Nonbenzodiazepines, which have similar effects to traditional benzodiazepines and mainly used to treat mild insomnia.
Melatonin-receptor agonist —This medication is used to treat insomnia characterized by difficulty with falling asleep. It shortens the time it takes to fall asleep in people with transient insomnia.
Sedating antidepressants —For long-term treatment of insomnia or when insomnia is accompanied by
and/or caused by depression. These antidepressants are different from other classes of antidepressants.
Nonprescription sleeping aids can leave people feeling drowsy the next day and may not always be effective at providing restful sleep. However, they are often used as the first line of treatment for short-term insomnia because they are not addictive and a fatal overdose is extremely rare. These include the following:
Antihistamines —There are many
available over-the-counter. Diphenhydramine is a commonly used antihistamine for insomnia.
Not all antihistamines are effective for this purpose, especially the newer, nondrowsy antihistamines.
Melatonin —A natural hormone produced in the brain. Melatonin triggers sleep and is more active at night. Your body produces more melatonin in a completely dark room than in a dimly lit one. Melatonin may be useful when your normal sleep cycle has been disturbed, such as during travel-induced jet lag.
Pain relievers —Can be useful when insomnia is caused by minor pain.
The information below relates to prescription sleep medications unless stated otherwise.
What These Medications Are Prescribed For
To promote sleep in someone who has insomnia, especially in these cases:
When sleep difficulties cause problems completing daily activities
When behavioral approaches have proven ineffective
Insomnia associated with:
Psychological condition, such as anxiety
Temporary changes in normal sleep cycles
Hypnotics may help to do the following:
Shorten the time it takes to fall asleep
Increase total sleep time
Decrease the number of wakings during sleep
How These Medications Work
Hypnotic drugs alter brain chemistry in different ways:
Benzodiazepine receptor agonists work by enhancing the effect of a brain chemical responsible for reducing neuron excitability.
Melatonin receptor agonists may enhance the properties of melatonin's sleep-inducing properties.
Antidepressants block the absorption of certain brain chemicals leaving them in the blood stream. This helps produce a feeling of drowsiness.
Precautions While Using These Medications
Avoid overuse and dependence —Benzodiazepines and other sleep medications 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.
There is no current evidence that melatonin receptor agonists lead to overuse or dependence.
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:
Melatonin receptor agonists are not associated with returning insomnia or withdrawal symptoms.
Do not combine with certain substances
—Be sure to tell your doctor about all of the medications, 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:
Opioid pain relievers
Antipsychotics, such as lithium or tranquilizers
H2 blockers for gastrointestinal disorders
Practice good sleep habits —Because of the risks of overuse and withdrawal, sleep medications should not be considered a long-term or first solution to insomnia. While using these medications, 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:
regularly, at least 3 hours before you want to sleep
Avoiding naps, especially longer than 30 minutes and after 3 pm
Going to sleep and waking up at the same time every day (even on days off)
Saving your worries for daytime (schedule time during the day to write down concerns.)
Practicing a relaxing bedtime ritual, like a hot bath or listening to calming music
Using your bed only for sleeping and sex
Your doctor will determine the appropriate dose and usage schedule for you.
Possible Side Effects
Elderly people are more susceptible to side effects and therefore hypnotics are not recommended for them.
Possible side effects of hypnotics include the following:
Clumsiness or unsteadiness
Drowsiness—more common with long-acting than short-acting drugs
Rare side effects include the following:
Odd moods and behavior
Lack of usual inhibitions
Possible side effects of antihistamines include the following:
Dry mouth and throat
With every medication, there are important precautions to consider. These include allergies, interactions with other drugs and medical conditions, and safety during pregnancy, lactation, and other stages of life. If you have insomnia, talk to your doctor about treatment options.
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