Prescription sleeping pills: What's right for you?

Sleeping pills help when stress, travel or other disruptions keep you awake. If you have chronic insomnia, a better approach may be to remove the cause by changing your lifestyle.

If you're regularly having trouble either falling or staying asleep (insomnia), make an appointment with your doctor. Treatment is available — but it depends on what's causing your insomnia. Sometimes, an underlying medical or sleep disorder can be found and treated, a much more effective approach than just treating the symptom of insomnia itself.

Behavior changes learned through cognitive behavioral therapy are generally the best treatment for persistent insomnia. However, there are times when prescription sleeping pills may be helpful. Although sleeping pills don't treat the underlying cause of your sleeping problems, they may help you get some much needed rest.

Today's prescription sleeping pills don't carry the same level of risks of dependence and overdoses as sleeping pills of the past. But risks remain — especially for people who have certain medical conditions, including liver or kidney disease. Always talk with your doctor before trying a new treatment for insomnia.

Here's information on some of the most common types of sleeping pills used today.

Types of prescription sleeping pills

Prescription sleeping pills are available to help you fall asleep easier, stay asleep longer — or both. Before prescribing a medication to help you sleep, your doctor will ask you a number of questions to get a clear picture of your sleep patterns. He or she may also order tests to rule out any underlying conditions that may be causing difficulty sleeping.

To reduce the risk of side effects and of becoming reliant on drugs to sleep, your doctor likely will prescribe medications for two to four weeks. If the first medication you take doesn't work after the full prescribed course, call your doctor. You may need to try more than one prescription sleeping pill before finding one that works for you.

Some prescription sleeping pills are available as generic drugs, which are typically less expensive than are brand-name drugs. Ask your doctor whether there is a generic version available of the medication he or she prescribes. Insurance companies may have restrictions on which sleeping pills are covered, and they may require that you try other approaches to your insomnia first.

Sleeping pills that help you fall asleep

The following prescription medications are used mainly to help you fall asleep.

Drugs that help you fall asleep
Drug	May not be safe if you:	Considerations
Eszopiclone (Lunesta)	Have a history of drug or alcohol abuse, depression, lung disease, or a condition that affects metabolism.	May be used for a longer period of time than zolpidem or zaleplon. High-fat meals may slow your absorption of the drug and make it less effective. Stopping the drug suddenly may cause symptoms of withdrawal, such as anxiety, unusual dreams, nausea and vomiting.
Ramelteon (Rozerem)	Are pregnant or breast-feeding. Have a history of kidney or respiratory problems, sleep apnea, or depression. Have a liver disease.	May interact with alcohol. High-fat meals may slow your absorption of the drug and make it less effective. A manufactured drug similar to melatonin. Not likely to be habit-forming.
Triazolam (Halcion)	Are pregnant or breast-feeding. Have a history of drug abuse, depression or respiratory conditions.	May interact with grapefruit juice, alcohol and many medications. Can be habit-forming. Seldom prescribed by sleep specialists. Drug must be stopped gradually.
Zaleplon (Sonata)	Have severe liver problems. Are pregnant or breast feeding. Have a history of depression, liver or kidney disease, or respiratory conditions.	May interact with other medications.  Can be habit-forming. High-fat meals may slow your absorption of the drug and make it less effective. Very short acting, so can be taken in the middle of the night following precautions from your doctor.
Zolpidem (Ambien, Edluar)	Have a history of depression, liver or kidney disease, or respiratory conditions.	May become less effective over time. Sleep behaviors, such as sleep-driving and sleep-eating may occur.

Sleeping pills that help you stay asleep

The following prescription medications are used to help you get to sleep and stay asleep.

Side effects of prescription sleeping pills

Side effects associated with prescription sleeping pills include:

• Dizziness
• Headache
• Gastrointestinal problems, such as diarrhea and nausea
• Prolonged drowsiness, more so with drugs that help you stay asleep
• Severe allergic reaction
• Sleep behaviors, such as sleep-driving and sleep-eating
• Daytime memory and performance problems

Medications to help you stay asleep may not be safe if you are pregnant, are breast-feeding or are an older adult. Sleeping pill use may increase the risk of nighttime falls and injury in older adults. If you're an older adult, your doctor may prescribe a lower dose of medication to reduce your risk of problems.

Sedating antidepressants

Sometimes prescription drugs used mainly to treat depression may ease insomnia when taken in lower doses. Although widely used, these are not approved by the Food and Drug Administration for insomnia only. Discuss alternatives with your doctor. When insomnia is secondary to depression or anxiety, antidepressants may improve both conditions at the same time.

Drugs that help you stay asleep
Drug	May not be safe if you:	Considerations
Estazolam	Are pregnant, breast-feeding, or are an older adult.	May interact with many other medications. Can be habit-forming.
Eszopiclone (Lunesta)	Have a history of drug or alcohol abuse, depression, lung disease, or a condition that affects metabolism.	High-fat meals may slow absorption of the drug and make it less effective. Stopping the drug abruptly may cause symptoms of withdrawal such as anxiety, unusual dreams, nausea and vomiting.
Temazepam (Restoril)	Have a history of severe depression, substance abuse, lung disease, or kidney or liver problems. Are pregnant or breast-feeding.	May interact with alcohol and many medications. Can be habit-forming.
Zolpidem (Ambien CR)	Have a history of depression, liver or kidney disease, or respiratory conditions. Are pregnant or breast-feeding.	This extended-release formula may be used for a longer period of time than regular zolpidem or zaleplon.
Doxepin (Silenor)	Have a history of glaucoma, trouble urinating (urinary retention) or heart disease.	May cause weight gain.

Drugs for when you can't sleep and you're depressed
Drug	May not be safe if you:	Considerations
Amitriptyline	Are recovering from a heart attack or have a history of seizures, glaucoma, trouble urinating (urinary retention).	May interact with many other medications.
Doxepin	Have a history of glaucoma, trouble urinating (urinary retention) or heart disease.	May interact with many other medications.
Trazodone (Oleptro)	Have a history of high blood pressure.	May interact with many other medications.
Mirtazapine (Remeron)		May cause weight gain. May cause daytime sedation. May interact with many other medications.

Side effects of sedating antidepressants

Side effects associated with sedating antidepressants include:

• Dizziness
• Headache
• Prolonged drowsiness
• Dry mouth
• Nausea
• Irregular heartbeats
• Weight gain

Taking sleeping pills

If your best attempts to get a good night's sleep have failed, prescription sleeping pills may be an option. Here's some advice on how to use them safely.

• Get a medical evaluation. Before you take sleeping pills, see your doctor for a thorough exam. Often your doctor may be able to find specific causes for your insomnia. Your doctor also likely will recommend trying nondrug approaches, such as cognitive behavioral therapy. Sleeping on a regular schedule, exercising regularly, avoiding caffeine and daytime naps, and keeping stress in check also are likely to help. In addition, if you're taking sleeping pills for more than a few weeks, be sure to schedule follow-up appointments with your doctor at least every six months.
• Never take a sleeping pill until you're going to bed. Sleeping pills can make you less aware of what you're doing, increasing the risk of dangerous situations. Wait to take your sleeping pill until you've completed all of your evening activities, about 15 to 30 minutes before you plan on sleeping.
• Plan to take your first sleeping pill when you can sleep in. Don't take a new sleeping pill the night before an important appointment or activity. Until you've taken the drug, you won't know how it affects you. So, make sure you take a sleeping pill for the first time on a night when you know you can sleep in the next day, such as on a Friday night if you work weekdays.
• Avoid alcohol. Never mix alcohol and sleeping pills. Alcohol increases the sedative effects of the pills. Even a small amount of alcohol combined with sleeping pills can make you feel dizzy, confused or faint. And, alcohol can actually cause insomnia.
• Quit carefully. When you're ready to stop taking sleeping pills, follow your doctor's instructions or the directions on the label. Some medications must be stopped gradually. Also, be aware that you may have some short-term rebound insomnia for a few days after you stop taking sleeping pills.
• Watch for side effects. If you feel sleepy or dizzy during the day, talk to your doctor about changing your dose or weaning off your pills.

If you continue to have trouble sleeping, ask your doctor for additional help.

References

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