Medicines such as as temazepam (Restoril®), zolpidem (Ambien®), eszopiclone (Lunesta®), zaleplon (Sonata®), and ramelteon (Rozerem®) are often used to treat insomnia. They all work on the same set of receptors in the brain to induce sedation. These drugs are helpful for short-term sleep problems caused by jet lag or acute stress. They are often prescribed for some people with chronic insomnia, too. Most sleep medicines are classified as controlled substances because of the potential for abuse, although this risk is thought to be lower with the newer medicines.
Different medicines stay in the body for different amounts of time. Short-acting medicines (such as Sonata® or Rozerem®) are used for people who have trouble falling asleep. For people who can't fall asleep quickly and wake up often, intermediate-acting medicines (such as Ambien®) may be helpful. People who wake up too early may be helped by a long-acting medicine (such as Lunesta® and Ambien CR®). People taking sedating medicines should keep in mind that they cause side effects:
- Long-acting medicines may cause sleepiness the next day. This may be more noticeable among the elderly. Accidents and falls due to grogginess may injure the elderly.
- Caution should be used when operating motor vehicles or doing other tasks that require alertness.
- Insomnia may develop again if medicines are stopped quickly. Talk to your doctor before you stop taking a medicine.
- Tolerance to the medicine may develop with long-term use of certain medications.
- Pregnant women and breast-feeding mothers should avoid these medicines.
- Doses may need to be changed in people with liver or kidney problems.
- Some medicines may suppress breathing and so may not be appropriate for those with sleep apnea or a chronic lung disorder.
Depression and insomnia are often linked. Indeed, insomnia is a common symptom of depression, often the first to appear.
Many antidepressants have the side effect of drowsiness. Further, those who are depressed may find that these antidepressants improve their mood as well as their sleep. Only doxepin (Silenor®) has received FDA approval for the treatment of sleep maintenance insomnia. No other antidepressants are approved by the Food and Drug Administration for the treatment of insomnia.