Sleep Medications

Behavioral changes learned through cognitive behavioral therapy for insomnia are generally the best solution for chronic insomnia, but there are times when adding sleep medications can help you get some rest.

Below you can find a list of the most commonly used medications for insomnia. They are divided into categories: Benzodiazepines, Z-Drugs, Antidepressants, and Melatonin Receptor Agonists

Benzodiazepines

Alprazolam (Xanax) Recommendation

This medication is indicated for treating anxiety, especially when accompanied by panic disorder and alcohol and other drug withdrawal. The effect of this medication, like Bromazepam, is shorter than other benzodiazepines.

Bromazepam (Lexotan) Recommendation

Bromazepam is a medication prescribed by doctors to treat problems such as anxiety, tension, and other psychological disorders like mood disorders, bipolar disorder, and schizophrenia. The effect of this medication, like Alprazolam, is shorter than other benzodiazepines.

Clonazepam (Klonopin) Recommendation

One of the most consumed benzodiazepines in Brazil, Clonazepam is a sleep medication that has tranquilizing and sedative effects. As such, it helps with muscle relaxation and ending convulsive seizures.

Diazepam (Valium) Recommendation

Diazepam can be used to treat anxiety, alcohol withdrawal, seizures, and insomnia, with fast and long-lasting effects allowing for sleep induction and maintenance.

Negative Points

• You can become physically and psychologically dependent on medications in this class.
• Sleeping pills may lose their effectiveness if used every night (being recommended for specific cases of maximum 3 to 4 weeks of use)
• Your overall sleep quality may be reduced, with less restorative deep sleep and REM sleep.
• The next day, you may experience cognitive sluggishness and drowsiness (the hangover effect).
• These medications do not cure insomnia, so when you stop using them, insomnia returns.
• There are studies showing that the use of this type of medication can lead to dementia (e.g., Alzheimer's).

Z-Drugs

Zolpidem (Ambien, Stilnox) Recommendation

The main indication for Zolpidem is to help people fall asleep, with lesser effect on sleep maintenance. The advantages of this medication over benzodiazepines are that they produce minimal changes in sleep architecture, maintaining deep sleep and REM sleep. This hypnotic has been identified as the most prescribed in the world.

Zaleplon (Sonata) Recommendation

Its main indication is for rapid sleep induction (faster than Zolpidem), with little effect on maintenance, and can be used in the middle of the night in cases of early awakening, without concerns of waking up groggy the next morning.

Zopiclone (Imovane) Recommendation

Zopiclone differs from zolpidem by having a longer duration of action, presenting greater potential for residual morning drowsiness, and studies have shown sleep alterations similar to benzodiazepines.

Negative Points

Although less harmful than benzodiazepines, they also present undesirable side effects, such as:

• The next day, you may experience cognitive sluggishness and drowsiness (the hangover effect).
• Continuous use of these medications promotes tolerance and potential dependence.
• The recommended use of Zolpidem (the best-selling medication in this class) is up to 4 weeks, with increased risks of dependence over longer periods.
• These medications do not cure insomnia, so when you stop using them, insomnia returns.
• Headaches, dizziness, nausea, difficulty swallowing or breathing
• In some cases, dangerous sleep-related behaviors, such as walking, driving, and eating while asleep
• Depression; suicidal thoughts or actions

Antidepressants

Some of the most commonly used antidepressants for insomnia are: Amitriptyline (Elavil), Trazodone (Desyrel), Doxepin (Silenor), and Fluoxetine (Prozac).

Recommendation

Sometimes, prescription medications used primarily to treat depression can relieve insomnia when taken at lower doses, as they cause drowsiness. When insomnia is secondary to depression or anxiety, antidepressants can improve both conditions at the same time.

Negative Points

Antidepressants that have a sedative effect may include side effects such as:

• Headaches and dizziness
• Daytime drowsiness
• Heart arrhythmia
• Weight gain

Melatonin Receptor Agonist

The medication Ramelteon is sold under the name Rozerem.

Recommendation

While most insomnia medications work by slowing down the central nervous system, ramelteon mimics melatonin, a chemical that contributes to regulating the body's natural sleep-wake cycle (circadian rhythm).

It is prescribed for people who have trouble falling asleep and is different from most medications mentioned as it shows no signs of abuse or dependence over periods of 6 months to 1 year.

Negative Points

• Headaches
• Daytime drowsiness
• Dizziness

The following table presents a summary of the main sleep medications and their effects

Medication Treatment Recommendations

If your best attempts at getting a good night's sleep have failed, sleep medications may be an option. Here are some tips on how to use them safely.

• Always have medical supervision before starting any medication treatment.
• Never take a sleeping pill until you go to bed.
• Take your sleeping pill when you can sleep a full night.
• Be aware of side effects and contraindications (talk to your doctor about them).
• Never mix alcohol and sleeping pills.
• Take sleeping pills strictly as prescribed by your doctor.
• Do not abruptly stop medication treatment to avoid withdrawal symptoms.