How to Treat Insomnia: 7 Common Medication Options
In last week’s episode, House Call Doctor discussed the top 10 tips for treating insomnia without the use of medications. Today, let’s learn about the 7 most common over-the-counter and prescription medications doctors dispense to help you catch your Z’s.
In last week’s episode, How to Treat Insomnia: 10 Medication-Free Tips, I discussed the 8 most common potential causes of insomnia. These include Restless Legs Syndrome, sleep apnea, certain medications, other medical conditions, and so forth.
Be sure to check out that episode to learn about the conditions that can interfere with a good night’s sleep. I also discussed my top 10 tips to treat your insomnia without medication.
However, if you and your doctor have ruled out various health conditions that can be causing or exacerbating your insomnia, if ou’ve attempted at least a few relaxation techniques at bedtime, and you’ve truly implemented the changes discussed in my prior episode but are still having difficulty functioning during the daytime as a result of your lack of sleep, then it may be time to consider medication treatment options.
But which ones? There are numerous options and you may need some help deciding. Let’s compare and contrast them today so you can be armed with as much information as possible before your next doctor’s appointment.
Sponsor: This episode is brought to you by the audiobook edition of Resistant by Michael Palmer. In this heart-stopping medical thriller, Dr. Lou Welcome is faced with a serious epidemic and the sinister group behind it. Listen to an excerpt at www.macmillanaudio.com/ResistantAudio.
Before we begin, it’s important to note that many of these sleep aids are habit forming. And what’s more, even taking over-the-counter drugs or those without an inherent addictive potential can still interfere with your body and brain’s natural sleep-wake cycles and become habit forming in and of themselves.
For instance, taking Benadryl at night may not be “addicting” per se, but having to train your body and brain to rely on taking a drug to sleep every single night can still be habit forming. It may seem “easier” to just pop a pill every night since that really takes little effort in comparison to actively making lifestyle and behavioral changes, but you may be cheating yourself out of a healthier mind and body in the long run.
7 Insomnia Medication Treatment Options
Having said that, let’s move on and learn about 7 of the most commonly used drugs to treat insomnia available on the market in the United States:
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Antihistamines: Diphenhydramine (generic for Benadryl) is a drug that blocks histamine, a chemical that plays a role in our immune system during allergic reactions. As a side effect, it tends to cause drowsiness and is a common drug patients use to treat insomnia. It’s also over-the-counter and the main ingredient in the over-the-counter drugs marketed for treating insomnia – which means it doesn’t require the time, cost, and effort it takes to visit your doctor. However, it can cause some undesirable side effects, such as residual drowsiness in the morning, blurry vision, dry mouth, and problems with urination (most especially in the elderly). -
Melatonin: This is an over-the-counter dietary supplement that is not FDA approved and should be used with caution. Melatonin is a hormone in our bodies that regulates our circadian rhythms – our innate sleep/wake schedules. Studies show a possible benefit in a small subset of insomniacs (typically those who are awake at nights and asleep during the days, referred to as “shift work” insomnia), but is recommended for no longer than 3 months.
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Ramelteon: This is a prescription drug that is approved in the U.S. (not currently in Europe) to treat insomnia by working on the melatonin system. Side effects are more tolerable and it is not shown to be habit-forming. Since it’s filtered through the liver, caution is advised in those with liver disease. Its main drawback is cost.
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Doxepin: This is the one antidepressant that is currently FDA approved for insomnia treatment. The benefit: like Ramelteon it’s not habit-forming. And if you suffer from depression as well, then you can tackle both medical conditions with the same pill.
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Trazodone: Trazodone is another antidepressant that is no longer used as a first-line drug for depression due its main side effect…drowsiness. Therefore, it is now more commonly prescribed as off-label use for insomnia, again because of its non-habit-forming nature. Also, it may be more useful if there is also depression present alongside the insomnia. -
Benzodiazepines: This is an old group of drugs that was initially created as a tranquilizer for anxiety and has also been used for the treatment of insomnia. Examples include lorazepam and tempazepam. However, they are highly habit-forming and not recommended for long-term treatment or frequent use for insomnia.
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Zolpidem, zaleplon, and eszopiclone: A commonly prescribed drug that works by binding to the same receptors in the brain as the benzodiazepines and mimicking its effects, and therefore, can also be habit-forming. There have been reports of hallucinations, sleep walking, and increased risk of pneumonia and other infections in those who routinely take this drug. If using this class of drugs, you should opt for the lowest possible dose and with the least frequency as possible.
Antihistamines: Diphenhydramine (generic for Benadryl) is a drug that blocks histamine, a chemical that plays a role in our immune system during allergic reactions. As a side effect, it tends to cause drowsiness and is a common drug patients use to treat insomnia. It’s also over-the-counter and the main ingredient in the over-the-counter drugs marketed for treating insomnia – which means it doesn’t require the time, cost, and effort it takes to visit your doctor. However, it can cause some undesirable side effects, such as residual drowsiness in the morning, blurry vision, dry mouth, and problems with urination (most especially in the elderly).
Trazodone: Trazodone is another antidepressant that is no longer used as a first-line drug for depression due its main side effect…drowsiness. Therefore, it is now more commonly prescribed as off-label use for insomnia, again because of its non-habit-forming nature. Also, it may be more useful if there is also depression present alongside the insomnia.Insomnia Precautions
There are 3 important points to keep in mind when being treated for insomnia:
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Elderly: Many of these drugs are considered unsafe for people aged 65 and older, as they tend to cause over-sedation and place patients at an increased risk of falls, hip fractures, delirium, confusion, memory loss, and overdose. This is because as we age our bodies tend to metabolize drugs less efficiently and the effects of the metabolites tend to linger much longer. Make sure to review this list with your doctor to see what is the safest solution for you. -
What to avoid: In addition, please never drink alcohol when taking medication for your insomnia. Also, don’t combine insomnia medication with other sedating drugs and/or drive when using these medications, whether over-the-counter or not.
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Sleep apnea: if you suffer from sleep apnea, be careful when selecting a sleep aid as it can worsen your condition.
Elderly: Many of these drugs are considered unsafe for people aged 65 and older, as they tend to cause over-sedation and place patients at an increased risk of falls, hip fractures, delirium, confusion, memory loss, and overdose. This is because as we age our bodies tend to metabolize drugs less efficiently and the effects of the metabolites tend to linger much longer. Make sure to review this list with your doctor to see what is the safest solution for you.If you still are struggling with insomnia, one option is to ask your doctor for a referral to a sleep disorder clinic with a sleep specialist who can monitor your sleep cycle and suggest potential treatments.
Share your insomnia ideas and learn more quick and dirty tips with us on the House Call Doctor’s Facebook and Twitter pages! You can even find me on Pinterest!
Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.
Young woman suffering from insomnia image courtesy of Shutterstock.
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About the Author
Dr. Sanaz Majd is a board-certified Family Medicine physician who graduated from Drexel University College of Medicine in Philadelphia. Her special interests are women’s health and patient education.
