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Sleeping Pills: What You Need to Know

From dependency risks to a.m. drowsiness, not all sleep aids work alike. Which is right for you?
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Common Prescription Sleep Aids

Selective Gamma-aminobutyric acid (GABA) medications are among the newest sleep medicines and include:

  • Ambien (zolpidem tartrate)
  • Ambien CR (zolpidem tartrate extended release)
  • Lunesta (eszopiclone)
  • Sonata (zaleplon)

These sleeping pills work on the GABA receptors in the brain, which help control our level of alertness or relaxation.

The selective GABA medications target only a certain type of GABA receptor, one believed to be more dedicated to promoting sleep.

"They're more rapid in onset, more selective in their action, and less prone to side effects," says Arthur Spielman, PhD, professor of psychology at the City College of the City University of New York. In most people, selective GABA medicines are metabolized completely before morning.

Because selective GABA medicines don't work on all the GABA receptors throughout the brain, "they are thought to be relatively safer" than benzodiazepines, the older drugs on which they're based, "with less addictive potential," says Esther.

However, selective GABA medicines do have potential side effects, which are usually mild and include:

  • Memory disturbances
  • Behavior changes prior to sleep
  • Hallucinations

Ambien and other medicines in this class have also been blamed for episodes of "confusional arousal" -- what most of us would call sleepwalking. In a few well-publicized cases, people drove cars or wandered away from home after taking the drugs. These cases represent only a tiny percentage of the number of people who have taken these medicines, however.

The Latest Prescription Sleep Medicine

Sleep-wake cycle modifiers: Ramelteon (Rozerem) is the newest prescription sleep medicine, and the only drug in its class. Ramelteon acts directly on the body's sleep-wake cycle, or circadian rhythm.

The sleep-wake cycle is partially controlled by a part of the brain called the hypothalamus. Ramelteon binds specifically to melatonin receptors in this "circadian clock" area of the brain, promoting sleep. "This might be good for a 'night owl' trying to get to sleep for a new job," says Esther.

Because its activity is limited to one part of the brain, ramelteon has few side effects compared to other medicines that act more generally. Its risk of physical dependence is thought to be essentially zero. However, all sleep medicines can cause psychological dependence.

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