A Guide To Sleeping Medication

You’ve heard of so many different sleeping medications, it gets confusing. You’re trying to make out what they are; which ones are safe and effective. You want to know your options and how to talk to your doctor intelligently or get one over the counter from the drugstore.

Here’s how you can easily learn that information and have it at your fingertips. Very broadly, just remember 2 key points:

1. There are 4 categories of sleeping medication available
2. There are 3 general guiding principles on how these sleeping medications are picked

4 CATEGORIES OF SLEEPING MEDICATION

1. The “Z” drugs:

They are the newest, most talked about and most expensive class of drugs used today. This class of sleeping medication is the non-benzodiazepines or “Non-Benzos” and sometimes called the ''Z'' drugs. They are popularly used because they achieve comparable efficacy with lesser side effects compared to the older generation of drugs i.e. the benzodiazepines.

-Lunesta (eszopiclone)
-Sonata (zaleplon)
-Ambien (zolpidem)
-Rozerem (ramelteon), the newest kid on the block

However, all of this sleep medication may cause severe allergic reaction, facial swelling and complex sleep-related behaviors such as sleep-driving and preparing and eating food while asleep. In one of these cases a patient woke with a paintbrush in her hand after painting the front door to her house. Another case involved a woman who gained 23 kilograms over seven months while taking zolpidem. “It was only when she was discovered in front of an open refrigerator while asleep that the problem was resolved,” according to the report.

2. The “Benzos”:

Benzodiazepines are the oldest class of sleeping medication and formerly the most commonly used treatment for insomnia. Due to the issues of inappropriate use (abuse), dependence, side effects such as memory or movement impairments, and next-day "hangover", these sleeping medications are now prescribed with greater caution. This explains why the “non-benzos” are today’s favored and first line treatment of insomnia.

- Dalmane (flurazepam)
- Doral (quazepam)
- Halcion (triazolam)
- Prosom (estazolam)
- Restoril (temazepam)

Even so, benzodiazepines remain a viable treatment option as some practitioners feel they offer better value than the newer more expensive non-benzodiazepines. As it is, proprietary or “branded” drugs like Dalmane and Restoril, sell in generic versions for only 30 to 50 cents each.

''We tend to use the old benzodiazepines,'' one medical practitioner explained. ''They appear to be as effective as some of the newer ones, and they're infinitely less expensive.''

3. The Antidepressants

You would have heard of antidepressants being used for their sedative side effects to treat insomnia.
- Desyrel (trazodone)
- Elavil (amitriptyline)
- Sinequan (doxepin)

In fact, the inexpensive antidepressant trazodone is the most commonly prescribed sleep medication for the treatment of insomnia in the United States (NIH conference 2005). Yet, the FDA has not approved it officially for insomnia treatment. This is possibly due to lack of long-term studies. As with all antidepressants, there is an inherent small but significant risk of suicidal thoughts or worsening of depression.

4. The “Over-the-counter” Sleeping Medication

The main ingredient of over-the-counter sleeping medication is an antihistamine. Antihistamines are mainly used to treat allergies. There are 2 types of antihistamine compounds i.e. doxylamine and diphenhydramine. Again, it is their sedative side effects that make you sleepy.

- Unisom (Doxylamine compound)
- Sleepinal (Doxylamine compound)
- Benadryl (Diphenhydramine compound)
- Nytol (Diphenhydramine compound)
- Sominex (Diphenhydramine compound)

It must be noted that other popular brands like Tylenol PM and Advil PM combine the antihistamine with the painkillers acetaminophen and ibuprofen respectively. You may be taking on additional risks with painkillers you don’t need. Generally, while these
OTC sleeping medications can have a mildly positive effect on short-term insomnia, the infamous next-day drowsiness can be common and severe. Not to mention tolerance to the sleep medication can easily develop in just a few days.

3 GENERAL GUIDING PRINCIPLES ON HOW SLEEPING MEDICATION IS USED:

1. To help you fall asleep, the sleeping medications below are used

- All the “Z” or “Non-Benzos” i.e. Lunesta, Rozerem, Sonata, Ambien
- “Benzo” drug i.e. Halcion (triazolam),

2. To help you stay asleep, the sleeping medications below are used
- “Z” drugs i.e. Lunesta and Ambien CR (extended release)
- “Benzo” drugs i.e. Restoril (temazepam) and estazolam (a benzodiazepine derivative)

3. To help you when you can’t sleep and are depressed at the same time, the sleeping medications below are used

- Antidepressants i.e. Pamelor (nortriptyline), Desyrel (trazodone), Elavil (amitriptyline)

LASTLY, here are other facts you should know for a better overall understanding:

- Sleeping medication is usually used for short periods of time (7-10 days, maximum 2 weeks). This is because they may lose their effectiveness over time.

- Existing medical conditions like liver, kidney and heart conditions must be pre-empted. Drug interactions between sleep medication and other medication you are taking for these conditions can be serious and life threatening. Also, impaired organ functions can cause the sleeping medication to accumulate in the body thereby increasing the associated side effects.

- Avoid alcohol. It increases the sedative effects of the pills. Even a small amount of alcohol combined with sleeping medication can make you feel dizzy, confused or faint. Paradoxically, alcohol alone can cause insomnia. Hence, you’ll always be asked whether you’ve any current or past problems with alcohol

- Your mental state (current or prior psychiatric disorders and depression) is also important as dependence on some of the sleeping medications can develop