14 May Medicines used to treat sleep disorders
When you haven’t slept in days and you have already tried several home remedies, but nothing has worked, the best thing to do is see a specialist who can give you a proper diagnosis and prescribe you suitable medication.
The medication that is usually prescribed to help with sleep disorders can include hypnotic drugs, sedatives or antidepressants. In this article, we have listed the most common medications, along with their advantages and disadvantages.
****Although in some cases, medication can be a suitable option, we always recommend exploring other treatment options before starting any pharmacological treatment.****
Medication for sleep disorders
There are many different types of sleep disorders and many different types of medication to treat each one.
Below is a list of these medicines, but we also recommend that you try combining these with other treatments that can naturally help manage insomnia, narcolepsy and other sleep disorders.
Remember that medication for sleep disorders must be prescribed by a doctor following a full medical examination and taking into account the patient’s medical and family history. Never self-medicate, as this can have serious consequences, which could be even harder to treat than the initial disorder.
Types of medication to treat sleep disorders
The most common and effective type of medicine used to treat insomnia are benzodiazepines (BDZ) and non-benzodiazepines, which are generally much safer and more effective compared to barbituric compounds (which are actually no longer used). Be sure not to confuse the names of the medicines mentioned below!
The following medicines are the most widely prescribed by certified health professionals to treat sleep disorders:
These are Central Nervous System (CNS) depressants. They act by stimulating the main neurotransmitter inhibitor in the central nervous system (GABA-A). They are hypnotics, which help to reduce anxiety, relax the muscles in the body and have the ability to stop seizures.
There are several different types of benzodiazepines that are not just used to treat sleep disorders, but a number of other mental health disorders as well.
Lorazepam and Temazepam are the least harmful types of benzodiazepines used to treat various types of sleep disorders.
- Fewer morning-after residual effects (compared to “Z” sedative-hypnotics)
- Effective for treating occasional insomnia
- Present a lower risk of overdose
- Long-acting benzodiazepines are associated with an increased risk of falling (especially in older people)
- Although they do not cause much discomfort, they have a higher risk of abuse than “Z” sedative-hypnotics
- They can cause dependence if they are taken for longer than 4 weeks
- Can induce alterations in the patient’s sleep architecture
- Can cause coordination problems and clumsiness
- Can cause retrograde amnesia (difficulty remembering what happened right before you fell asleep)
- Residual daytime drowsiness
- Can cause cognitive damage and/or disorders
- Patients can experience withdrawal symptoms
When patients stop taking this drug, they may experience insomnia, anxiety, lack of appetite, altered perceptions, nightmares and reduced memory; withdrawal symptoms can occur anywhere between a few hours to 3 weeks after taking this medication. It is therefore recommended to stop taking benzodiazepines gradually.
Non-benzodiazepine “Z” sedative-hypnotics
These have no chemical relation to BDZ, but their pharmacology and mechanisms of action are similar. They act as hypnotics but without the muscle-relaxant effect; they do not have much effect on anxiety.
Zolpidem (Ambien, Intermezzo), Zaleplon (Sonata) and Eszopiclone (Lunesta) work by inhibiting brain activity.
- These drugs significantly reduce the time it takes to fall asleep, increase the length of sleep and reduce the number of sleep disturbances during the night
- They do not affect sleep architecture
- Zolpidem has a variety of formulations that can be used for many different types of insomnia
- Zaleplon is fast-acting, so it is used when you wake up in the middle of the night
- Eszopiclone is long-acting, so it should be used when patients are planning to sleep for at least 7 hours
- Risk of abuse and dependence
- Can produce tolerance
- Dizziness and coordination problems
- Vivid dreams and parasomnias (sleep disorders where the person experiences abnormal movements, behaviors, emotions, perceptions or dreams)
- Zaleplon can cause problems with hearing, smelling, feeling or seeing (changes in perception of color) things that are not there, as well as photosensitivity
- Should not be taken if the patient: suffers from chronic obstructive pulmonary disease, respiratory insufficiency, serious depression, alcoholism, is pregnant or breastfeeding
Orexin receptor antagonists
Orexin receptors are responsible for wakefulness (orexins are hormones that modulates wakefulness and when they do not communicate properly with the brain, we have trouble sleeping). This type of medication regulates orexin receptors in the brain, helping patients to fall asleep.
Included in this group of medicines are Suvorexant or Belsomra, which were approved in the US in 2014.
- Shown to be effective for falling asleep and prolonging sleep
- Produce fewer side effects than the medicines mentioned above
- Make it easier to fall asleep more quickly and sleep for longer, to promote more restful sleep
- It is a new drug, but so far there have not been any cases of retrograde amnesia
- No significant evidence of abuse potential
- No significant evidence of rebound insomnia
- No significant evidence of withdrawal syndrome four weeks after treatment
- Produces daytime drowsiness
- Has abuse potential (although the risk is lower than that of “Z” sedative-hypnotics and benzodiazepines)
- Should not be used to treat narcolepsy
- Can be expensive
Melatonin receptor antagonists
Melatonin (a naturally occurring hormone in the body, responsible for regulating between sleep and wakefulness) has been a topic of significant research in terms of treating sleep disorders. Although it is very popular for treating insomnia and jet lag, its effectiveness is being questioned within the medical community.
Melatonin is very fast-acting. The higher the dose, the faster it will take effect; meaning that higher doses should be taken closer to the target bedtime. Long-acting medications are more similar to the action of the body’s natural hormone, which is why they are the preferred option.
The most well-known melatonin receptor antagonist is Ramelteon (Rozerem).
- Milder side effects than those produced by “Z” sedative-hypnotics
- Can be used in patients with a greater risk of falling (older people)
- Helps patients fall asleep
- Has a positive effect on the duration and quality of sleep
- Its effects do not last as long as other slow-release drugs (it works for falling asleep but not staying asleep).
- Should not be taken with food (particularly foods with a high fat content)
The use of these drugs will depend on the cause of the insomnia, as their prescription depends on the evaluation made by a certified doctor. They can be used by depressive patients with insomnia and insomnia patients who also show other signs of depression.
As their name suggests, antidepressants are medicines that are usually prescribed to treat depression. However, they also have a sedative effect that can improve sleep and thus can be used to treat people with sleep disorders.
Among the most common antidepressants are Silenor (a form of doxepin), Trazodone and Mirtazapine.
- Silenor is good for staying asleep (not for falling asleep)
- Silenor is administered at a much lower dose to treat sleep disorders than when it is used as an antidepressant, so it does not produce as many side effects as when it is used to treat problems with depression
- Trazodone, at low doses, does not increase the risk of falling
- Silenor is not as effective for falling asleep
- Mirtazapine should be used at low doses, as it can produce adverse effects when combined with other medication
- Be very careful not to confuse Trazodone with Tramadol!
There are also tricyclic antidepressants, such as amitriptyline and imipramine, which can also be used to treat insomnia. However, these should be taken with extreme caution, since their side effects are stronger than those of other antidepressants
Complementary treatments for insomnia
As we mentioned at the beginning of this article, these medicines are usually combined with other treatments, including:
- Cognitive behavioral therapy (CBT): this treatment focuses on identifying and modifying the thoughts and behaviors that are causing you to have trouble sleeping.
- Routines and sleep hygiene: our bodies are already naturally equipped with everything they need to be able to sleep well. However, due to the way our routines have changed, sleep disorders and becoming increasingly common nowadays.
To help combat them, you should try adopting certain habits and routines to help you fall asleep naturally, such as avoiding looking at screens (e.g. your TV or cell phone) or having a warm shower before bed, clearing your mind of stressful thoughts and sticking to a regular sleep schedule. Click here for more useful tips to help you fall asleep.
- Relaxation, meditation and exercise: you can reduce the various symptoms of sleep disorders through certain meditation and relaxation techniques, like yoga. Exercise has also been shown to help treat insomnia and other sleep issues. However, it is not recommended to workout at night, as exercise causes the body to remain active and prevents it from preparing for sleep. Learn about other natural ways to treat sleep disorders here.
Now that you know the pros of cons of common medication for sleep disorders, you are ready to talk to your doctor and make an informed decision about the most suitable treatment for you.
Remember that these medicines should be prescribed by a doctor following a full medical evaluation.
Sleep disorders are extremely common, so why not share this information with your friends and family? You never know who might need it. If you would like to know more about sleep disorders and the best natural home remedies to help you fall asleep, click here.