Regardless of the type of therapy used, the treatment of chronic insomnia has two primary objectives: improving sleep quality and quantity and improving daytime impairments. Non-pharmacological treatments, such as cognitive-behavioral therapy for insomnia (CBT-I) are considered as first-line or in combination with medications.
The management of insomnia with medication involves a comprehensive understanding of the pharmacologic options, their mechanisms of action, indications, contraindications, and potential side effects. Here is an overview of insomnia prescription medication management.
A thorough assessment is vital before prescribing. It’s essential to determine if the insomnia is primary or secondary to another condition. The choice of medication depends on the specific sleep complaint, e.g., trouble falling asleep versus trouble staying asleep. The potential for side effects, drug interactions, and dependency should always be considered. Regular follow-ups are essential to monitor efficacy, side effects, and the potential for misuse or dependency.
These are a class of drugs called hypnotics. Examples include Temazepam (Restoril), Lorazepam (Ativan), Alprazolam (Xanax), Diazepam (Valium), Clonazepam (Klonopin), Triazolam (Halcion) and others. These are older insomnia drugs that stay in the system longer and can be addictive. Because of concerns about dependence, withdrawal, and rebound insomnia, these are typically prescribed for short-term use. They help by reducing sleep latency (the time it takes to fall asleep) and increasing total sleep time.
Examples: Zolpidem (Ambien), Zaleplon (Sonata), and Eszopiclone (Lunesta). These drugs are indicated for the short-term treatment of insomnia. They can cause drowsiness, dizziness, complex sleep behaviors (e.g., sleepwalking, sleep-eating), and next-day impairment. Ambien has been associated with nausea, nightmares and agitation. Sonata is advantageous for help middle of the night awakening.
Orexins are chemicals involved in the sleep-wake cycle and play a role in keeping you awake. Suvorexant (Belsomra) is on type. It is indicated for the treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance. Side Effects include drowsiness, headache, and next-day drowsiness.
Ramelteon (Rozerem) is indicated for the treatment of insomnia characterized by difficulty falling asleep. Side Effects include dizziness, fatigue, and somnolence.
Brands include Trazodone (Desyrel), Mirtazapine (Remeron). They are often used off-label for insomnia, especially when insomnia is comorbid with depression. Side Effects can include drowsiness, dry mouth, constipation, and potential cardiac arrhythmias (in high doses).
This drug is used for people who have trouble staying asleep.
These drugs can treat restless leg syndrome, other limb movement disorders. They include carbamazepine (Tegretol), gabapentin enacarbil (Horizant), pregabalin (Lyrica) and valproate (Depakote)
Most of these are antihistamines that work well for insomnia but can cause daytime drowsiness. Examples are Diphenhydramine (Benadryl) which can be used for short-term relief. Side effects include Dry mouth, dizziness, urinary retention, constipation, blurred vision, and potential confusion in the elderly.
The list includes FDA approved drugs for the treatment of insomnia, and other FDA approved drugs used off-label to treat insomnia. Often short-term medication can help to resolve insomnia in combination with non-drug treatments and therapies.
Insomnia is a vexing problem. When you can’t sleep contact Mercie Health and Wellness in Katy, Texas. We have the tools and therapies to help you get the quality sleep you need to lead a more productive and fulfilling life. We take a humane and personalized approach to treating insomnia. You will always be treated with respect and dignity at Mercie Health.
At a Glance
Dr. Sylvia Udokoro Nwakanma
- Doctor of Nursing Practice (DNP)
- Double Board Certified in Psychiatric Mental Health Nurse Practitioner (PMHNP-BC) and Family Nurse Practitioner (FNP-C)
- SAMSHA Certified Addictions Nurse Practitioner
- Learn more