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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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The Latest Prescription Sleep Medicine continued...

Ramelteon also does not seem to have any potential for abuse, so it is not controlled like benzodiazepines and selective GABA medicines such as Ambien, Lunesta, or Sonata. So far, it has not been shown to cause hallucinations or sleepwalking.

Studies show that ramelteon works well in older adults with chronic insomnia. Because it acts on a part of the brain that controls hormones, ramelteon may affect hormone levels if taken for extended periods. This can reduce sex drive in men or make it harder for women to get pregnant.

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.

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