Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Insomnia facts
- What is insomnia?
- What causes insomnia?
- What situational and stress factors cause insomnia?
- What are the risk factors for insomnia?
- What are the symptoms of insomnia?
- When should I call the doctor about insomnia?
- How is insomnia diagnosed?
- How is insomnia treated?
- What are non-medical treatments for insomnia?
- What is sleep hygiene?
- How can stimulus control help with insomnia?
- What is sleep restriction?
- What medications are used to treat insomnia?
- What is the outlook for insomnia?
- Find a local Sleep Specialist in your town
What medications are used to treat 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).
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 (without a prescription).
Ramelteon (Rozerem), which is an insomnia drug that acts by mimicking the action of melatonin, is a newer drug. It has been used effectively in certain groups of patients with insomnia.
Learn more about: Rozerem
Suvorexant (Belsomra), falls into a newer 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 and has only recently become available. It is thought to be generally safe and well tolerated, but some patients may have side effects.
There are 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.
Learn more about: Benadryl
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.
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. None of these medications may be taken without the supervision of the prescribing physician.
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