In some cases, doctors will prescribe drugs for the treatment of insomnia. All insomnia medications should be taken shortly before bed. Do not attempt to drive or perform other activities that require concentration after taking an insomnia drug because it will make you sleepy and can increase your risk for accidents. Medications should be used in combination with good sleep practices.
Here are some medications that can be used to treat insomnia.
- Antidepressants: Some antidepressant drugs, such as trazodone (Desyrel), are very good at treating sleeplessness and anxiety.
- Benzodiazepines: These older sleeping pills -- emazepam (Restoril), triazolam (Halcion), and others -- may be useful when you want an insomnia medication that stays in the system longer. For instance, they have been effectively used to treat sleep problems such as sleepwalking and night terrors. These medications have some serious downsides. They can cause addiction and dependence. Dependence means that you have physical withdrawal when you stop them, which you can have in the case of benzos. Also, there is a black box warning against their use with opioids, because both depress respiration and increase your risk of overdose.
- Doxepine (Silenor): This sleep drug is approved for use in people who have trouble staying asleep. Silenor may help with sleep maintenance by blocking histamine receptors. Do not take this drug unless you are able to get a full 7 or 8 hours of sleep.
- Eszopiclone (Lunesta): Lunesta also helps you fall asleep quickly, and studies show people sleep an average of 7 to 8 hours. Don't take Lunesta unless you are able to get a full night's sleep as it could cause grogginess. Because of the risk of impairment the next day, the FDA recommends the starting dose of Lunesta be no more than 1 milligram.
- Lemborexant (Dayvigo): This drug is approved for people who have trouble falling asleep and staying asleep. It works by suppressing the part of the central nervous system that keeps you awake. It may cause you to feel sleepy the next day.
- Ramelteon (Rozerem): This sleep medication works differently than the others. It works by targeting the sleep-wake cycle, not by depressing the central nervous system. It is prescribed for people who have trouble falling asleep. Rozerem can be prescribed for long-term use, and the drug has shown no evidence of abuse or dependence.
- Suvorexant (Belsomra): It works by blocking a hormone that promotes wakefulness and causes insomnia. It is approved by the FDA to treat people that have insomnia due to an inability to fall asleep or to stay asleep. The drug may cause you to feel sleepy the following day.
- Zaleplon (Sonata): Of all the newer sleeping pills, Sonata stays active in the body for the shortest amount of time. That means you can try to fall asleep on your own. Then, if you're still staring at the clock at 2 a.m., you can take it without feeling drowsy in the morning. But if you tend to wake during the night, this might not be the best choice for you.
- Zolpidem (Ambien, Edluar, Intermezzo): These medicines work well at helping you get to sleep, but some people tend to wake up in the middle of the night. Zolpidem is now available in an extended release version, Ambien CR. This may help you go to sleep and stay asleep longer. The FDA warns that you should not drive or do anything that requires you to be alert the day after taking Ambien CR because it stays in the body a long time. You should not take zolpidem unless you are able to get a full night's sleep -- at least 7 to 8 hours. In rare instances, these medications have been known to cause injuries because of behaviors while asleep or partially asleep such as sleep walking and sleep driving, among others. The FDA has approved a prescription oral spray called Zolpimist, which contains zolpidem, for the short-term treatment of insomnia brought on by trouble falling asleep.
- Over-the-counter sleep aids: Most of these sleeping pills are antihistamines. There is no proof that they work well for insomnia, and they can cause some drowsiness the next day. They're safe enough to be sold without a prescription. But if you're taking other drugs that also contain antihistamines -- like cold or allergy medications -- you could inadvertently take too much.
If these medications don’t work for you, your doctor may suggest something off-label. These are medications used to treat conditions they weren’t originally made for. Older antidepressants are sometimes prescribed to treat insomnia because they change brain chemicals, which can help regulate sleep. These older medications also tend to have a sedative effect or make you sleepy. They include:
- Amitriptyline (Elavil)
- Mirtazapine (Remeron SolTab, Remeron)
- Nortriptyline (Aventyl, Pamelor)
The FDA issued warnings for prescription sleep drugs, alerting patients that they can cause rare allergic reactions and complex sleep-related behaviors, including "sleep driving." They also warned people that taking sleeping medication at night can impair their ability to drive or be fully alert -- even the next day.
Keep in mind that sleep drugs are not for long-term use. Talk to your doctor if you’re still having trouble sleeping after 2 weeks.