Insomnia Medication: Understand the Differences

The U.S. Food and Drug Administration (FDA) has approved a list featuring a variety of sleep aid medications to treat insomnia. Because these are powerful medications, they should be used carefully and, in most cases, not for extended periods. If your doctor suggests medications to treat your insomnia, be sure to review the risks, side effects, and proper use of these drugs.

This list of insomnia medication choices includes both prescription and over-the-counter (OTC) drugs. If you’re having trouble sleeping and wondering how to cure insomnia, you should try non-pharmacological solutions before turning to drugs. Basic tips—avoiding caffeine late in the day, keeping your room darker and cooler at night, following a consistent sleep schedule, and exercising every day (but not right before bedtime)—may help you sleep better naturally.

And before you try any OTC sleep aid medications on your own, be sure to consult with your doctor. These drugs all come with side effects, and can interact with other medications and supplements you take. Remember, just because a medication can be purchased without a prescription doesn’t mean it’s not strong.

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Among the insomnia medication products approved by the FDA are:

Hypnotics

FDA-approved hypnotics affect benzodiazepine receptors in the brain to promote drowsiness. Newer drugs—eszopiclone (Lunesta), zolpidem (Ambien) and zaleplon (Sonata)—act as benzodiazepine receptor agonists, but have a different chemical structure than older benzodiazepines. These sleep aid medications are shorter-acting and have fewer side effects than older sleeping pills. Sonata is the shortest-acting. Studies show these newer agents are safe when taken at the right dose, but they do pose a risk of dependency.

A recent study showed that short-term use of zolpidem extended-release 12.5 mg, taken three to seven nights per week for up to six months, provided sustained and significant improvements in sleep onset and maintenance, and also improved next-day concentration and morning sleepiness in people with insomnia. Eszopiclone has also been shown to have continued benefit when taken over long periods.

Benzodiazepines

If anxiety is causing your insomnia, benzodiazepine drugs such as alprazolam (Xanax), which combat anxiety and promote drowsiness when taken at bedtime, can also help you sleep better. However, older people should use caution when taking sedating benzodiazepines like triazolam (Halcion), because of next-day anxiety and balance problems, which may increase the risk of falls. Recent research suggests that exercise, a non-drug option, could also help.

If your problem is staying asleep, you may need a longer-acting, sedating benzodiazepine such as temazepam (Restoril) or flurazepam (Dalmane). However, these insomnia medications remain in your system longer and may lead to a “hangover” sensation in the morning and/or daytime drowsiness.

Antidepressants

Antidepressants in low doses may also help with difficulty sleeping. Sedating antidepressants include mirtazapine (Remeron), trazodone (Desyrel), and doxepin (Sinequan).

In cases of atypical or major depression, treating the condition with higher doses of different antidepressants during the daytime often can help resolve nighttime sleep problems. However, some antidepressants can cause insomnia and others may worsen restless-legs syndrome and exacerbate periodic limb movements.

Over-the-Counter Sleep Aids

OTC sleep aid medications such as Unisom, Compoz, Nytol, Sleep-eze, and Sominex all contain the same 50 milligram (mg) dose of diphenhydramine (Benadryl), which produces drowsiness. However, Benadryl is an antihistamine and can dry mucous membranes, causing a problem if you suffer from dry eyes or a dry mouth.

Tylenol PM is a combination of acetaminophen (a pain reliever) and Benadryl. These insomnia medications can lead to morning hangover, and you may develop a tolerance to these sleep aids with repeated use. These medications also can remain in your system and still affect you in the morning, causing daytime drowsiness, diminished cognitive function and even delirium, the latter being of particular concern among the elderly, according to the National Institutes of Health. OTC insomnia medication may help on an occasional sleepless night, but they are not meant for regular or long-term use.


Originally published in February 2016 and updated.

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