Medications: General Overview

Hypnotics (Sleep medications)

Sleeping pills help many people with insomnia. It is far better to take a sleeping pill with a known safety profile than to go for days or years with the misery of sleep deprivation and fatigue from bad sleep. Sleeping pills have their place in helping those with insomnia. However, they should not be the only option used to manage insomnia. Optimal sleep habits are important. Also, make sure you know that your insomnia is not caused by some other sleep disorder such as sleep apnea or periodic limb movements disorder (both make you wake up frequently at night) or restless legs syndrome (makes it difficult to fall asleep). In these situations, you need to treat the sleep apnea or restless legs and the insomnia may get better on its own.

FDA approved sleeping pills fall into generally two categories:

Benzodiazepines: these are the older class of drugs and have been around for years. They work well for the insomnia but in some cases, their effect tends to wear off (known as tolerance) after months or years later. They also affect the sleep architecture by reducing deep sleep (slow wave sleep). They are useful for a short –term need. Examples of this class of drugs include Restoril (temazepam).

Nonbenzodiazepines: have been developed more recently. They are also effective in treating insomnia but again they can cause tolerance but not to the same degree as the benzodiazepines. They typically have no to little effect on the sleep architecture. Examples of this class include Ambien (zopidem), Sonata (zaleplon) and Lunesta (eszopiclone).

Non-FDA approved sleeping aids:

Rozerem (ramelteon) is another drug that belongs to neither of the above classes but it works on a different receptor in the brain, the melatonin receptor.

Trazodone, even though it is not FDA approved for the treatment of insomnia is prescribed very commonly by doctors for insomnia.

Other medications such as valium, ativan and xanax are also used.

Alcohol is a very commonly self-prescribed hypnotic. The British National Formulary described : “Alcohol is a poor hypnotic because its diuretic action interferes with sleep during the latter part of the night. Alcohol also disturbs sleep patterns, and so can worsen sleep disorders.”

Caution must be practiced when using or prescribing hypnotics in the following situations:

  • Untreated sleep apnea/hypopnea syndrome: this is because certain sleeping pills can worsen the breathing problems at night.
  • Elderly folks need to be careful: due to increased risks of falls and mental cloudiness.
  • Dependency and habit-forming as possibilities in some but not all hypnotics.
  • Sleep walking and doing other activities including driving have been reported in the newer sleeping aids.
  • Many of the sleeping pills have been studied for few weeks but not more than 1 year. Therefore their long term effect on health is unknown.

Tips on the use of sleeping pills:

  • Implement good sleep habits as your first line of improving your sleep quality and combating insomnia.
  • If you need to take pills, use them at the lowest doses and infrequently (instead of every day).
  • Pay attention to the side effects. Read the label. Ask the pharmacist and the prescribing doctor.
  • When you are ready to take your first dose, take it on the night when you don’t have to work or drive the following day (Fridays/Saturdays usually) to see how you response to it. If it makes you too drowsy, take a lower dose (perhaps half the pill) or talk to your doctor about switching to another one.
  • If you suspect you have sleep apnea syndrome, get tested and treated first. If you need a sleeping pill while you use the CPAP, that should be safe- as long as you are using it.
  • If you stop taking a sleeping pill after using it for a long time, expect to go through withdrawal symptoms (recurrent insomnia, anxiety) for a couple of days. It is better to taper slowly.