Prescription Medication Treatments

If practicing good sleep habits does not cure insomnia, your health care provider may prescribe sleeping pills. The side effects and long-term effectiveness of sleeping pills are still being studied. Short-acting medications are often preferred because they can improve your sleep while allowing you to remain alert throughout the next day.

When insomnia is caused by another condition, the condition causing the insomnia should be treated first. For instance, if someone has pain, giving a pain medication may cure the insomnia. Sometimes antidepressants, such as amitriptyline, nortriptyline, doxepin, trazodone and the newer agent mirtazapine (Remeron) are prescribed to help patients who experience depression with insomnia.

A number of medications are available for insomnia treatment. Prescription medications include benzodiazepine compounds and non-benzodiazepine compounds. Over the counter medications include antihistamines and herbal products.

Benzodiazepine medications are some of the oldest sleep agents on the market. Currently there are five benzodiazepines on the market that are specifically indicated for insomnia. How soon the medication begins to work and how long it lasts in the body varies for each medication and is important to consider when choosing which agent is most suitable for the particular sleep problem. For instance, Halcion (triazolam) acts rapidly and leaves the body quickly. As a result most people fall asleep soon after taking it and feel alert throughout the following day. Dalmane (flurazepam), on the other hand, has a much longer duration of action and may cause the patient to be drowsy the next day. Benzodiazepines have a high risk of dependence associated with them, tolerance (decrease effectiveness over time) and rebound insomnia (inability to sleep when stopped abruptly). They are recommended for short term use only.

Non-Benzodiazepine medications act at the same site in the body as benzodiazepine medications to improve sleep. However, they are considered safer. Ambien CR® (zolpidem tartrate extended-release) tablets and Lunesta® (eszopiclone) do not have the short term use limitations that are applied to benzodiazepines and are often prescribed nightly for longer periods of time for chronic insomnia. Because these medications work quickly they are helpful for patients who experience difficulty falling asleep. Because of their quick action they should be taken at bedtime and not before. These medications also leave the body quickly and therefore cause less daytime sleepiness. For people who experience frequent awakening during the night, extended release formulations, like AMBIEN CR are recommended. These release the drug early to help you fall asleep and again later to help you stay asleep. It is important to speak with your doctor to make sure you take these medications at the proper time to insure that you wake up alert. Be sure you're able to devote 7 to 8 hours to sleep before being active again.

Selective melatonin receptor agonist. The sleep-wake cycle is a daily cycle that typically allows people to function well for approximately 16 hours and then sleep for about 8 hours during the night. This rhythm can be disrupted by jet lat or shift work. Our body produces a hormone known as melatonin, which assists with sleep. Typically, melatonin levels are low throughout the daytime and then increase in the evening as bedtime approaches. Melatonin levels then level off during the night and fall as the sleep period ends in the morning. Rozerem™ (ramelteon) is a non-sedating insomnia medication that works by selectively stimulating melatonin receptors. In this way it enhances sleep onset at bedtime and is therefore primarily used in people who experience difficulty going to sleep. It is a safe medication without the same abuse potential that benzodiazepines have. The medication should be taken approximately 30 minutes before bedtime. It is generally well tolerated with side effects such as sleepiness, dizziness, and fatigue.