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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?

Older Sleep Aids

Benzodiazepines are older medicines that effectively help people get to sleep, and were previously the most commonly used sleep medicines. Drugs in the benzodiazepine class include:

  • Ativan (lorazepam)
  • Halcion (triazolam)
  • Restoril (temazepam)
  • Valium (diazepam)
  • Xanax (alprazolam)

Benzodiazepines activate GABA receptors in the brain, causing sedation and relaxation and promoting sleep. Because they act on various types of GABA receptors throughout the brain, though, benzodiazepines have other effects:

  • Reduced anxiety
  • Muscle relaxation
  • Poor memory of some events while taking the drug
  • Euphoria

Benzodiazepines are only available by prescription. While they are sometimes the right medicine, benzodiazepines should be used with caution:

  • People who take benzodiazepines regularly may develop tolerance, or even a physical dependence on the drug (addiction).
  • Benzodiazepines have a relatively high potential for abuse.
  • They are not appropriate for long-term use.

"You wouldn't want to use them more than a few days," or longer in rare cases, according to Esther.

These days, physicians prescribe benzodiazepines infrequently, because newer medicines generally work as well without as much potential for abuse or dependence.

Tricyclic Antidepressants as Sleep Aids

Physicians usually prescribe tricyclic antidepressants, called TCAs, for depression or chronic pain. TCAs include:

  • Adapin (doxepin)
  • Aventyl (nortriptyline)
  • Elavil (amitriptyline)
  • Pamelor (nortriptyline)
  • Sinequan (doxepin)
  • Trazodone (desyrel)

For people with depression or chronic pain who also suffer from insomnia, TCAs may play a role in treatment. But because they act throughout the brain, tricyclic antidepressants can have pronounced side effects:

  • Blurry vision
  • Dry mouth
  • Difficulty urinating
  • Dizziness

The lower doses used for treatment of insomnia tend to reduce these effects. These medicines can be useful for "someone who has failed better agents or is anxious about the other medicines," says Erman.

Good Sleep Habits: Part of the Sleep Solution

Experts agree that while sleeping pills can be an important and necessary part of a successful sleep program, they can't be the only answer.

"Medicines can be helpful, but they shouldn't be a quick fix," says Esther. "They need to be part of a balanced plan of habits and common sense."

According to the National Sleep Foundation and others, good sleep habits should include:

  • No caffeine later in the day
  • Avoid nicotine or alcohol two to three hours before bedtime.
  • Use your bedroom only for sleeping and sex.
  • Maintain a regular sleep-wake schedule on all days, including weekends.
  • Exercise regularly but complete it several hours before bedtime.
  • Finish eating at least 2-3 hours before bedtime
  • Create a restful sleep environment by reducing noise, light, and temperature extremes with ear plugs, window blinds, an electric blanket, or air conditioner.

Sleeping Pills: The Risk of Dependence

All sleep medicines have the potential to cause dependence, according to sleep experts. Dependence means not being able to stop taking the drug without problems. Nearly always, this is a psychological dependence.

According to Erman, "If you're used to taking the drug to sleep, going without it will make you anxious, and in fact, unable to sleep"-- even though you're not physically dependent on the medicine.

If you feel you're dependent on a sleep medicine, see your doctor. He or she will address the problem with you. Your doctor may refer you to a sleep specialist.

Taking benzodiazepines regularly can lead to a physical tolerance and dependence, or addiction. If you've been taking these medicines for a prolonged period, do not stop abruptly. See your doctor and work out a schedule to stop taking them safely.

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