Medicinal Insomnia Treatment

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Over The Counter Sleep Aids

OTC sleep aids (Benadryl, Nytol, Sominex, Unisom, Tylenol PM, etc) are good at helping you get to sleep for a night or two during a bout of temporary insomnia or during a mild illness, such as a cold or flu. However, they are not a preferred insomnia treatment for chronic insomnia for the following two reasons.

First, over the counter (OTC) sleep aids use a sedating antihistamine to induce sleep. For example, Tylenol PM contains the antihistamine diphenhydramine, which may cause drowsiness. Additional typical side effects include morning hangover, nausea, dizziness, upset stomach, dry mouth, and disturbed coordination. Also, tolerance to and dependence on OTC aids develops quickly. Second, over the counter sleep aids will not address any underlying conditions like anxiety or depression that cause chronic insomnia.

 


 

Prescription Sleep Aids

If you have chronic insomnia that necessitates medical therapy, prescription sleep aids are the preferred insomnia treatment. Typically, short-term treatment with prescription sleep aids resolves insomnia, and long-term treatment with prescription sleep aids is only used if short-term treatment periods fail. Consult a physician to determine the best sleep aid for you, but first check out some of the more common prescription sleep aids below including non-benzodiazepine hypnotics and benzodiazepine hypnotics.

Non-Benzodiazepine Hypnotics

Non-benzodiazepine hypnotics include several classes of prescription sleep aids that have largely replaced formerly prescribed benzodiazepines as initial treatment for insomnia. Sleep aids in this category include Ambien, Sonata, Ambien CR, and Lunesta. Ambien and Sonata act quickly and possess relatively short half-lives. They are better to take for problems falling asleep. Ambien CR and Lunesta possess longer half-lives. They are better to take for problems staying asleep although they also help you fall asleep.

Pros: 

  • They possess fewer side effects than benzodiazepines and OTC sleep aids and typically won’t leave you with a morning hangover.
  • They have less of a negative effect on the amount of deep sleep.
  • Some (Lunesta specifically) are approved for long-term use.

Cons:

  • Long-term use will still lead to dependence, just as it will with the other types of medicinal sleep aids.

Benzodiazepines

Benzodiazepines are another class of sleep aids. They are used to treat many different conditions, such as anxiety, pain, alcohol withdrawal, and seizures. They also have strong sedative effects and are commonly used to treat resistant insomnia.

There are many benzodiazepines on the market, each used to treat one or more conditions. The first four (Ativan, Klonopin, Valium, and Xanax) are used to treat anxiety.  The second five (Halcion, Dalmane, Doral, ProSom, and Restoril) are specifically indicated to treat insomnia.

Pros: 

  • In the short term, this class is very effective in helping people fall asleep and stay asleep.
  • If anxiety is the cause of insomnia, certain benzodiazepines may effectively treat your anxiety, thus also curing the insomnia.

Cons:

  • They cause muscle relaxation, making them bad for men with untreated sleep apnea or other breathing difficulties.
  • They generally remain in the body longer and cause a greater reduction in the amount of deep sleep than non-benzodiazepine hypnotics.
  • Both dependence and tolerance will develop more quickly with long-term use. You will need a higher dose to fall asleep and will have difficulty stopping use.
  • They are only approved for short-term treatment of insomnia.

EMG’s Sleep Homepage: Importance of Sleep

Updated: April 10th, 2015