withdrawal, sleep medicines should not be considered a long-term or first solution to insomnia. While using these medicines, it is essential to adopt good sleep habits in order to establish normal sleeping patterns that can be maintained without the use of drugs. These habits include the following:

• Avoiding naps
• Exercising regularly, at least six hours before you want to sleep
• Going to sleep and waking up at the same time every day
• Practicing a relaxing bedtime ritual, like a hot bath or listening to calming music
• Saving your worries for daytime (Schedule time during the day to write down concerns.)
• Using your bed only for sleeping and sex

Your doctor will determine the appropriate dose and usage schedule for you.

Elderly people are more susceptible to side effects and therefore hypnotics are not recommended for them.

Possible side effects of hypnotics include the following:

• Agitation
• Clumsiness or unsteadiness
• Depression
• Dizziness or lightheadedness
• Drowsiness (more common with long-acting than short-acting drugs)
• Headache
• Memory loss
• Slurred speech
• Weakness

Rare side effects include the following:

• Confusion
• Hallucinations
• Lack of usual inhibitions
• Odd moods and behavior
• Sleepwalking

Possible side effects of antihistamines include the following:

• Blurred vision
• Constipation
• Dizziness or lightheadedness
• Drunken movements
• Dry mouth and throat
• Urinary retention