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The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

If you have insomnia, medication may be prescribed to help you sleep. Medication should be used only in combination with good sleep practices and/or behavioral changes. In general, sleep-promoting medications should be reserved for short term or occasional use. Studies have shown that the best therapies for lasting improvement in sleep involve the use of behavioral changes and techniques learned from cognitive behavioral therapy. Consult with your doctor before taking over-the-counter medications to make sure they will not interfere with sleep or interact with other medications you take.

Prescription Medications

Benzodiazepine Hypnotics

  • Flurazepam (Dalmane)
  • Triazolam (Halcion)
  • Estazolam (ProSom)
  • Temazepam (Restoril)

Nonbenzodiazepine Hypnotics

  • Zaleplon (Sonata)
  • Zolpidem (Ambien)
  • Eszopiclone (Lunesta)

Melatonin Receptor Agonist

  • Ramelteon (Rozerem)

Sedating antidepressants

  • Amitriptyline (Elavil)
  • Doxepin (Sinequan)
  • Trimipramine (Surmontil)
  • Nefazodone
  • Trazodone (Desyrel)
  • Mirtazapine (Remeron)
Over-the-Counter Medications

Antihistamines

  • Diphenhydramine (Benadryl)
  • Doxylamine (Unisom)
Prescription Medications
Benzodiazepine Hypnotics

Common names include:

  • Flurazepam (Dalmane)
  • Triazolam (Halcion)
  • Estazolam (ProSom)
  • Temazepam (Restoril)

Hypnotics, or sedatives, are drugs that cause relaxation and help induce and maintain sleep. They affect chemicals in the brain that may be out of balance and causing the insomnia. These drugs are for short-term use. In any situation where long-term use is required, use should be closely monitored by your doctor. These drugs can react with other drugs you may be taking. Before starting a benzodiazepine hypnotic, tell your doctor about any and all drugs, vitamins, herbs, and supplements you are taking. Do not take any medications unless your doctor approves them.

Before using these drugs, tell your doctor if you have any of these conditions:

These medications will make you sleepy and perhaps lightheaded. When taking one of these drugs, use the following guidelines:

  • Do not drive, operate machinery, or do any hazardous activities.
  • Take the medication just before going to bed.
  • Do not drink alcohol while taking hypnotics.
  • Do not take this medication unless you are able to get adequate rest before you must become active again.
  • Do not stop taking the drug suddenly if you have been taking it for several days or longer.

Possible side effects include:

  • Allergic reaction (swelling of the face or mouth, difficulty breathing, rash)
  • Hallucinations, strange behavior, or severe confusion
  • Suicidal thoughts
  • Changes in your vision
  • Drowsiness, lightheadedness, or clumsiness
  • Amnesia (loss of memory)
  • Cognitive slowing
  • Depression
  • Fatigue
  • Nausea, vomiting, diarrhea , or constipation
  • Vivid dreams
  • Headache
  • Unpleasant taste
  • Rebound insomnia when the medication is suddenly stopped
Nonbenzodiazepine Hypnotics

Common names include:

  • Zaleplon (Sonata)
  • Zolpidem (Ambien)
  • Eszopiclone (Lunesta)

Nonbenzodiazepine hypnotics are structurally different than benzodiazepines hypnotics. They are most useful for inducing sleep. Before starting a nonbenzodiazepine hypnotic, tell your doctor about any and all drugs (including herbs and natural supplements) you are taking. Do not take any medications unless your doctor approves them.

Before using these drugs, tell your doctor if you have any of these conditions:

These medications will make you sleepy and perhaps lightheaded. When taking one of these drugs, use the following guidelines:

  • Do not drive, operate machinery, or do any hazardous activities.
  • Take the medication just before going to bed.
  • Do not drink alcohol while taking hypnotics.
  • Do not take this medication unless you are able to get adequate rest before you must become active again.
  • Do not stop taking the drug suddenly if you have been taking it for several days or longer.

Possible side effects include:

  • Allergic reaction (swelling of the face or mouth, difficulty breathing, rash)
  • Drowsiness, lightheadedness, or clumsiness
  • Hallucinations, strange behavior, or severe confusion
  • Headache
  • Diarrhea
  • Amnesia
  • Worsening of depression
  • Rebound insomnia when the medication is suddenly stopped
Melatonin Receptor Agonist

Common name is Ramelteon (Rozerem)

Ramelteon binds to specific melatonin receptors to induce sleep. Unlike other hypnotics, Ramelteon has not shown any potential for dependence or abuse. Because of this, Ramelteon can be used as long-term therapy for insomnia. Before starting a melatonin receptor hypnotic, tell your doctor about any and all drugs (including herbs and natural supplements) you are taking. Do not take any medications unless your doctor approves them.

Before using these drugs, tell your doctor if you have any of these conditions:

  • Moderate or severe liver disease
  • History of alcohol addiction
  • Sleep apnea
  • Take fluvoxamine for obsessive-compulsive or social anxiety disorders
  • Presently are pregnant or are trying to become pregnant

When taking one of these drugs, use the following guidelines:

  • Do not drive, operate machinery, or do any hazardous activities.
  • Take the medication just before going to bed.
  • Do not take with high-fat or heavy meals.
  • Do not drink alcohol while taking hypnotics.
  • Do not take this medication unless you are able to get adequate rest before you must become active again.

Possible side effects include:

  • Allergic reaction
  • Drowsiness, lightheadedness, or clumsiness
  • Headache
  • Fatigue
  • Behavioral changes, including worsening of depression
  • Residual effects from previous night's dosing, such as memory problems and irritation
Sedating Antidepressants

Common names include:

  • Amitriptyline (Elavil)
  • Doxepin (Sinequan)
  • Trimipramine (Surmontil)
  • Nefazodone
  • Trazodone (Desyrel)
  • Mirtazapine (Remeron)

Sedating antidepressants work by treating the underlying depression that may be the cause of the insomnia, while at the same time having a sedative effect. While there are many medications for depression, sedating antidepressants may be helpful for people who have both insomnia and depression.

Before starting an antidepressant, tell your doctor about any and all drugs (including herbs and natural supplements) you are taking. Do not take any medications unless your doctor approves them.

Before using these drugs, tell your doctor if you have any of these conditions:

  • Any drug allergies
  • Liver disease
  • Kidney disease
  • Asthma
  • Glaucoma , or pressure inside the eye
  • Diabetes
  • Enlarged prostate, bladder problems, or difficulty urinating
  • Thyroid disease
  • High or low blood pressure or any heart problems
  • Stomach or intestinal problems
  • Pregnancy or breastfeeding
  • Manic-depressive disorder
  • Blood problems
  • Personal or family history of heart arrhythmias

Take these medications with a full glass of water. Some of these medications may take four weeks or more before you feel its full therapeutic effect.

Possible side effects include:

  • Allergic reaction (swelling of the face or mouth, difficulty breathing, rash)
  • Seizures
  • Fast or irregular heart beat
  • Heart attack
  • High blood pressure
  • Painful or inappropriate erections (trazadone)
  • Dry mouth and eyes
  • Mild tremor or agitation
  • Difficulty urinating
  • Fever, with muscle stiffness or weakness
  • Drowsiness, lightheadedness, or clumsiness
  • Nausea or constipation
Over-the-Counter Medications
Antihistamine

Common medications include:

  • Diphenhydramine (Benadryl)
  • Doxylamine (Unisom)

An antihistamine is a medication that blocks an allergic reaction in the body. Because one of its side effects is drowsiness, it is sometimes used to induce sleep. This and any other over-the-counter sleep aid should be taken only with the approval of your doctor. It can be taken with or without food, and with a full glass of water. These drugs can react with other drugs you may be taking. Before taking an antihistamine, tell your doctor about any drugs you are taking.

Before using these drugs, tell your doctor if you have any of these conditions:

Possible side effects include:

  • Dry mouth
  • Sleepiness, fatigue, or lightheadedness
  • Headache
  • Difficulty urinating
  • Constipation
  • Blurred vision
  • Delirium
Special Considerations

If you are taking medications, follow these general guidelines:

  • Take your medication as directed. Do not change the amount or the schedule.
  • Know what the results and side effects. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medication, herbs, and supplements.
When to Contact Your Doctor

Hypnotics and sedating antidepressants can have side effects. Call your doctor right away if you experience:

  • Fast or irregular heart beat
  • Chest pain or pressure
  • Trouble breathing
  • High blood pressure
  • Difficulty urinating

Many of these medications need to be tapered off when stopping them. Stopping your medication abruptly can lead to “rebound insomnia,” which worsens your condition. Talk your doctor before stopping your medication.

References:

Cagnacci A, Arangino S, Renzi A, et al. Influence of melatonin administration on glucose tolerance and insulin sensitivity of postmenopausal women. Clin Endocrinol (Oxford). 2001;54:339-346.

FDA requests label change for all sleep disorder drug products. FDA News . March 14, 2007. Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm108868.htm . Accessed May 6, 2007.

Fraschini F, Cesarani A, Alpini D, et al. Melatonin influences human balance. Biol Signals Recept . 1999;8:111-119.

Graw P, Werth E, Krauchi K, et al. Early morning melatonin administration impairs psychomotor vigilance. Behav Brain Res . 2001;121:167-172.

Insomnia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated April 11, 2013. Accessed May 15, 2013.

Insomnia. Quick Answers to Medical Diagnosis and Therapy. Access Medicine website. Available at: http://accessmedicine.com/content.aspx?aid=3267380 .

Melatonin. EBSCO Natural and Alternative Treatments website. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthlibrary . Updated July 25, 2012. Accessed May 15, 2013.

Morin C, Vallieres A, Guay B, et al. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized, controlled trial. JAMA . 2009;301(19):2005-2015.

Morin AK, Jarvis CI, Lynch AM. Therapeutic options for sleep-maintenance and sleep-onset insomnia. Pharmacotherapy . 2007;27:89-110.

Nave R, Iani C, Herer P, et al. Residual effects of daytime administration of melatonin on performance relevant to flight. Behav Brain Res . 2002;131:87-95.

Ramelteon. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated January 18, 2013. Accessed May 15, 2013.

Silber MH. Chronic insomnia. N Engl J Med . 2005;353:803-810.

Sivertsen B, Omvik S, Pallesen S, et al. Cognitive behavioral therapy versus zopiclone for treatment of chronic primary insomnia in older adults: a randomized, controlled trial. JAMA . 2006;295(24):2851-2858.

Sleep aids and insomnia. National Sleep Foundation website. Available at: http://www.sleepfoundation.org/article/sleep-related-problems/sleep-aids-and-insomnia . Accessed May 15, 2013.

Sutherland ER, Ellison MC, Kraft M, et al. Elevated serum melatonin is associated with the nocturnal worsening of asthma. J Allergy Clin Immunol . 2003;112:513-517.

Zolpidem. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated January 18, 2013. Accessed May 15, 2013.

2/18/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry . 2010;71(10):1259-1272.



Last reviewed May 2013 by Brian Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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