Chronic insomnia is highly prevalent and affects approximately 30% of the general population. When you have sleep issues, this doesn’t automatically mean you should start taking pills. Especially over-the-counter, with no supervision! Insomnia can be annoying and exhausting, even in milder cases. If you experience the symptoms of it, it is vital that you reach out to a professional before taking any action.
Things to Try Before Opting for Sleeping Pills
Before opting for pills, you should always try some less-invasive alternatives, such as natural sleep aids or CBT-I. Some of our top picks for natural sleep aids can be found here.
When it comes to Cognitive Behavioral Therapy, this method of treating insomnia doesn’t involve any medications and instead focuses on improving your sleep hygiene and general wellbeing by reducing stress, setting up a sleeping schedule, etc.
If these still didn’t provide you with the so much wanted relief from insomnia (and you also tried other common-sense methods like limiting processed foods, caffeine and alcohol intake and getting more physically active) it might be time to look into sleep drugs and prescription medicine.
What Your Doctor Should Consider
When considering sleeping medication (or any medication really) for the first time, it is important to know exactly how it works and what are the possible side effects and complications for your health. Before going into different drug options, your doctor will ask you some general questions to determine which course of action is appropriate for you. These will typically cover your medical history, age, sleeping hygiene, allergies and any other medication you might be taking.
After that, he or she will move on to your insomnia symptoms. In case your insomnia is secondary (caused by another medical condition), you will need to address the underlying condition.
It’s also important to determine whether you have issues with falling asleep (sleep onset insomnia) or staying asleep (sleep maintenance insomnia), as different medications target different problems.
Finally, your doctor should be able to prescribe a medication that potentially fits your needs, and schedule an appropriate follow-up, as most medications are meant for short-term use only. In case the first drug doesn’t work for you in the previously established period, make sure to report back to your doctor so he or she can adjust your therapy accordingly – don’t drop the whole treatment for some over-the-counter pill.
Types of Prescription Medications
There are a lot of different sleeping drugs out there, varying in their active substances, targeting issues, side-effects and form in which they are consumed. Some of them weren’t even primarily made to fix sleeping problems, but due to some fortunate side-effects, can be prescribed to treat insomnia. Most commonly used drugs can be divided into three groups: Benzodiazepines, Z-drugs and Other medications.
Primarily used to treat anxiety, Benzodiazepines have also found common use in treating sleeping disorders by acting on benzodiazepine receptors in the brain. They belong to the group called Central Nervous System (CNS) depressants and work by decreasing excitability in certain parts of the brain, thus helping reduce both anxiety and insomnia symptoms. Two birds with one stone, now you just have to stock up on these, and you’re good, right? Well, no. Benzodiazepines work best when used for shorter periods, and aren’t as useful for longer-term problems. Partly, this is because your body gets used to the initial dose after two or three weeks, and the drug loses its use. So if you want to keep taking it, you have to keep increasing the dose (which alone is not advisable), and the same thing will happen. This effect is called tolerance.
Also, due to the addictive nature of the medicine – you start relying on it to feel normal. If you stop taking it abruptly after using it for over a month, you will experience withdrawal symptoms. These could be physical (inability to sleep, sweating, tremor, headache, nausea, sensitivity to light), psychological (odd sensations, panic attacks, anxiety, etc.) or both, and often beat the whole purpose of taking the drug in the first place. This can happen with overusing Z-drugs as well, and the symptoms could last up to six weeks after you’ve stopped medicating.
Some commonly used Benzodiazepines are: diazepam, estazolam, temazepam, triazolam, clonazepam, lorazepam, loprazolam.
– comes in a tablet form, taken orally, usually in 1-2mg dosage
– treats insomnia
– helps with falling and staying asleep
– has dependency potential
– side-effects may include: headache, drowsiness, dizziness, weakness, constipation, agitation, slowed movements
Estazolam, or ProSom, is supposed to be taken at bedtime, or as needed when experiencing difficulty falling asleep, and isn’t recommended if you know you won’t be able to sleep for longer than 6 hours – even after you have slept the night, chances are you will still have difficulties waking up. Estazolam is not for pregnant women and people with liver problems.
– capsule form, 15, 7.5, 30, 22.5mg
– recommended dosage: up to 30mg
– falling and staying asleep
– should be taken for 7-10 days
– possible side effects: nausea, vomiting, drowsiness, headache, fatigue
Another typical Benzodiazepine drug, Temazepam belongs in the hypnotic class, also known under the name Restoril. It’s meant to keep you asleep for at least 8 hours, so don’t be surprised if you wake up a bit disoriented and need some time to shake it off.
– tablet form, either 0.125 or 0.25mg
– recommended daily dose: 0.5mg or less
– treats severe insomnia
– helps with sleep onset but not with maintenance
– dependency potential
– side effects may include: drowsiness, nausea, headaches, lightheadedness, skin tingling, nervousness, problems with coordination
– more dangerous side effects: rash, hives, itching, difficulty breathing, swelling
Triazolam is used on a short term basis to treat severe insomnia, although clinical studies have shown that it also reduces nighttime wakefulness. Common under the names Halcion, Apo-Triazo, Hypam and Trilam, this drug works by slowing brain activity, thus helping you fall asleep. The maximum dosage is 0.5mg per day, but smaller amounts are usually sufficient. If you experience any of the severe side-effects mentioned above, contact your doctor immediately.
Zaleplon, zolpidem and eszopiclone/zopiclone are the three medications regularly grouped as Z-drugs because of their Z-names and similar function. They are primarily used to treat insomnia, and although they aren’t structured like Benzodiazepines, they affect the same parts of the brain to induce sleep. Z-drugs carry a slightly lower risk of abuse, but can also lead to dependence if taken for over three weeks, with same potential withdrawal symptoms as with Benzodiazepines. Their most common side-effect is drowsiness – many people reported being less attentive or “feeling like a zombie” while on a Z-drug.
– tablets, 5 or 10mg
– Dosage: up to 20mg
– helps onset sleep
– can be addictive
– some potential side-effects: numbness, loss of appetite, tingling in arms or legs, sensitivity to smell, headache, vision problems
Zaleplon (Sonata) is not indicated for sleep maintenance. It is a hypnotic, shown to help patients fall asleep, and FDA approved its use for up to one month. The recommended dosage is 10mg, for elderly and debilitated patients lower than 5mg. In some countries, Zaleplon is also available as Hegon, Zaplon or Andante.
– available in capsules of 5 or 10mg
– recommended daily dosage: 10mg or less
– indicated for patients with difficulties falling asleep
– side effects: dizziness, lightheadedness, headache, drowsiness, fogginess
Commonly sold under the names Intermezzo, Ambien, Ambien CR, and Edluar, Zolpidem is a hypnotic drug that, much like Zaleplon, aids sleep onset issues and not maintenance. If you have troubles staying asleep, this one is not for you. Zolpidem has also been linked to CNS depression and has the potential for abuse.
– comes as a tablet of 1, 2 or 3mg
– recommended dosage: under 3mg
– indicated for both sleep onset and maintenance
– classified as hypnotic
– potential side-effects: headache, pains, unpleasant taste, dry mouth, heartburn, unusual dreams, short-term memory loss, decreased libido
Prior to the introduction of this drug, the FDA didn’t approve using hypnotics for a period longer than one month. Eszopiclone or Lunesta has been shown to be mostly non-habit-forming, although this is still discussed among professionals. This pill is classified as a hypnotic and meant to treat short-term insomnia. Don’t eat foods high in fats shortly before taking it, and make sure you are in bed maximum 30 minutes after. Otherwise, you may experience side-effects. It is not recommended for pregnant women.
Some prescription sleep medications that don’t classify under Benzodiazepines or Z-drugs, but are regularly prescribed to treat insomnia, are Ramelteon and Suvorexant.
Ramelteon’s main distinction from other commonly used sleep meds is that it acts on melatonin receptors in the brain instead of GABA receptors or benzodiazepine receptors. Melatonin is a hormone produced by the pineal gland in our brains that helps maintain a healthy sleep-wake cycle monitored by circadian rhythm, which helps us sleep through the night and wake up in the morning, triggered by daylight. Although still quite new to the market (FDA approved less than two decades ago), Ramelteon has shown to be a very reliable sleep pill without being addictive. One possible side effect is dizziness and recommended daily dosage is 8mg – meaning, one pill a day.
Suvorexant, or Belsomra, is classified as a sedative-hypnotic, but also an orexin agonist, which means it acts on orexin receptors in the brain. The US National Library of Medicine Institute of Health defines orexins as “recently described hypothalamic neuropeptides thought to have an important role in the regulation of sleep and arousal states.” Suvorexant comes in 10mg capsules, with recommended daily dosage being no more than 20mg. Side effects may include diarrhea, nausea, dizziness and dry mouth. It also has a potential for dependency, but lower than with Benzodiazepines or Z-Drugs.
Antidepressants with a sedating effect
We mentioned before that treating secondary insomnia without treating the underlying condition would be unwise. While that is true, there are certain situations where you could (at least temporarily) treat both at the same time, and one of those situations is the combination of depression and insomnia. Namely, some medication widely used to treat depression may help ease insomnia symptoms. These drugs are not FDA approved to treat sleep issues alone, but if insomnia is secondary to depression, using some antidepressants could be beneficial for both conditions. A few of these examples include Amitriptyline, Mirtazapine (Remeron) and Trazodone.
In short? Don’t do it.
Mixing prescription medication with over-the-counter medication is extremely dangerous, and mixing two prescriptions is just as bad, if not worse. Especially with something that has to do with your metabolic system, depending on how bad you mess up, it can result in a coma, even death. Your doctor has to be informed of your entire background before prescribing you a new pill. Otherwise, you are putting yourself at great risk.
Mixing drugs with alcohol is a terrible idea as well. When taken together, the sedative effect on your central nervous system is double, and short-term side effects could include:
– impaired motor function
– falling asleep while doing something that requires attentiveness, such as driving
– cardiac arrest
If alcohol abuse is what induced insomnia in the first place, sleeping pills could be very risky.
Conclusion and Safety Considerations
Reaching for pills may seem easy, but could be very dangerous if not taken seriously. Out of the three groups of prescription medications, older and more tried out ones are Benzodiazepines and some Z drugs, but they can have some milder side-effects like drowsiness, decreased attentiveness or headache. Perhaps more promising and seemingly less harmful would be Ramelteon, with no dependency risks, or even Suvorexant, but these drugs are still relatively new on the market, and not as vastly tested as the older ones.
There are many medications not highlighted in this article with different variations of traits covered here, but the key is to talk to your doctor and be open to some trial time before you find one suitable for you.
Pills don’t combine with other pills without expert advice, and pills with alcohol – never!
Lastly, if you are pregnant, breastfeeding, or have an existing condition such as kidney disease, arrhythmias, other heart or liver issues, low blood pressure – you might want to reconsider taking sleep medication altogether.
Co-founder of Counting Sheep and Sleepaholic