The most common prescription Sleeping aids approved for use in treating insomnia are as follows: benzodiazepines (such as temazepam, estazolam,and others); the newer, non-benzodiasepines (such as zolpidem [Ambien,Ambien CR], Zaleplon [Sonatal], and eszopiclone [Lunesta]; and the melatonin receptor agonist ramelteon (Rozerem).
These three Sleeping aids work best when the individuals who are treated for insomnia are diagnosed by a physician and follow up treatment is regular. It is not uncommon that with these medications, some form of therapy may be needed. For example, Sonata has a one hour duration of action, so it can be used for middle-of-the night awakenings. Giving the relatively level “therapeutic playing field” among the hypnotic sleeping aids, the cost to the patient should be considered when selecting a medication. Of course, the list of approved medications in the patient’s health plan much be considered.
The medications usually have a low incidence of side effects, and a low abuse potential. For example, according to a published study in the American journal of Medicine in 1996 in which they analyzed various outcomes in 170 adult patients with long-standing sleep-disruptive disorders who were treated with nightly benzodiazepine therapy (usually clonazepan) for at least six months, and often for many years. Among these patients, 146 (86 percent found that this therapy completely or substantially controlled their sleep problems, 8 percent had adverse effects (such as morning sedation ) requiring Sleeping aids changes, 2 percent had relapses of alcohol or chemical abuse requiring hospitalization, and 1 percent at times misused their medications. Other less common side effects include morning, “hangover”, dizziness, problems with balance, memory, or confusion.
Zolpidem, zaleplon, and eszopiclone are imidazopyridine medications that interact with a benzodiazepine receptor in the brain. Their advantages are rapid absorption, lack of active metabolites, and low risk for side effects or abuse. Zolpidem has been extensively studied, with an excellent therapeutic profile during nightly use for up to six months, although in our experience it can be used safely on a nightly bsis for well over a year in patients who are carefully followed. The usual dose is 5-10 mg. at bedtime, with doses with doses of 15-20 mg at times being used. Zaleplon is an ultra-short-acting agent that is effective in promptly restoring sleep in patients having problems with nocturnal awakenings. The usual dose is 2 or 3 mg at bedtime.
The following antidepressant agents at times can also be effective in controlling insomnia: doxepin or amitriptyline (10-50+mg), trimipramine (25-100 mg), imipramine (10-75+mg), and trazodone (25-100+mg). Doxepin in particular has clinical research backing its use in insomnia, with the other agents having far less research backing. Also, these agents carry risks of untoward effects.