There are several types of prescription and nonprescription medications that can be used to treat insomnia.
Benzodiazepine-receptor agonists —These are hypnotic drugs that have a sedative effect. This class includes:
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 depression 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 antihistamines 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.
To promote sleep in someone who has insomnia, especially in these cases:
Hypnotics may help to do the following:
Hypnotic drugs alter brain chemistry in different ways:
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:
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:
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:
Rare side effects include the following:
Possible side effects of antihistamines include the following:
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.
National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov
National Sleep Foundation
http://www.sleepfoundation.org
Better Sleep Council Canada
http://www.bettersleep.ca
Health Canada
http://www.hc-sc.gc.ca
Insomnia in adults. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T114839/Insomnia-in-adults. Updated October 31, 2016. Accessed November 28, 2016.
Proctor A, Bianchi MT. Clinical pharmacology in sleep medicine. ISRN Pharmacol. 2012 Nov [epub ahead of print].
Ramelteon. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T232998/Ramelteon. Updated November 15, 2016. Accessed November 28, 2016.
Sack RL, Auckley D, Auger RR, et al. Circadian rhythm sleep disorders: Part I, basic principles, shift work and jet lag disorders. Sleep. 2007;30:1460-1483.
Safe use of sleep aids. National Sleep Foundation website. Available at: https://sleepfoundation.org/insomnia/content/safe-use-sleep-aids. Accessed October 25, 2016.
Last reviewed November 2016 by Michael Woods, MD Last Updated: 11/25/2014
