Treating Insomnia with Medications
The Food and Drug Administration (FDA) has approved certain
medications for the treatment of insomnia. These are called hypnotic
medications or sleep medications. Below is a brief discussion of
medications that are commonly used for sleep. The discussion is
organized by classes of medication.
One class of sleep medication is called benzodiazepines. These
medications are older and have a higher potential for dependency. The
following five medications, listed in alphabetical order, are approved
by the FDA for the treatment of insomnia:
- Estazolam
- Flurazepam
- Quazepam
- Temazepam
- Triazolam
Other benzodiazepine medications approved by the FDA for the
treatment of anxiety, such as Lorazepam, Clonazepam, and Alprazolam,
are sometimes prescribed for insomnia as well. Benzodiazepines are
generally recommended for short-term use because tolerance and
dependence can develop. In addition, some medications in this class
can produce a "hangover" or grogginess the next day.
For these reasons, newer sleep medications have been developed and
approved by the FDA. Most of these newer medications work on the
benzodiazepine receptors in the brain, but do it more selectively than
the medications in the benzodiazepine class. Therefore, these newer
sleep medications are safer and have lower potential for dependence
and fewer side effects. They're called
"non-benzodiazepines", a confusing name given that they
still operate by acting on the benzodiazepine receptors. The
"non-benzodiazepines" are:
Some people experience grogginess in the morning even with sleep
medications from this newer class. This happens because people differ
in how they metabolize the medications. Grogginess in the morning
occurs when a sleep medication is metabolized slowly, and it's still
active upon waking up in the morning. Because of their safety profile
and their lower potential for dependence, some medications in this
class are approved by the FDA for continuous long-term use.
Ramelteon is another new sleep medication. It has a very different
mechanism of action. It affects the melatonin receptor in the brain.
Sometimes doctors prescribe a medication that is sedating even
though it was not specifically developed to help with sleep. For
example, a sedating antidepressant medication is often prescribed to
help with insomnia. The most common antidepressants prescribed for
sleep are Trazodone, Doxepine, and Elavil. These medications are
usually prescribed at doses that are lower than what is required for
the treatment of depression and they do not lead to tolerance or drug dependence.
Some people use over-the-counter medications, which usually contain
antihistamines, or natural remedies for insomnia. These remedies
include herbs, such as valerian, and supplements, such as melatonin
and L-tryptophan. The FDA does not regulate herbs and supplements.
This means that their dose and purity are not monitored.
Discontinuing Sleep Medications
It is not necessary to discontinue sleep medication in order to
benefit from CBTI. However, individuals who have used sleep
medications for a long period of time and wish to discontinue need to
do so gradually and under the supervision of a physician. Most newer
sleep medications don't cause physical dependence but they can cause
psychological dependence. An abrupt discontinuation of a sleep
medication can cause a very fitful sleep on the first night or two
after the discontinuation. The fitful night is often caused by the
discontinuation itself and usually does not reflect the underlying
insomnia. The bad nights caused by withdrawal lead many people to
promptly resume use of the sleep medications. The alternative is to
slowly reduce the dose over a period of time (e.g. 25% reduction per
week). A small reduction in dose rarely produces noticeable difference
in sleep quality. The small steps add up and before long, you can
discontinue medications altogether.
* Replicated with permission from Google Knol 2012
