There are several types of prescription and nonprescription medications that can be used to treat insomnia.
—These are hypnotic drugs that have a sedative effect. This class includes: Benzodiazepines, which are also used to treat depression, anxiety, or seizure disorder. Nonbenzodiazepines, which have similar effects to traditional benzodiazepines and mainly used to treat mild insomnia.
Melatonin-receptor agonist—This medication is used to treat insomnia characterized by difficulty with falling asleep. It shortens the time it takes to fall asleep in people with transient insomnia.
Sedating antidepressants—For long-term treatment of insomnia or when insomnia is accompanied by
and/or caused by depression. These antidepressants are different other classes of antidepressants.
Nonprescription sleeping aids can leave people feeling drowsy the next day and may not always be effective at providing restful sleep. However, they are often used 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:
Antihistamines—There are many
available over-the-counter. Diphenhydramine is a commonly used antihistamine for insomnia.
Not all antihistamines are effective for this purpose, especially the newer, nondrowsy antihistamines.
Melatonin—A natural hormone produced in the brain. Melatonin triggers sleep and is more active at night. Your body produces more melatonin in a completely dark room than in a dimly lit one. Melatonin may be useful when your normal sleep cycle has been disturbed, such as during travel-induced jet lag.
Pain relievers—Can be useful when insomnia is caused by minor pain.
The information below relates to prescription sleep medications unless stated otherwise.
To promote sleep in someone who has insomnia, especially in these cases: When sleep difficulties cause problems in accomplishing daily activitiesWhen behavioral approaches have proven ineffective
Insomnia associated with:
Psychological condition, such as anxietyTemporary changes in normal sleep cycles
Hypnotics may help to do the following: Shorten the time it takes to fall asleepIncrease total sleep timeDecrease the number of wakings during sleep
Hypnotic drugs alter brain chemistry in different ways: Benzodiazepine receptor agonists work by enhancing the effect of a brain chemical responsible for reducing neuron excitability.Melatonin receptor agonists may enhance the properties of melatonin's sleep-inducing properties.Antidepressants block the absorption of certain brain chemicals leaving them in the blood stream. This helps produce a feeling of drowsiness.
Avoid overuse and dependence
—Benzodiazepines and other sleep medications may become less effective over time, requiring higher doses to produce effects. This can lead to dependence. Antidepressants and antihistamines present a lower risk for dependency.
There is no current evidence that melatonin receptor agonists lead to overuse or dependence.
Do not 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 of benzodiazepines 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 concentrationTremorMuscle and abdominal crampsDecreased appetite
(in severe cases)
Melatonin receptor agonists are not associated with returning insomnia or withdrawal symptoms.
Do not combine with certain substances
—Be sure to tell your doctor about all of the medications, both prescription and nonprescription and any herbal supplements you take. Hypnotics can have potentially dangerous interactions when combined with certain other substances, such as the following:
dental anestheticsAntiseizure medicationsTricyclic antidepressantsOpioid pain relieversSedativesAntipsychotics, such as lithium or tranquilizersH2 blockers for gastrointestinal disordersAntifungal medications
Practice good sleep habits
—Because of the risks of overuse and withdrawal, sleep medications should not be considered a long-term or first 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 drugs. These habits include the following:
regularly, at least 3 hours before you want to sleep
Avoiding naps, especially longer than 30 minutes and after 3 pmGoing to sleep and waking up at the same time every day (even on days off)Saving your worries for daytime (schedule time during the day to write down concerns.)Practicing a relaxing bedtime ritual, like a hot bath or listening to calming musicUsing your bed only for sleeping and sex
Your doctor will determine the appropriate dose and usage schedule for you.
Elderly people are more susceptible to side effects and therefore hypnotics are not recommended for them.
Possible side effects of hypnotics include the following: Clumsiness or unsteadinessLightheadednessDrowsiness—more common with long-acting than short-acting drugsWeaknessSlurred speechAgitationHeadacheDepressionMemory loss
Rare side effects include the following: SleepwalkingOdd moods and behaviorHallucinationsLack of usual inhibitionsConfusion
Possible side effects of antihistamines include the following: 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. If you have insomnia, talk to your doctor about treatment options.
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Sleep aids and insomnia. National Sleep Foundation website. Available at:
http://www.sleepfoundation.org/article/sleep-related-problems/sleep-aids-and-insomnia. Accessed November 25, 2014.
Last reviewed November 2014 by Michael Woods, MD
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.
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