Anti-Insomnia Drugs Health Article

Definition

Anti-insomnia drugs are medicines that help people fall asleep or stay asleep.

Purpose

Physicians prescribe anti-insomnia drugs for short-term treatment of insomnia—a sleep problem in which people have trouble falling asleep or staying asleep or wake up too early and can't go back to sleep. These drugs should be used only for occasional treatment of temporary sleep problems and should not be taken for more than a week or two at a time. People whose sleep problems last longer than this should see a physician. Their sleep problems could be a sign of another medical problem.

Description

The anti-insomnia drug described here, zolpidem (Ambien), is a classified as a central nervous system (CNS) depressant. CNS depressants are medicines that slow the nervous system. Physicians also prescribe medicines in the benzodiazepine family, such as flurazepam (Dalmane), quazepam (Doral), triazolam (Halcion), estazolam (ProSom), and temazepam (Restoril), for insomnia. Benzodiazepine drugs are described in the essay on antianxiety drugs. Zaleplon (Sonata) is another anti-insomnia drug that is not related to other drugs with the same effect. The barbiturates, such as pentobarbital (Nembutal) and secobarbital (Seconal) are no longer commonly used to treat insomnia because they are too dangerous if they are taken in overdoses. For patients with mild insomnia, some antihistamines, such as diphenhydramine (Benadryl) or hydroxyzine (Atarax) may be used, since these also cause sleepiness.

Zolpidem is available only with a physician's prescription and comes in tablet form.

Recommended dosage

The recommended dose for adults is 5-10 mg just before bedtime. The medicine works quickly, often within 20 minutes, so it should be taken right before going to bed.

For older people and others who may be more sensitive to the drug's effects, the recommended starting dosage is 5 mg just before bedtime.

Never take more than 10 mg of zolpidem in one 24-hour period. Overdoses can lead to excessive sleepiness or coma.

Zolpidem may be taken with food or on an empty stomach, but it may work faster when taken on an empty stomach. Check with a physician or pharmacists for instructions on how to take the medicine.

Precautions

Zolpidem is meant only for short-term treatment of insomnia. If sleep problems last more than seven to 10 days, check with a physician. Longer-lasting sleep problems could be a sign of another medical problem. Also, this drug may lose its effectiveness when taken every night for more than a few weeks.

Some people feel drowsy, dizzy, confused, light-headed, or less alert the morning after they have taken zolpidem. The medicine may also cause clumsiness, unsteadiness, double vision, or other vision problems the next day. For these reasons, anyone who takes these drugs should not drive, use machines or do anything else that might be dangerous until they have found out how zolpidem affects them.

This medicine has caused cause behavior changes in some people, similar to those seen in people whose behavior changes when they drink alcohol. Examples include giddiness and rage. More extreme changes, such as confusion, agitation, and hallucinations, also are possible. Anyone who starts having strange or unusual thoughts or behavior while taking this medicine should get in touch with his or her physician.

Zolpidem and other sleep medicines may cause a special type of temporary memory loss, in which the person does not remember what happens between the time they take the medicine and the time its effects wear off. This is usually not a problem, because people go to sleep right after taking the medicine and stay asleep until its effects wear off. But it could be a problem for anyone who has to wake up before getting a full night's sleep (seven to eight hours). In particular, travelers should not take this medicine on airplane flights of less than seven to eight hours.

Because zolpidem works work on the central nervous system, it may add to the effects of alcohol and other drugs that slow down the central nervous system, such as antihistamines, cold medicine, allergy medicine, medicine for seizures, tranquilizers, some pain relievers, and muscle relaxants. Zolpidem may also add to the effects of anesthetics, including those used for dental procedures. The combined effects of zolpidem and alcohol or other CNS depressants (drugs that slow the central nervous system) can be very dangerous, leading to unconsciousness or even death. People who take zolpidem should not drink alcohol and should check with their physicians before taking any other CNS depressant. Anyone who shows signs of an overdose or of the effects of combining zolpidem drugs with alcohol or other drugs should have immediate emergency help. Warning signs include severe drowsiness, severe nausea or vomiting, breathing problems, and staggering.

Anyone who takes zolpidem for more than one to two weeks should not stop taking it without first checking with a physician. Stopping the drug abruptly may cause rebound insomnia; increased difficulty falling asleep for the first one of two nights after the drug has been discontinued. In rare cases, withdrawal symptoms, such as vomiting, cramps, and unpleasant feelings may occur. Gradual tapering may be necessary.

Older people may be more sensitive to the effects of zolpidem. This may increase the chance of side effects, such as confusion, and may also increase the risk of falling.

In people with breathing problems, zolpidem may worsen the symptoms.