Carl R. Darnall Army Medical Center - Health Library

Medications for Insomnia

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

If you have insomnia, medication may be prescribed to help you sleep. Medication should be used only in combination with good sleep practices and/or behavioral changes. In general, sleep-promoting medications should be reserved for short term or occasional use. Studies have shown that the best therapies for lasting improvement in sleep involve the use of behavioral changes and techniques learned from cognitive behavioral therapy. Consult with your doctor before taking over-the-counter medications to make sure they will not interfere with sleep or interact with other medications you take.

Prescription Medications

Benzodiazepine Hypnotics

  • Lorazepam
  • Flurazepam
  • Triazolam
  • Estazolam
  • Temazepam

Nonbenzodiazepine Hypnotics

  • Zaleplon
  • Zolpidem
  • Eszopiclone

Melatonin Receptor Agonist

  • Ramelteon

Sedating Antidepressants

  • Amitriptyline
  • Doxepin
  • Trimipramine
  • Nefazodone
  • Trazodone
  • Mirtazapine

Over-the-Counter Medications

Antihistamines

  • Diphenhydramine
  • Doxylamine

Prescription Medications

 

Benzodiazepine Hypnotics

Common names include:

  • Flurazepam
  • Triazolam
  • Estazolam
  • Temazepam

Hypnotics, also called sedatives, are drugs that cause relaxation and help induce and maintain sleep. They affect chemicals in the brain that may be out of balance and causing the insomnia. These drugs are for short-term use. In any situation where long-term use is required, use should be closely monitored by your doctor. These drugs can react with other drugs you may be taking. Before starting a benzodiazepine hypnotic, tell your doctor about any and all drugs, vitamins, herbs, and supplements you are taking. Do not take any medications unless your doctor approves them.

Before using these drugs, tell your doctor if you have any of these conditions:

These medications will make you sleepy and perhaps lightheaded. When taking one of these drugs, use the following guidelines:

  • Do not drive, operate machinery, or do any hazardous activities.
  • Take the medication just before going to bed.
  • Do not drink alcohol while taking hypnotics.
  • Do not take this medication unless you are able to get adequate rest before you must become active again.
  • Do not stop taking the drug suddenly if you have been taking it for several days or longer.

Possible side effects include:

  • Allergic reaction (swelling of the face or mouth, difficulty breathing, rash)
  • Hallucinations, strange behavior, or severe confusion
  • Suicidal thoughts
  • Changes in your vision
  • Drowsiness or lightheadedness
  • Clumsiness
  • Loss of memory—amnesia
  • Cognitive slowing
  • Depression
  • Fatigue
  • Nausea, vomiting, diarrhea, or constipation
  • Vivid dreams
  • Headache
  • Unpleasant taste
  • Rebound insomnia when the medication is suddenly stopped
 

Nonbenzodiazepine Hypnotics

Common names include:

  • Zaleplon
  • Zolpidem
  • Eszopiclone

Nonbenzodiazepine hypnotics are structurally different than benzodiazepines hypnotics. They are most useful for inducing sleep. Before starting a nonbenzodiazepine hypnotic, tell your doctor about any and all drugs (including herbs and natural supplements) you are taking. Do not take any medications unless your doctor approves them.

Before using these drugs, tell your doctor if you have any of these conditions:

  • Drug allergies
  • History of drug or alcohol use disorders
  • Depression or suicidal thoughts
  • Liver disease
  • Kidney disease
  • Asthma, bronchitis, emphysema, or other lung diseases
  • Myasthenia gravis
  • Sleep apnea
  • Presently are pregnant or are trying to become pregnant

These medications will make you sleepy and perhaps lightheaded. When taking one of these drugs, use the following guidelines:

  • Do not drive, operate machinery, or do any hazardous activities.
  • Take the medication just before going to bed.
  • Do not drink alcohol while taking hypnotics.
  • Do not take this medication unless you are able to get adequate rest before you must become active again.
  • Do not stop taking the drug suddenly if you have been taking it for several days or longer.

Possible side effects include:

  • Allergic reaction (swelling of the face or mouth, difficulty breathing, rash)
  • Drowsiness or lightheadedness
  • Clumsiness
  • Hallucinations, strange behavior, or severe confusion
  • Headache
  • Diarrhea
  • Amnesia
  • Worsening depression
  • Rebound insomnia when the medication is suddenly stopped
 

Melatonin Receptor Agonist

Common name: Ramelteon

Ramelteon binds to specific melatonin receptors to induce sleep. Unlike other hypnotics, Ramelteon has not shown any potential for dependence or abuse. Because of this, Ramelteon can be used as long-term therapy for insomnia. Before starting a melatonin receptor hypnotic, tell your doctor about any and all drugs (including herbs and natural supplements) you are taking. Do not take any medications unless your doctor approves them.

Before using these drugs, tell your doctor if you have any of these conditions:

  • Moderate or severe liver disease
  • History of alcohol addiction
  • Sleep apnea
  • Take fluvoxamine for obsessive-compulsive or social anxiety disorders
  • Presently are pregnant or are trying to become pregnant

When taking one of these drugs, use the following guidelines:

  • Do not drive, operate machinery, or do any hazardous activities.
  • Take the medication just before going to bed.
  • Do not take with high-fat or heavy meals.
  • Do not drink alcohol while taking hypnotics.
  • Do not take this medication unless you are able to get adequate rest before you must become active again.

Possible side effects include:

  • Allergic reaction (swelling of the face or mouth, difficulty breathing, rash)
  • Drowsiness or lightheadedness
  • Clumsiness
  • Headache
  • Fatigue
  • Behavioral changes, including worsening of depression
  • Residual effects from previous night's dosing, such as memory problems and irritation
 

Sedating Antidepressants

Common names include:

  • Amitriptyline
  • Doxepin
  • Trimipramine
  • Nefazodone
  • Trazodone
  • Mirtazapine

Sedating antidepressants are often given in low doses for a sedative effect. They may be helpful if you have underlying depression or if other treatments have not worked. If you have both insomnia and depression, you may need higher doses or additional medications.

Before starting an antidepressant, tell your doctor about any and all drugs (including herbs and natural supplements) you are taking. Do not take any medications unless your doctor approves them.

Before using these drugs, tell your doctor if you have any of these conditions:

  • Any drug allergies
  • Liver disease
  • Kidney disease
  • Asthma
  • Glaucoma, or pressure inside the eye
  • Diabetes
  • Enlarged prostate, bladder problems, or difficulty urinating
  • Thyroid disease
  • High or low blood pressure or any heart problems
  • Stomach or intestinal problems
  • Pregnancy or breastfeeding
  • Bipolar disorder
  • Blood problems
  • Personal or family history of heart arrhythmias

Take these medications with a full glass of water. Some of these medications may take 4 weeks or more before you feel its full therapeutic effect.

Possible side effects include:

  • Allergic reaction (swelling of the face or mouth, difficulty breathing, rash)
  • Seizures
  • Fast or irregular heart beat
  • Heart attack
  • High blood pressure
  • Painful or inappropriate erections (trazadone)
  • Dry mouth and eyes
  • Mild tremor or agitation
  • Difficulty urinating
  • Fever, with muscle stiffness or weakness
  • Drowsiness or lightheadedness
  • Clumsiness
  • Nausea or constipation

Over-the-Counter Medications

 

Antihistamine

Common medications include:

  • Diphenhydramine
  • Doxylamine

An antihistamine is a medication that blocks an allergic reaction in the body. Because one of the side effects of these antihistamines is drowsiness, they are sometimes used to induce sleep. This and any other over-the-counter sleep aid should be taken only with the approval of your doctor. An antihistamine can be taken with or without food, and with a full glass of water. These drugs can react with other drugs you may be taking. Before taking an antihistamine, tell your doctor about any drugs you are taking.

Before using these drugs, tell your doctor if you have any of these conditions:

  • Glaucoma, or pressure inside the eye
  • Stomach ulcer
  • Enlarged prostate, bladder problems, or difficulty urinating
  • Hyperthyroidism
  • High blood pressure or any heart problems
  • Asthma

Possible side effects include:

  • Dry mouth
  • Sleepiness, fatigue, or lightheadedness
  • Headache
  • Difficulty urinating
  • Constipation
  • Blurred vision
  • Delirium

Special Considerations

If you are taking medications, follow these general guidelines:

  • Take the medication as directed. Do not change the amount or the schedule.
  • Ask what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medication.
  • Do not share your prescription medication.
  • Medications can be dangerous when mixed. Talk to your doctor or pharmacist if you are taking more than one medication, including over-the-counter products and supplements.
  • Plan ahead for refills as needed.

When to Contact Your Doctor

Hypnotics and sedating antidepressants can have side effects. Call your doctor right away if you experience:

  • Fast or irregular heart beat
  • Chest pain or pressure
  • Trouble breathing
  • High blood pressure
  • Difficulty urinating

Many of these medications need to be tapered off when stopping them. Stopping your medication abruptly can lead to “rebound insomnia,” which worsens your condition. Talk your doctor before stopping your medication.

REFERENCES:

Insomnia in adults. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T114839/Insomnia-in-adults. Updated June 5, 2017. Accessed March 7, 2018.

Melatonin. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/biomedical-libraries/natural-alternative-treatments. Updated October 16, 2017. Accessed March 7, 2018.

Morin AK, Jarvis CI, Lynch AM. Therapeutic options for sleep-maintenance and sleep-onset insomnia. Pharmacotherapy. 2007;27(1):89-110.

Morin C, Vallieres A, Guay B, et al. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized, controlled trial. JAMA. 2009;301(19):2005-2015.

Ramelteon. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T232998/Ramelteon. Updated March 6, 2018. Accessed March 7, 2018.

Safe use of sleep aids. National Sleep Foundation website. Available at: https://sleepfoundation.org/insomnia/content/safe-use-sleep-aids. Accessed March 2, 2016.

Zolpidem. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T233439/Zolpidem. Updated March 6, 2018. Accessed March 7, 2018.

2/18/2011 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T113820/Antidepressant-medication-overview: Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010;71(10):1259-1272.

Last reviewed March 2018 by EBSCO Medical Review Board Monica Zangwill, MD, MPH  Last Updated: 3/7/2018