How to Choose a Sleeping Pill
Best Sleep Aids for Insomnia and Other Types of Sleep Disorders
Jan 15, 2009
Not all problems with sleep are the same, and neither are the medications used in their treatment. Some work better for those who can't fall asleep, others for those who have poor quality of sleep due to other medical problems. Most of the sleep aids discussed here are prescription drugs, so you have to ask your doctor about them.
Herbs and Supplements
Herbs and supplements generally work the best for mild to moderate sleeping problems. However melatonin (OTC in most countries) can sometimes cure even an hardcore insomniac. If the effect isn't long-lasting enough, a slow-release form can be tried. Melatonin can also relieve migraine and IBS.
Inositol and ashwagandha can also be very helpful for those who tend wake up at night and can't fall asleep again. Side effects are rare and like melatonin, they do not form tolerance.
Sedatives
Benzodiazepines like diazepam (Valium) are popular sleep aids. Their half-lives vary widely, so some are only useful for problems with sleep initiation, but others last throughout the night. The problem is that they tend to form tolerance and dependency, which is why they are usually only recommended as a temporary treatment.
The "Z drugs" are benzodiazepine derivatives that are thought to cause fewer problems with dependency. Zaleplon (Sonata) has the shortest duration of action, only about an hour, while zolpidem (Ambien) lasts for 2-3 hours. Zopiclone (Imovane) and eszopiclone (Lunesta) work longer, about six hours. Zaleplon often causes an unpleasant taste in the mouth.
Psychiatric drugs
Many antidepressants are very sedative for some yet cause insomnia in others. Tricyclic antidepressants are rarely used in the treatment of depression any more, but they are often utilized as sleep aids, especially in chronic pain. Weight gain and morning drowsiness are common side effects.
The most sedative newer antidepressants are considered to be mirtazapine (Remeron) and trazodone (Desyrel). Mirtazapine is unfortunately also infamous for causing weight gain by increasing appetite. It can also worsen restless legs syndrome (RLS).
Antipsychotic (neuroleptic) drugs tend to be very sedative and are used for sleeping problems. In many countries quetiapine (Seroquel) is used more often as a sleep aid than for actual psychosis. Sometimes olanzapine (Zyprexa) and risperidone (Risperdal) are prescribed. This class of drugs can cause fairly severe side effects, so it should be reserved for treatment of refractory cases.
Anticonvulsants
Many anticonvulsants (epilepsy drugs) such as gabapentin (Neurontin) and pregabalin (Lyrica) can be used to help sleep, even if they are not particularly sedative. They are especially useful for those who complain about poor quality of sleep and those suffering from chronic pain or restless legs.
Antihistamines
Diphenhydramine (Benadryl) and doxylamine (Unisom) are very effective sedatives for many people. In one study doxylamine worked even better than phenobarbital, a heavy-duty hypnotic drug rarely used any more. Hydroxyzine (Atarax) is another popular choice only available on prescription. These drugs can also help pain and urinary frequency.
The biggest problem with antihistamines is that they often cause day-time drowsiness. This can often be avoided by taking a smaller dose. Some people only take small pieces of Atarax tablets for sleep.
Muscle Relaxants
Muscle relaxants tend to be quite sedative. They are often prescribed for those with muscle pain and headaches. Cyclobenzaprine (Flexeril), baclofen (Lioresal), orphenadrine (Norflex) and tizanidine (Zanaflex) all have different modes of action, so their effects and side effects also vary. They can cause morning grogginess and dry mouth.
Other Options
Ramelteon (Rozerem) is a melatonin agonist (it acts on the melatonin receptors). There is no evidence showing that it is in any way more useful or better tolerated than melatonin itself.
Sodium oxybate (Xyrem) is officially only indicated for narcolepsy, but it is also an highly effective sleep aid with few side effects. Sadly it is also extremely expensive.
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