Sleep Disorders: Medications for Circadian Rhythm Disorders

If you suffer from a sleep problem associated with disruptions to your biological clock (circadian rhythm), there are a number of treatment options to consider, including behavioral modifications and medications.

Medications that are used to treat circadian rhythm disorders include the following:


Melatonin is a natural hormone produced by a gland in the brain at night (when it is dark outdoors). Melatonin levels in the body are low during daylight hours and high during the night.

Melatonin supplements, available over-the-counter, may be used to enhance the natural sleep process and for resetting the body's internal time clock when traveling through different time zones. Melatonin supplements have been reported to be useful in treating jet lag and sleep-onset insomnia in elderly persons with melatonin deficiency. However, melatonin supplements have not been approved by the FDA; therefore, it is not clear as to how much melatonin is safe and effective.

Melatonin Warning

  • Some people, such as those with immune disorders, should not take melatonin.
  • Melatonin may interact with other medications.
  • Consult your doctor before using melatonin.

Melatonin Receptor Stimulant

Rozerem, a melatonin receptor stimulant, is also available to treat circadian rhythm disorders, but requires a doctor's prescription. Rozerem is used to promote the onset of sleep and help normalize circadian rhythm disorders. It works differently than melatonin supplements, as it is not melatonin but a stimulator of melatonin receptors in the brain. Rozerem is approved by the FDA for treating insomnia characterized by difficulty falling asleep.

Other Medications for Circadian Rhythm Disorders

  • Benzodiazepines. Short-acting benzodiazepines, such as Xanax, are often prescribed in the early treatment of a circadian rhythm disorder and are used in conjunction with behavioral therapy. Long-term use of these medications is not recommended due to potential side effects, such as the rebound phenomenon (the original problem returns at a higher level), and the risk of developing a dependence on these drugs.
  • Nonbenzodiazepine hypnotics. These medications, such as Ambien, Sonata, and Lunesta, are gaining popularity because they do not have a significant effect on the regular sleep cycle and are not associated with the rebound phenomenon seen with benzodiazepines. However, the FDA has warned that “rare but serious injuries” have occurred in people taking these prescription medications for insomnia. The injuries have resulted from "complex sleep behaviors'' such as sleepwalking and sleep driving.
  • Orexin receptor antagonists. Orexins are chemicals that are involved in regulating the sleep-wake cycle and play a role in keeping people awake. This type of drug alters the action of orexin in the brain. The only approved drug in this class is Belsomra.


Treatment of Sleep Disorders Associated With Shift Work

Provigil is a stimulant indicated to treat workers with sleep disorders caused by their shift work. It has wake-promoting actions and is taken an hour before the start of the work shift.

WebMD Medical Reference Reviewed by Nayana Ambardekar, MD on September 15, 2019


SOURCE: eMedicine Health. News release, FDA.

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