Ask the Expert: Is It Safe to Take Medication to Treat Insomnia?

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Your doctor may prescribe a sleep medication if cognitive behavioral therapy and lifestyle changes don’t improve your sleep quality. Some sleep medications are available over-the-counter (OTC) or as supplements.

Is it safe to take medication to treat insomnia?

The cornerstone of insomnia therapy involves cognitive behavioral therapy (CBT). This therapy provides techniques to help the body relax and develop habits to improve sleep. It’s performed by a medical professional with specialized training.

Medications are typically used as add-on therapy when general sleep hygiene and CBT don’t work because taking any medication comes with risks, especially in older adults.

When considering a sleep medication, it’s important to think about:

  • how long it stays in your body
  • what side effects it may have
  • the level of dependency it may cause

    • Review medications with your doctor. Some may have secondary side effects, such as daytime sleepiness.

    Always take medications as your doctor prescribes. You should have a timeline and goal for when to start, decrease, and stop taking the medication.

    Most people typically improve with CBT alone. But some have persistent insomnia and frequent recurrence. They might require both CBT and medication to get adequate sleep at night.

    What medications are available to treat insomnia?

    Doctors may recommend several medications to treat insomnia.

    Over-the-counter (OTC) medications

  • diphenhydramine (Benadryl)
  • doxylamine (Unisom)

    • Dietary herbals

  • melatonin
  • valerian root
  • magnesium
  • hops from beer
  • chamomile tea
  • CBD

    • Food and Drug Administration (FDA) approved prescription medications

    Prescription insomnia medications fall under several subcategories:

  • non-benzodiazepine agonists:
  • eszopiclone (Lunesta)
  • zaleplon (Sonata)
  • zolpidem (Ambien)
  • traditional benzodiazepines:
  • estazolam (Prosom)
  • flurazepam (Dalmane)
  • quazepam (Doral)
  • temazepam (Restoril)
  • triazolam (Halcion)
  • antihistamines:
  • doxepin (Silenor)
  • melatonin receptor agonists
  • ramelteon (Rozerem)
  • dual orexin receptor agonists (DORAs):
  • lemborexant (Dayvigo)
  • suvorexant (Belsomra)

    • Prescription medications not approved by the FDA

    The following medications have a secondary effect of sleepiness and are sometimes prescribed for insomnia:

  • amitriptyline (Elavil)
  • mirtazapine (Remeron)
  • quetiapine (Seroquel)
  • trazodone (Desyrel)

    • How do sleep medications work?

    Medications to treat insomnia work in a variety of ways.

    OTC medications

    OTC medications, such as Unisom and Benadryl, are available without a prescription at any pharmacy. They’re often used to treat insomnia because of their known side effect of causing drowsiness.

    Medications such as Tylenol PM or Advil PM may help with sleep, but they contain other potentially harmful ingredients.

    Dietary herbals

    The dietary supplement melatonin mimics a hormone that your brain produces in response to darkness. It also helps with the timing of your circadian rhythm with sleep.

    Evidence-based data is significantly lacking on:

  • whether other herbals used to promote sleep actually work
  • how much to take
  • what route to take with them

    • Herbal medications can have harmful consequences on the body.

    Prescription medications

  • Traditional benzodiazepines: activate gamma-aminobutyric acid (GABA), a sleep-inducing neurotransmitter. Healthcare professionals don’t commonly prescribe them for insomnia because of side effects, habit-forming properties, and the need to taper off.
  • Non-benzodiazepine agonists: have replaced traditional benzodiazepines because they target a more specific receptor on GABA for sleep. These medications have fewer habit-forming properties than traditional benzodiazepines but still have side effects to consider.
  • Antihistamines: help with sleep because they block histamine, a neurotransmitter that plays a role in wakefulness. When medication, such as Benadryl, blocks histamine, it removes its stimulation of wakefulness, resulting in drowsiness and sleep.
  • Melatonin receptor agonists: bind to your body’s melatonin receptors in the brain, which play a major role in the signaling pathway for sleep.
  • Dual orexin receptor antagonists (DORAs): inhibit the effect of orexin, a neurotransmitter in the brain involved in keeping you awake. Blocking it can help you fall asleep more easily.
  • Prescription medications not approved by the FDA: include antidepressants, antipsychotics, and mood stabilizers. A healthcare professional may prescribe them because they have a secondary effect of drowsiness or sleepiness.

    • What are the potential risks or side effects of OTC sleep medications?

    When taken over a long period of time or in high volume, OTC sleep medications can potentially cause significant organ damage.

    Some medications may interact with other medications you take or foods you consume. Residual sleepiness, drowsiness, dizziness, and nausea are common side effects of most OTC medications.

    Antihistamines block the effect of another neurotransmitter known as acetylcholine. A lack of acetylcholine is known to play a role in Alzheimer’s disease. Chronic Benadryl use may be associated with dementia.

    Taking any of these medications with alcohol can be very dangerous.

    When might I need a prescription sleep medication?

    Finding a quick fix with medications is not often the first choice for treating insomnia.

    Many people may have trouble sleeping at some point in their lives. Stress can sometimes keep you from sleeping well for days or weeks but often improves in under a month without treatment.

    Sometimes difficulty sleeping can become a long-term problem, especially if you continue to worry about not sleeping well.

    Chronic insomnia is characterized by difficulty sleeping 3 times per week for more than 3 months. It can significantly affect your quality of life.

    Your doctor may consider using prescription medications if you have a long term, recurring sleep issue that significantly affects your quality of life and CBT cannot manage.

    Insomnia is often associated with other health conditions, such as depression or chronic pain. When these conditions occur together, it’s very important to treat the insomnia and the underlying disorder with medications such as antidepressants or analgesics if necessary.

    After addressing any underlying medical conditions, your doctor might look to FDA-approved medications to treat insomnia. Medication choice is based upon:

  • complaints of sleep onset
  • sleep maintenance
  • early morning awakenings

    • No medication should be intended for permanent use. You should always have regular follow-ups with your doctor to reevaluate the need for medication.

    Some people, however, may require lifelong therapy and treatment to achieve adequate, consistent sleep.

    What are the potential risks or side effects of prescription sleep medications?

    Almost all prescription medications can cause mild side effects, such as:

  • drowsiness
  • nausea
  • dizziness
  • fatigue
  • headache

    • All benzodiazepines can be habit-forming. They may have amnesic (memory loss) and hypnotic properties. Non-benzodiazepine agonists are commonly used as first-line prescription medications.

    Prescription medications not FDA-approved for insomnia may have higher risks because they’re used for other psychiatric and behavioral concerns. They may cause:

  • altered behavior
  • a change in sleep patterns
  • hallucinations

    • When it comes to prescription medications, it’s always important to weigh benefits versus risks.

    What’s the safest prescription sleep medication?

    No medication is 100 percent safe. All medications should be prescribed by a doctor who’s familiar with dosing and side effects.

    Typically, medications that have a shorter duration of action (or stay in your body for a shorter amount of time) are preferred but tend to be more habit-forming.

    The hardest type of insomnia to treat is early morning awakenings, which require medications with a long half-life, so they remain in the body all night. But long-acting medications may cause “sleep drunkenness” or sleep inertia the following day.

    Are sleep medications habit-forming? Will I ever be able to stop taking my medication once I start?

    Sleep medications can be habit-forming, especially benzodiazepines. With any medication, less is always preferred. You must always watch for side effects.

    Coming off medication once it starts to work can be hard. That’s why it’s important to regularly follow up with your doctor to have a strategic plan to help you sleep well at night in a healthy way.

    Gradually weaning off insomnia medication is almost always preferred. Some medications may have rebound side effects, including insomnia and seizures.

    With proper motivation and guidance, most people can manage their insomnia with minimal medication support.

    Why might I not be able to take sleep medication?

    Always consider your current medications for possible drug interactions. Look at the ingredients and make sure you are not allergic to any of them.

    Any medications that can make you drowsy should typically not be taken when drinking or driving, and older adults should avoid them.

    How can I take sleep medication safely?

  • Avoid alcohol.
  • Follow prescriptions.
  • Follow up with your doctor regularly.
  • Have an endpoint for medications.
  • Exercise.
  • Eat a balanced diet.

    • Raj Dasgupta MD, FACP, FCCP, FAASM, is a pulmonary, critical care, and sleep medicine specialist and a medical advisor for Healthline. He practices at the University of Southern California, where he is an associate professor of clinical medicine, assistant program director of the Internal Medicine Residency Program, and the associate program director of the Sleep Medicine Fellowship. Dr. Dasgupta is an active clinical researcher and has been teaching around the world for more than 18 years.

    Posted : 2024-09-30 09:08

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