Insomnia is a disorder in which a person has trouble or an inability to fall asleep or stay asleep. Insomnia can be a short-term condition brought on by stress, medication, or other medical conditions. In some cases it’s a long-term problem that can affect a person’s quality of life. People with insomnia often feel tired during the day, have trouble concentrating, and feel like any sleep they did get was not restful.
If you are diagnosed with insomnia, your doctor will recommend strategies to eliminate the causes of insomnia and retraining your sleep habits to improve your ability to fall asleep and stay asleep. If those methods aren’t effective, your doctor may prescribe medication to help you obtain a more deep and hopefully restful sleep.
Your doctor may prescribe a benzodiazepine if you can’t sleep. These medications are sedative-hypnotics and work by slowing down your brain’s activity so you can sleep. Benzodiazepines are a large category of medications used for many purposes including the management of anxiety, muscle spasms, and seizures. Those benzodiazepines prescribed for insomnia usually have a rapid onset and a relatively short activity time (known pharmacologically as half-life). These medications usually come in pill or capsule form and are taken once a day before bedtime. Some typical benzodiazepines used for insomnia are:
Benzodiazepines can have some serious side effects. If you take them for extended periods, you can build up a tolerance to the medication and need higher doses. It’s also possible to develop a dependency on these kinds of drugs even after a few weeks. Other side effects include:
- sleep walking
- impaired coordination
In rare cases, benzodiazepines can cause respiratory or breathing problems. In most cases reducing the dosage amount can alleviate some of the side effects. If you stop taking the medication after prolonged use, you can experience withdrawal symptoms like irritability, nervousness, insomnia, and most seriously, the possibility of seizures. If you have been taking benzodiazepines for a prolonged period of time, you should always consult with your physician to determine how to safely discontinue these medications. You should not simply abruptly stop taking them.
You should not operate machinery or drive while taking these medications. Doctors may advise against using benzodiazepines if you are pregnant or if you are over 60. There has been a recently published report in the British Journal of Medicine suggesting an increased risk of developing Alzheimer disease if you use these medications long-term. However, the design of this study was such that the results did not permit easy establishment of cause and effect, and whether or not this is a true risk or a confounding observation remains an actively debated issue.
Nonbenzodiazepines are prescribed to help people suffering from insomnia. These medications work like benzodiazepines to slow down your brain’s activity. However, there is less risk of developing a tolerance or dependence and almost no risk of developing more serious respiratory side effects. These come in pill or capsule form and are taken once at bedtime. Common drugs that doctors prescribe are:
- zolpidem (Ambien)
- zaleplon (Sonata)
- eszopiclone (Lunesta)
The side effects of using these medications are fewer, but still significant. Most people using these experience the side effects the next morning. Dizziness, lightheadedness, headache and confusion are common morning symptoms. Some people have gastrointestinal problems, rashes, and a dry mouth.
If you are prescribed these medications, be careful if you have to perform tasks that require you to be alert like driving. The lowest possible recommended dose should be taken to reduce some of the side effects.
There is an increased risk for falls and confusion in older adults.
Another drug that can be prescribed for insomnia is ramelteon (Rozerem). This drug is for people who have trouble falling asleep. The drug targets the melatonin receptors in your brain. Melatonin is a hormone your body produces when it’s dark to trigger your body to go to sleep. It comes in a tablet and should be taken around bedtime.
The side effects of taking this include drowsiness and dizziness. You should be careful about operating machinery or driving a car the next morning. You shouldn’t take this medication if you are on fluvoxamine (Luvox).
If you have insomnia due to depression or anxiety your doctor may prescribe an antidepressant to help your insomnia.
While there are over-the-counter medications that you can buy, these are sometimes ineffective and you can easily build up a tolerance to these medications.
If you are prescribed these medications, be sure to tell your doctor about any other medications you are taking as they may interact with these drugs. Don’t drink alcohol, and make sure you have at least seven to eight hours to devote to sleep. Call your doctor immediately if you have an allergic reaction or breathing problems.