November 30, 2015
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Sleep Aids And Stimulants (cont.)

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What prescription medicines are there for insomnia?

There are numerous prescription medications options a doctor may prescribe if a person is suffering from short-term or chronic insomnia. Most are not recommended for long-term use.

Medication to treat insomnia includes several classes of drugs;

  • Short-acting sedative-hypnotics (non-benzodiazepines) - these medications slow activity in the brain to allow sleep.
    • zolpidem (Ambien, ZolpiMist)
      • Intermezzo was approved by the FDA in 2011. It is a form of zolpidem, taken sublingually (dissolved under the tongue) and in smaller doses than Ambien.
    • zaleplon (Sonata)
    • eszopiclone (Lunesta)

In 2007, the FDA issued a warning in regard to sedative-hypnotic drugs and their risks, which "...include severe allergic reactions and complex sleep-related behaviors, which may include sleep driving. Sleep driving is defined as driving while not fully awake after ingestion of a sedative-hypnotic product, with no memory of the event." The recommended dosing has recently changed ans is different based on gender and other factors. You should ask your doctor and pharmacist about appropriate levels and warnings.

  • Orexin receptor antagonists – suvorexant (Belsomra) – this is a newer classification of insomnia medication working on orexin receptors in the lateral hypothalamus in the brain.  The drug acts by decreasing activity in the wake centers of the brain and helping patients transition to sleep.  This is in contrast to traditional insomnia medications which attempt to increase activity in the sleep centers of the brain.  The medication is generally thought to be safe an well tolerated but some side weffects may occur.
  • Melatonin receptor agonists - used to help patients who have difficulty falling asleep and it works similarly to melatonin
    • ramelteon (Rozerem): Ramelteon is a medication taken by mouth 30 minutes prior to bedtime. Ramelteon should not be taken if the patient will not be able to sleep for at least 7-8 hours. Insomnia usually improves in 7-10 days.
    • One of the advantages of ramelteon over other prescription sleep medications is the lack of dependence on the medication.
  • Benzodiazepines (tranquilizers) - this class of medication is used to slow down the central nervous system, causing drowsiness. These medications have a high risk of dependence with chronic usage.
    • flurazepam (Dalmane)
    • temazepam (Restoril)
    • estazolam (ProSom)
  • Tricyclic antidepressants: Tricyclic antidepressants are medications work by increasing the amounts of certain natural substances in the brain that are needed for mental balance.
    • doxepin (Silenor): in 2010, this sleep medicine was approved for the use in people who have trouble staying asleep. Silenor may help with sleep maintenance by blocking histamine receptors.

If your doctor recommends prescription sleep medications:

  • Follow all prescribing instructions given by your physician.
  • Tell your doctor any other medications or supplements you take as many can have adverse interactions with sleep medications.
  • Tell your doctor about any pre-existing medical conditions.
  • Note any possible negative side effects (changes in your body, and even your emotions)
  • Do not use the medications nightly unless instructed to do so by a doctor - this can lead to dependence.
  • Avoid drinking alcohol or taking other non-prescription drugs while using sleep medication.
  • Never drive a car or operate machinery after taking a sleeping pill.
Medically Reviewed by a Doctor on 11/20/2015


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