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Prescription and non-prescription insomnia treatment options

What are sleeping pills, exactly? And how do they work? Well, there are lots of prescription and over-the-counter (OTC) drugs that are designed to treat insomnia and help you get more zzz’s. Even just glancing at the list might feel overwhelming! This guide, below, may help you decide with your doctor which ones are best for treating the kind—and severity—of insomnia that you are experiencing.

Even OTC treatments should be used under a doctor’s supervision, especially since matching the right treatment to the right individual is complex. And you may want to first try lifestyle changes, such as improving your sleep habits, exercising daily, or trying cognitive behavior therapy, since sleep drugs can cause side effects, including next-day drowsiness, rebound insomnia, dependency and abuse.

(And if you’re interested in trying a sleep supplement(such as melatonin), as opposed to a sleep drug, check out this article for more information.)

Benzodiazepines

How they work: These enhance the action of something called GABA, a neurotransmitter that slows activity in the brain.

Examples: flurazepam (Dalmane), triazolam (Halcion), temazepam (Restoril), diazepam, alprazolam, and lorazepam

What You Should Know: These older, prescription sedatives may work just as well for you as some of the newer sleeping pills. Benzodiazepines are considered useful for people who have an anxiety disorder that also causes sleep problems, and they may be more likely than newer sleep drugs to cause abuse and/or dependency problems.

Non-benzodiazepine hypnotics

How they work: This type affects only specific parts of GABA.

Examples: zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata)

What you should know:  This might be a good choice for someone who needs a short-term solution to insomnia. Zolpidem and zaleplon act more quickly in the body and may be more effective at helping you fall asleep, while eszopiclone’s long-lasting effects may help you stay asleep/sleep longer. It’s important to note that in January of 2013, the FDA recommended to manufacturers of zoplidem that the dosage for women be lowered from 10 milligrams for immediate-release products (Ambien, Edluar, and Zolpimist) and from 12.5 milligrams to 6.25 milligrams for extended-release products (Ambien CR). How come? The drug remains in women’s bodies longer than it does in men’s bodies and can make it harder to focus on tasks that require concentration the following morning, such as driving. The FDA recommends that health care professionals consider prescribing these lower doses to men, too.

Antidepressants

How they work: Through altering neurochemicals such as serotonin and norepinephrine, antidepressants can create a sedating effect that both helps you sleep and helps treat depression.

Examples: trazodone (Desyrel, Oleptro, Trialodine); amitriptyline (Elavil, Endep, Levate)

What you should know: Trazodone is rarely prescribed for depression anymore, but is commonly prescribed for insomnia.

Diphenhydramine, doxylamine (antihistimines)

How they work:These drugs block the effects of histamine, the chemical responsible for many allergy symptoms. Diphenhydraminesalso have a sedating effect.

Examples: Advil PM, Unisom sleep, Sominex

What you should know:These OTC drugs may not be as helpful as better-studied prescription sleep drugs. Nonprescription antihistamines should not be used on a long-term basis for sleep problems, because they can cause next-day drowsiness, daytime sleepiness, constipation and urinary retention. 

Orexin receptor antagonists

How they work:The medications hinder the activity of the chemical orexin in the brain, which may turn off wakefulness and promote sleep.

Examples: Suvorexant, the chemical name for Belsomra, was recently approved by the FDA.

What you should know: Newer drugs may be less studied than more established ones that have been on the market for a longer period of time.