Common Medication Prescribed

Prescription drugs

You may need medication if:

• Insomnia is causing problems with daily activities.
• Changes in sleep habits are not working.
• Insomnia is part of a known medical condition.
• Your insomnia is a condition by itself and is chronic.

Some commonly prescribed medicines include:

• Ambien®/Ambien CR®
• Butisol®
• Carbrital®
• Dalmane®
• Doral®
• Halcion®
• Lunesta®
• Placidyl®
• Prosom®
• Restoril®
• Rozerem®
• Seconal®
• Sonata®

Newer sleeping medicines include: Ambien®, Sonata®, Rozerem®, and Lunesta®. Your doctor may try these medications first because they do not seem to have as many withdrawal or tolerance effects (with the exception of Roserem) as the older sleeping pills do. Rozerem is the first sleeping pill that the FDA has not categorized as a controlled substance because studies have shown no evidence that Rozerem is addictive.

FDA recommendations
For many people, sleeping pills work well and don't cause side effects. However, there are some risks. Reports of people who have taken sleeping pills and "sleeping driving" and other strange behaviors have become more common with more people taking sleeping pills. These medications also have been reported to cause severe allergic reactions in some people. The FDA has asked drug companies to provide guides about those risks.

The guides explain the proper way to take sleeping pills. They also discuss certain medications you should avoid (including alcohol) if you're taking them. Ask your pharmacist for the new guide. If you still have questions, ask your doctor.

Short- and long-acting benzodiazepines, such as Halcion, Seconal and Restoril, are all habit-forming and more or less physically addictive. They are only to be used as short-term treatment. Hypnotics can:

• Shorten the time it takes to fall asleep.
• Increase total sleep time.
• Decrease how often you wake.

Because insomnia can be a symptom of depression, antidepressants may help and can be used long-term. However, some such as selective serotonin reuptake inhibitors may cause insomnia. Anti-anxiety drugs called anxiolytics are used if anxiety is related to insomnia. Clonazepam (Klonopin®), which is a sedative, can be addictive if used long-term.

Substances that can interfere with sleep medicines:

• Over-the-counter sleep medicines.
• Alcohol.
• Other sedatives.
• Valerian.

Common side effects of sleep medications:

These may be more pronounced when you wake up. However newer medications such as Sonata® and Ambien® generally don't cause daytime sleepiness:

• Daytime sleepiness.
• Withdrawal (anxiety, insomnia, headaches, low mood, shivering).
• Forgetfulness.
• Clumsiness.
• Risk for falling down and causing injury.
• Inability to drive safely.

Over-the-counter medications

Some sleep medications are sold over the counter (OTC) in supermarkets and drug stores. They tend to be less effective than prescription drugs. If you take OTC products for sleep, use them carefully and watch for side effects because they may make you drowsy the next day. Always advise your doctor of over-the-counter medicines, supplements, or herbals that you use.

Antihistamines block chemicals released during a cold or allergy attack. Many have a sedating, or calming effect. These products may not be safe to take if you are or plan to become pregnant, breastfeeding, excessively drinking alcohol, taking medications that have sedating effects or have untreated sleep apnea. Older people should also be careful. People with glaucoma, chronic bronchitis and who have trouble urinating because of an enlarged prostate gland should not take them. It's important to read package directions and precautions on all over-the-counter medications.

Supplements and herbal remedies

Melatonin, which is a natural hormone in your body, has received a lot of attention and so, too, has Valerian. Both are sold without a prescription. Like other supplements and herbal remedies, these are not regulated by the Food and Drug Administration and do not go through the same rigorous testing as prescription medications. Talk to your doctor before using any supplement or herb. Their long-term impact, side effects and possible interactions with other drugs or medical conditions are often not well known.

Children, teens and adults being treated with antidepressants, particularly anyone being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns immediately with a doctor.

Paxil may increase the risk for birth defects, particularly heart defects, when women take it during the first three months of pregnancy, according to a 2005 advisory from the Food and Drug Administration (FDA). The FDA is waiting for the results of recent studies to better understand the higher risk. Discuss with your doctor about the health risks of Paxil if you plan to become pregnant or are in the first three months of pregnancy. You may want to consider taking a different antidepressant. Do not stop taking the drug without first talking to your doctor.

More on Insomnia

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This article was reviewed and updated June 2007.