Sleep Medications

Medication Brand names Nefazodone Serzone Trazodone Desyrel, Trazon, Trialodine Amitriptyllne Elavil Nonprescription Drugs Nonprescription sleeping aids can leave people feeling drowsy the next day and may not always be effective at providing restful sleep. But they are often recommended as the first line of treatment for short-term insomnia because they are not addictive and a fatal overdose is extremely rare. These include the following: AntihistaminesThere are many antihistamines available over-the-counter. Note: Only the older antihistamines are effective for this purpose. The newer antihistamines, such as Claritin, do not cause drowsiness. Pain relieversThese drugs are useful when insomnia is caused by minor pain. They do not cause daytime sleepiness. Acetaminophen Nonsteroidal anti-inflammatory agents (NSAIDs) The information below relates to hypnotics, unless stated otherwise. What These Medications Are Prescribed For To promote sleep in someone who has insomnia, especially in these cases:

Sleep difficulties cause problems in accomplishing daily activitiesBehavioral approaches have proven ineffectiveAs an interim measure until behavioral therapy fully takes effect Insomnia occurs in association with: Medical condition (eg, premenstrual syndrome)Psychological condition (eg, anxiety)Temporary changes in circadian rhythms (internal body clock), such as jet lag or shift work Hypnotics can help to do the following: Shorten the time it takes to fall asleepIncrease total sleep timeDecrease the number of awakenings during sleep How These Medications Work The BzRA drugs work by enhancing the effect of a brain chemical responsible for reducing neuron excitability. Antidepressants may cause immediate drowsiness as well as alter brain chemistry in such a way as to improve sleep. Antihistamines of the older type cause immediate drowsiness. Precautions While Using These Medications Avoid overuse and dependence. Benzodiazepines may become less effective over time, requiring higher doses to produce effects. This can lead to dependence, particularly for the longer-acting formulations. This does not seem to be as much of a problem for the non-benzodiazepine drugs. Antidepressants and antihistamines present a very low risk for dependency.

Don't stop suddenly. When you are discontinuing regular use of a prescription sleep aid, your doctor may gradually lower your dose. Stopping abruptly can cause withdrawal. Mild withdrawal following discontinuation of BzRAs is common. The usual symptom is several nights of poor sleep. More serious withdrawal may occur with higher doses of benzodiazepines and may include the following symptoms: AnxietyIrritabilityDepressionInsomniaSweatingVomitingDiarrheaBlurred visionImpaired memory and concentrationTrouble walkingTremorsMuscle and abdominal crampsDecreased appetiteHallucinations or seizures (in severe cases) Do not combine with certain substances. Be sure to tell your doctor about all of the medications, both prescription, nonprescription, and herbal supplements that you take. Hypnotics can have potentially dangerous interactions when combined with certain other substances, such as the following: Central nervous system depressants, including: Alcohol Anesthetics, including dental anesthetics Anticonvulsants (barbiturates, other benzodiazepines, hydantoins, succinimide, and others) Antidepressants (MAO inhibitors, tricyclics, fluoxetine [Prozac], fluvoxamine [Luvox], paroxetine [Paxil], sertraline [Zoloft], trazodone, venlafaxine [Effexor], Nefazodone [Serzone]) Lithium Narcotic analgesics for pain relief and for surgery and obstetricsSedatives Antipsychotic tranquilizing agents (phenothiazine, clozapine, haloperidol, loxapine, molindone, pimozide, risperidone, thioxanthenes) Cimetidine (Tagamet) Fluconazole (Diflucan) Itraconazole (Sporanox) Ketoconazole (Nizoral)

Practice good sleep habits. Due to the risks of overuse and withdrawal, sleep medications should not be considered a long-term solution to insomnia. While using these medications, it is essential to adopt good sleep habits in order to establish normal sleeping patterns that can be maintained without the use of these drugs. These habits include the following: Exercising regularly, at least four hours before you want to sleep.Avoiding napsGoing to sleep and waking up at the same time every daySaving your worries for daytime (If concerns come to mind in bed, write them down in a "worry" book, then close the book until the morning.)Practicing a relaxing bedtime ritual, like a hot bath or listening to calming music.Using your bed only for sleeping and for sex. Proper Usage and Missed Dose Your doctor will determine the appropriate dose and usage schedule for you. The drug eszopiclone (Lunesta) is the only sleep medication that has been specifically studied for long-term usage, but other medications may be beneficial in the long-term as well. The non-benzodiazepine drugs have a very intense, rapid onset, and they should only be used when it is possible to go to sleep immediately after taking them.

Possible Side Effects Elderly people are more susceptible to side effects and should usually start at half the dose prescribed for younger people. Also, they should not take long-acting forms. Possible side effects of hypnotics include the following: Clumsiness or unsteadinessDizziness or lightheadednessDrowsiness (more common with long-acting than short-acting drugs)WeaknessSlurred speechNauseaNightmaresAgitationHeadacheDepressionMemory loss Rare side effects include the following: SleepwalkingOdd moods and behaviorHallucinationsLack of usual inhibitionsConfusion Possible side effects of antidepressants include the following: Abnormal dreamsAgitationBlurred vision or other changes in visionClumsiness or unsteadinessConfusionConstipationDecreased sexual abilityDiarrheaDizziness, lightheadedness, or faintingDrowsinessDryness of mouthFast or irregular heartbeatFlushing, feeling of warmth, and/or increased sweatingHeadacheHeartburnIncreased or decreased appetiteMemory problemsNausea and vomitingProblems urinatingRinging in the earsSkin rash, or itching, tingling, burning, or prickly sensationsSuicidal thoughtsSwelling of arms or legsTrembling or shakingTrouble sleepingUnpleasant tasteUnusual tiredness or weakness

Possible side effects of antihistamines include the following: Dizziness or lightheadednessDrunken movementsBlurred visionDry mouth and throatUrinary retentionConstipation With every medication, there are important precautions to consider. These include allergies, interactions with other drugs and medical conditions, and safety during pregnancy, lactation, and other stages of life. Acetaminophen Antihistamines Benzodiazepines Nefazodone Nonsteroidal anti-inflammatory agents (NSAIDs) Paroxetine Trazodone Zaleplon Zolpidem RESOURCES: National Center on Sleep Disorders Research http://www.nhlbi.nih.gov National Sleep Foundation http://www.sleepfoundation.org CANADIAN RESOURCES The Canadian Sleep Society http://www.css.to/ Better Sleep Council Canada http://www.bettersleep.ca/default_main.aspx Last reviewed August 2007 by J. Thomas Megerian, MD, PhD, FAAP 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.