Treating Insomnia With Prescription Medicines

Getting a short-term prescription from your doctor for sleeping pills may help your insomnia when over-the-counter remedies don’t work. Learn about the different options for insomnia treatment.

Once again, it’s 2 a.m. and you’re lying awake, tossing and turning. Soaking in a warm bath, reading a book, sipping chamomile tea, and taking over-the-counter sleeping pills haven’t done the trick. If you’ve read all about non-prescription insomnia options and none are helping, the next step might be prescription medication for insomnia treatment.

“There are more prescription medications available for insomnia than ever before, but the way they work and the side effects vary,” says Paul Selecky, MD, medical director of the Hoag Sleep Disorders Center in Newport Beach, Calif.

Here’s a look at the most commonly prescribed sleeping pills, their benefits, side effects, and risks.

Prescription Sleeping Pills: Benzodiazepine Hypnotics

This type of sleep medication acts on receptors in the brain to slow down the nervous system, allowing you to fall asleep and stay asleep. “They’re thought to boost the activity of the neurotransmitter GABA, which calms brain activity,” says Dr. Selecky. Benzodiazepines are also used to reduce anxiety, which can help ease insomnia.

If your main problem is getting to sleep, your doctor may prescribe a quick-acting sleeping pill that won’t stay in your body long, such as triazolam (Halcion). However, according to Selecky, if your problem is staying asleep, a sleep medication that lasts longer, such as flurazepam (Dalmane), clonazepam (Klonopin), temazepam (Restoril), or lorazepam (Ativan), may be more appropriate.

These insomnia medications are not designed for long-term use because you can quickly start to develop a tolerance, creating the need for more and more drugs to be able to sleep. This can start to happen within just a few weeks. Other side effects include daytime sleepiness, fuzzy thinking, dizziness, and headaches. They can also reduce the amount of deep REM sleep. While “benzos” used to be commonly prescribed to help people relax or get to sleep, these days they are recommended much less frequently due to their side effects and the availability of other options.

Prescription Sleeping Pills: Non-Benzodiazepine Hypnotics

This class of sleep medication acts on the same neurotransmitters as benzodiazepines, but the chemical structure of these drugs is different “They’re newer than benzodiazepines and are thought to have a lower risk of dependency,” says Selecky.

Insomnia treatment drugs within this class include zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata). In recent studies, Lunesta has been shown effective for people with sleep problems due to arthritis pain. One study of rheumatoid arthritis patients found that almost half had no insomnia at all after taking the medication for four weeks. Side effects are similar to those of benzodiaxepines, but are generally less severe. Plus, they don’t interfere with REM sleep the way benzodiazepines can. Some people taking Ambien have done things like drive and eat while still asleep, but this is rare.

Stopping non-benzodiazepines quickly can cause withdrawal symptoms, such as nausea, vomiting, sweating, shaking, and extreme anxiety, so discontinuing long-term use should be done under a doctor’s supervision. To decrease the risk of dependency and unpleasant withdrawal symptoms, doctors typically don’t prescribe these drugs for more than four weeks, says Selecky.

Prescription Sleeping Pills: Sedating Antidepressants

Some antidepressants can help ease insomnia when taken in low doses by reducing the amount of time it takes to fall asleep and allowing deeper, uninterrupted sleep.

Antidepressants used for this purpose are typically those in the older classes of drugs (tricyclics, tetracyclics) that carry the side effects of drowsiness and sedation. Examples of these sedating antidepressants include amitriptyline (Elavil, Endep) and trazodone (Desyrel). For people with depression, sedating antidepressants can do double duty, relieving depression and insomnia. Additionally, these drugs have been shown to help ease pain from certain chronic conditions such as arthritis and fibromyalgia.

Other side effects of sedating antidepressants include weight gain, dizziness, blurred vision, constipation, and prolonged drowsiness. They can also worsen restless legs syndrome.

The appropriate medication for you will depend on the type of insomnia that’s keeping you awake and its cause, so discuss your shut-eye struggles with your doctor. And because most sleep medications are recommended only for limited periods of time, you probably will want to explore non-drug therapies as well. If you have chronic insomnia, talk to your doctor about behavior changes and other non-drug treatments like cognitive-behavioral therapy — these lifestyle approaches may be your best bet for long-term relief.

By Jan Sheehan – Medically reviewed by Cynthia Haines, MD