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Insomnia (cont.)

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Benzodiazepine, non-benzodiazepine, and antidepressant medications to cure insomnia

The main classes of medications used to treat insomnia are the sedatives and hypnotics, such as the benzodiazepines and the non-benzodiazepine sedatives.

Several medications in the benzodiazepine class have been used successfully for the treatment of insomnia, and the most common ones include:

  • quazepam (Doral),
  • triazolam (Halcion),
  • estazolam (ProSom),
  • temazepam (Restoril),
  • flurazepam (Dalmane), and
  • lorazepam (Ativan).

Another common benzodiazepine, diazepam (Valium), is typically not used to treat insomnia due to its longer sedative effects.

Non-benzodiazepine sedatives are also used commonly for the treatment of insomnia and include most of the newer drugs. Some of the most common ones are:

  • zaleplon (Sonata),
  • zolpidem (Ambien or Ambien CR [note that as of January 1, 2014 the FDA changed the recommended dosage and precautions], Zolpimist, Intermezzo), and
  • eszopiclone (Lunesta).

Some anti-depressants (for example, trazodone [Desyrel], amitriptyline [Elavil, Endep], doxepin [Sinequan, Adapin]) can be used effectively to treat insomnia in patients who also may suffer from depression. Some anti-psychotics have been used to treat insomnia, although their routine use for this purpose is generally not recommended.

Melatonin, Rozerem, and Belsomra for problems sleeping

Melatonin: a chemical released from the brain which induces sleep, has been tried in supplement form for treatment of insomnia as well. It has been generally ineffective in treating common types of insomnia, except in specific situations in patients with known low levels of melatonin. Melatonin may be purchased over-the-counter (OTC without a prescription).

Ramelteon (Rozerem): a newer drug that acts by mimicking the action of melatonin. It has been used effectively in certain groups of patients with the problem.

Suvorexant (Belsomra): is a drug that belongs to a fairly new classification of medications for treating insomnia. It acts by decreasing the activity on orexin receptors in wake system (lateral hypothalamus) of our brain, rather than increasing the activity in the sleep centers of our brain. The medication is an orexin antagonist. It is thought to be generally safe and well tolerated, but some patients may have side effects.

Antihistamines: There also other medications that are not in the sedative or hypnotic classes, which have been used in the treatment of insomnia. Sedative antihistamines, diphenhydramine (Benadryl) have been used as sleep aids because of their sedative effects. However, this is not a recommended use of these or other similar drugs due to many side effects and long-term drowsiness the following day.

A doctor or sleep specialist is the best person to discuss these different medications, and to decide which one may be the best for each specific individual. Many of these drugs have a potential for abuse and addiction and need to be used with caution. Several of these medications can not taken without the supervision of the prescribing doctor.

Can insomnia be cured?

Insomnia overall has a favorable outlook. Many cases of insomnia are related to transient situational stresses and are easily reversed when the situation is resolved. In cases of long-standing (chronic) insomnia, any medical or psychiatric cause needs to be assessed and treated. Medical and non-medical home remedies are available for treating insomnia and are generally successful. Combinations of non-medical and medical therapy are usually the most successful. Medical treatment for insomnia without addressing the underlying cause of a person's insomnia will often result in long-term medication use with no resolution of the underlying cause.

REFERENCES:

American Academy of Sleep Medicine. "Insomnia."
<http://www.aasmnet.org/practiceparameters.aspx?cid=109>

American Academy of Sleep Medicine. "Practice Guidelines."
<http://www.aasmnet.org/practiceguidelines.aspx>

MedscapeReference. Insomnia

Insomnia. In: American Academy of Sleep Medicine. The International Classification of Sleep Disorders. 2nd ed. Westchester, Illinois: American Academy of Sleep Medicine; 2005:1-31.

Past contributing medical author: Siamak T. Nabili, MD, MPH


Medically Reviewed by a Doctor on 4/19/2017

Source: MedicineNet.com
http://www.medicinenet.com/insomnia/article.htm

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