Treating Insomnia with Medications

The Food and Drug Administration (FDA) has approved certain medications for the treatment of insomnia.  These are called hypnotic medications or sleep medications. Below is a brief discussion of medications that are commonly used for sleep. The discussion is organized by classes of medication.

One class of sleep medication is called benzodiazepines.  These medications are older and have a higher potential for dependency.  The following five medications, listed in alphabetical order, are approved by the FDA for the treatment of insomnia:

  • Estazolam
  • Flurazepam
  • Quazepam
  • Temazepam
  • Triazolam

Other benzodiazepine medications approved by the FDA for the treatment of anxiety, such as Lorazepam, Clonazepam, and Alprazolam, are sometimes prescribed for insomnia as well. Benzodiazepines are generally recommended for short-term use because tolerance and dependence can develop. In addition, some medications in this class can produce a "hangover" or grogginess the next day.

For these reasons, newer sleep medications have been developed and approved by the FDA.  Most of these newer medications work on the benzodiazepine receptors in the brain, but do it more selectively than the medications in the benzodiazepine class. Therefore, these newer sleep medications are safer and have lower potential for dependence and fewer side effects. They're called "non-benzodiazepines", a confusing name given that they still operate by acting on the benzodiazepine receptors. The "non-benzodiazepines" are:

Some people experience grogginess in the morning even with sleep medications from this newer class. This happens because people differ in how they metabolize the medications. Grogginess in the morning occurs when a sleep medication is metabolized slowly, and it's still active upon waking up in the morning. Because of their safety profile and their lower potential for dependence, some medications in this class are approved by the FDA for continuous long-term use.

Ramelteon is another new sleep medication. It has a very different mechanism of action. It affects the melatonin receptor in the brain.

Sometimes doctors prescribe a medication that is sedating even though it was not specifically developed to help with sleep. For example, a sedating antidepressant medication is often prescribed to help with insomnia. The most common antidepressants prescribed for sleep are Trazodone, Doxepine, and Elavil. These medications are usually prescribed at doses that are lower than what is required for the treatment of depression and they do not lead to tolerance or drug dependence.

Some people use over-the-counter medications, which usually contain antihistamines, or natural remedies for insomnia.  These remedies include herbs, such as valerian, and supplements, such as melatonin and L-tryptophan. The FDA does not regulate herbs and supplements. This means that their dose and purity are not monitored.

Discontinuing Sleep Medications

It is not necessary to discontinue sleep medication in order to benefit from CBTI.  However, individuals who have used sleep medications for a long period of time and wish to discontinue need to do so gradually and under the supervision of a physician. Most newer sleep medications don't cause physical dependence but they can cause psychological dependence. An abrupt discontinuation of a sleep medication can cause a very fitful sleep on the first night or two after the discontinuation. The fitful night is often caused by the discontinuation itself and usually does not reflect the underlying insomnia. The bad nights caused by withdrawal lead many people to promptly resume use of the sleep medications. The alternative is to slowly reduce the dose over a period of time (e.g. 25% reduction per week). A small reduction in dose rarely produces noticeable difference in sleep quality. The small steps add up and before long, you can discontinue medications altogether.

* Replicated with permission from Google Knol 2012

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