Sleeping Pills and Sleep Medications for Insomnia:

The dangers of treating insomnia with sleep medications

Many people experiencing sleep problems understandably want a quick fix for their suffering. But the causes of insomnia are complex and vary by person. Several of the successful behavioral treatments for insomnia are time-intensive and require a lot of work by the person experiencing insomnia. The thought of a pill that can solve the problem quickly is very appealing. Unfortunately, sleep medications don’t cure insomnia, and they can often exacerbate the problem over the long term.

Other concerns about the use of both over-the-counter and prescription sleep medications include:

• development of drug tolerance
• development of drug dependence
• physical side effects
• interactions with other drugs or chemicals in the body
• withdrawal symptoms
• rebound insomnia

If you want to take medications to help you sleep because you are in a great deal of pain, are traveling, or just need to get some sleep, pay attention to the type of medication you choose and try to use the medication only when you really need it. If you also commit to making your sleep habits and sleep environment more conducive to sleep, you can limit the effects of insomnia on your life.

Over-the-counter sleep aids

You can walk into a drugstore and choose from an array of sleep aids, offered without prescription. The main ingredient of over-the-counter sleeping pills is an antihistamine. Antihistamines are generally taken for allergies, but also make you feel very sleepy. Common over-the-counter sleep medications are Sleep-Eze, Sominex, Nytol, and Unison; they contain antihistamines such as diphenhydramine hydrochloride, diphenhydramine citrate, or doxylamine succinate.

In general, over-the-counter sleep medications are not a good choice because they are not intended for long-term use. They can also interfere with mental alertness during the day, so you should avoid driving and other similar tasks. And sleep medications can actually reduce the quality of your sleep by reducing time you spend in deep sleep.

Use over-the-counter sleep medications only for transient or short-term insomnia and in conjunction with changes to your sleeping habits. Be sure to pay attention to your body’s physical response to these sleep medications. Immediately discontinue use if you experience any severe adverse effects.

In addition, you can develop a tolerance for over-the-counter sleep aids after using them for just a few days. You may find quickly that you need a higher dosage to accomplish the same effect. As with any medication, it is advisable to consult with your doctor before taking over-the-counter sleep medications.

Types of prescription sleep medications

The following are commonly prescribed sleep medications, along with links to individual drug reviews by Consumer Reports Medical Guide.

Short-acting sedative-hypnotics (Non-benzodiazepines)

This class of medications causes you to feel sleepy by increasing the normal effects of the brain chemical gamma-aminobutyric acid (GABA). They are more effective and safer for long-term, nightly use than benzodiazepines. However, they may lead to addiction.

Some popular medications in this class are:

• Zolpidem (Ambien)
• Zalepon (Sonata)
• Eszopiclone (Lunesta)

Melatonin receptor agonists

This newer hypnotic reduces alertness by acting on the melatonin receptors in the brain. It’s used for sleep onset problems. The medication has some side-effects, but is not a narcotic. It is not effective for problems in staying asleep.

• Ramelteon (Rozerem)

Benzodiazepines (tranquilizers)

This class of medications works by slowing down the central nervous system to cause drowsiness. They are effective only for a few weeks and may lead to drug-dependence, impairment in memory and movement, and a hangover the next day.

These drugs are now less frequently prescribed than non-benzodiazepines. Some popular medications in this class are:

• Flurazepam (Dalmane) 
• Temazepam (Restoril)
• Estazolam (ProSom)

Other sleep medications

In addition, sedating antidepressants are sometimes prescribed for insomnia. These medications are primarily for the treatment of depression, but have sedating side-effects. Sedating antidepressants have more negative effects than the sedative-hypnotics and are generally best prescribed only for insomnia in the context of depression. Note that all antidepressants carry the risk of serious side-effects. An example is Trazodone (Desyrel).

Older sleep medications are the barbiturates, no longer recommended for insomnia treatment. Barbiturates include Phenobarbital and come with a high risk of overdose, addiction, and abuse.

Tips for using prescription sleep medications

Sleep medications are meant to provide temporary relief from insomnia, not a long-term solution. The safety of long-term use of sleeping pills has not been established. Changes in your sleep habits and sleep environment, plus behavioral therapies, provide a better long-term solution to insomnia.

However, if you do decide to try prescription sleep medications, it is wise to:

• Follow directions closely, starting with a very small dose and increasing gradually, according to the doctor’s schedule. Most sleep medications need to be taken just before or at bedtime, but some may be able to be taken after bedtime, in response to symptoms or awakenings. Speak with your doctor about appropriate usage of the medication he/she prescribed.
• Tell your doctor about other medications you are taking. Some medications may have negative interactions with sleeping pills. Also inform your doctor of any existing or potential medical conditions to avoid serious risks.
• Pay attention to your body, emotions, and actions to determine if any negative side effects are occurring.
• Use the medications intermittently, rather than nightly, in order to decrease the negative effects and to increase the effectiveness when you do use them.
• Avoid drinking alcohol or taking other non-presciption drugs while using sleep medication, as these substances can exacerbate or change the effects of the drug.
• Never drive a car or operate machinery after taking a sleeping pill. Especially when you first start taking a new sleep aid, you may not know how it will affect you, so proceed with caution.
• Ask your doctor for specific instructions for decreasing and/or terminating use.

Related links for sleep medications

Sleep aids and general guidelines

Sleep Aids: All You Ever Wanted to Know...but Were Too Tired to Ask − An overview of insomnia and the sleep aids and medications commonly used to treat it. (National Sleep Foundation)

Taking Sleep Medications for Insomnia guidelines to make sure that you use sleep medications safely and properly (American Academy of Sleep Medicine)

What Are Drug Treatments for Insomnia? − General guidelines on medications for insomnia, as well as natural remedies. (University of Maryland Medical Center)

More on benefits and side effects of sleep aids

Do Drugstores Have the Cure for Your Insomnia? Taking a Closer Look at Common Treatments – An investigative article that looks at various over-the-counter sleep aids, including antihistamines, melatonin, and herbal remedies, and reports on their effectiveness. (American Academy of Sleep Medicine)

Medications – Describes various sleep medications and provides answers to questions on their safety and recommended length of use. (American Insomnia Association)

Experts Discuss Sleep Aids – The American Academy of Sleep Medicine’s position statement on treating insomnia with over-the-counter sleep aids and/or herbal supplements. (PsychCentral.com, commercial site)

Tina de Benedictis, Ph.D, Gina Kemp, M.A., Suzanne Barston and Robert Segal, M.A., contributed to this article. Last modified on: 12/14/07.