Medication Treatment Options
Medicines are the most common treatment for sleep problems. Treatment of insomnia with medicines should:
- Begin with the lowest possible effective dose
- Be short-term, if used nightly
- Be intermittent, if used long-term
- Be used only in combination with good sleep practices and/or behavioral approaches
Types of Medicines for Sleep Problems
Sedative-hypnotic medicines (“Sleep Medicines”) reduce the length of time it takes to fall asleep and/or increase sleep duration. There are different classes of sedative-hypnotic medicines; most sleep medicines fall into a class of drugs known as benzodiazepines, or into a newer class of drugs known as non-benzodiazepine sedative-hypnotics.
Long-acting benzodiazepines – Dalmane® (flurazepam), Doral® (quazepam), Valium® (diazepam), Librium® (chlordiazepoxide – are not appropriate for use in older persons, because they cause prolonged sedation, confusion, and increased risk for falls. Take a look at the list of potentially inappropriate medicines. All benzodiazepines may cause memory problems, impairments in movement, and “hangover” effect. Non-benzodiazepine sedative-hypnotics may have better safety profiles. Medicines with a short duration of effect are generally preferred for treatment of insomnia, because they are less likely to cause sleepiness the morning after being used.
Benzodiazepine sedative-hypnotics:
- Dalmane® (flurazepam) (long-acting)
- Doral® (quazepam) (long-acting)
- Halcion® (triazolam) (short-acting)
- Prosom® (estazolam) (long-acting)
- Restoril® (temazepam) (long-acting)
Non-benzodiazepine sedative-hypnotics include:
- Ambien® (zolpidem)
- Lunesta® (eszopiclone)
- Sonata® (zaleplon)
Other sedative-hypnotics:
- Rozerem® (ramelteon)
Sedating Antidepressants
Sometimes physicians will use sedating antidepressants to help persons with a variety of problems, including, but not restricted to depression. Examples include:
- Desyrel® (trazodone)
- Remeron® (mirtazapine)
Over-the-Counter (OTC) Medicines
OTC medicines for the treatment of insomnia – such as Nytol®, Sleep-Eze®, and Sominex® – contain antihistamines such as diphenhydramine (Benadryl®), that act as sedatives. Antihistamines are potentially inappropriate for use in older adults due to their strong anticholinergic effects. These effects include:
- confusion
- delirium
- oversedation
- falls
- urinary retention
- constipation
- irregular heart rhythms
Take a look at the list of potentially inappropriate medicines.
“Natural” and Herbal Remedies
Melatonin is a hormone involved in the regulation of sleep and wakefulness. It has been shown that taking melatonin before bedtime will help individuals fall asleep. However, scientific data have failed to confirm that melatonin is useful in maintaining sleep. Learn more about melatonin.
Herbal products such as valerian, chamomile, kava kava, and others have been promoted as natural remedies for insomnia. However, the effectiveness and safety of these products has not been documented. Learn more about valerian.