Sleep Aids and Insomnia

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are the most effective sleep aids available.

The particular medication prescribed to treat insomnia should depend on a patient's diagnosis, medical condition, use of alcohol or other drugs, age, and need to function when awakened during the usual sleep period. If the cause of the sleep problem is depression, an antidepressant may be the best solution. Anti-anxiety drugs (anxiolytics) are prescribed if anxiety is related to insomnia.

Note: Some antidepressants cause insomnia, so patients should be sure to discuss their sleep problems with their doctor. Also, some antidepressants (the tricyclics) may worsen restless legs syndrome and periodic limb movements (characterized by jerking legs during sleep).

Increasingly, some sedating antidepressants have been prescribed in low doses for insomnia. However, many experts believe that in the absence of clinical depression, there is little evidence to support the use of these drugs for insomnia.

Among the prescription hypnotic drugs, a group of hypnotics called benzodiazepine agonists were developed in the l960's. These sleep-promoting drugs have since proven effective and safe. Benzodiazepine agonists can be either benzodiazepines or nonbenzodiazepines; each has a different chemical structure. All hypnotics induce and maintain sleep. The benzodiazepines agonists work by acting at areas in the brain believed to be involved in sleep promotion. They are the drugs of choice because they have the highest benefit and the lowest risk as sleep-promoting drugs.

Hypnotics differ by half-life as well as chemical structure. Half-life refers to how long a drug is active in the body. Drugs that have a shorter half-life are effective in the body for a shorter time. Shorter half-lives are usually preferred so that daytime functioning is not impaired the next day or after waking. The benzodiazepine triazolam has a short half-life, as do the non-benzodiazepines zolpidem and zaleplon.

Hypnotics also differ in the dose range over which they are effective. Scientists have established the effective dose range for each hypnotic. Dose becomes a problem when higher doses than those established as effective are used. Use of high doses increases the risk of rebound insomnia . Rebound insomnia occurs when a person stops taking