Insomnia is a common sleep disorder that affects many people of all ages, although prevalence increases with age and diagnosis criteria vary depending on the range and severity of symptoms.
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| 7 Prescription Drugs Used to Treat Insomnia [image: pexels by cottonbro] |
The American Academy of Sleep Medicine defines insomnia as an inability to fall asleep or stay asleep, accompanied by symptoms associated with sleeplessness. Insomnia is categorized into three types: chronic insomnia, short-term insomnia, and associated insomnia; treatments are determined based on diagnoses and symptoms.
Pharmacological treatment is a common approach to alleviating insomnia symptoms, in addition to other nonpharmacological interventions and therapeutic methods. Questions such as: “what is a benzodiazepine and how is it used for the treatment of insomnia?” and “how long do prescription medications take to work?” are common.
The following seven prescription drugs are most common for pharmacological treatment of chronic and short-term insomnia, or other insomnia-related sleep disorders.
1. Benzodiazepines
Benzodiazepine hypnotics and sedatives are approved by the FDA for short-term treatment of chronic insomnia and are considered an alternative to barbiturates with less abuse and overdose potential.
Benzodiazepines work as agonists that bind to GABA receptors in the brain, thereby improving sleep quality and efficiency, and decreasing wakefulness after sleep onset. They are available as short-acting and extended-release variants, and some also treat co-occurring disorders such as anxiety.
The following are the most commonly prescribed benzodiazepines for insomnia:
- estazolam
- flurazepam (Dalmane)
- temazepam (Restoril)
- quazepam (Doral)
- triazolam (Halcion)
- bromazepam
- loprazolam
2. Nonbenzodiazepine Hypnotics
Nonbenzodiazepines are another FDA-approved class of drug for treating insomnia, with similar effects as benzodiazepines but fewer adverse risks overall, including tolerance and rebound effects. They’re generally shorter-acting and can be used for longer-term durations of treatment.
Common nonbenzodiazepines include:
- zolpidem (Ambien)
- zaleplon (Sonata)
- eszopiclone (Lunesta)
3. Melatonin Agonists
Melatonin agonists are analogs of melatonin, a naturally secreted hormone that sustains sleep regulation. The effects of melatonin receptor agonists are known to treat insomnia as well as depression and other coexisting and mutually exacerbating mood disorders.
Ramelteon, extended-release melatonin, agomelatine, and tasimelteon are the primary melatonin agonists currently on the market that are prescribed for insomnia treatment.
4. Antidepressants
Antidepressants are frequently used for their sedative effects to improve quality of sleep, while simultaneously treating depression. Treatment with antidepressants may be combined with psychotherapy for optimal results.
Antidepressants that treat depression-related insomnia may be in the SSRI (selective serotonin reuptake inhibitor) or SNRI (serotonin and norepinephrine reuptake inhibitors) drug families. There are also SARI (serotonin receptor antagonists and reuptake inhibitors) antidepressants, namely trazodone.
SSRI antidepressants include:
- citalopram (Celexa)
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
SNRI antidepressants include the following:
- desvenlafaxine (Pristiq)
- duloxetine (Cymbalta)
- levomiltrapin (Fetzima)
- venlafaxine (Effexor)
5. Atypical Antipsychotics
Atypical antipsychotics such as quetiapine, olanzapine, and risperidone are not FDA approved for the treatment of insomnia, yet they are sometimes prescribed for comorbid insomnia cases. The sedation they produce can ameliorate the symptoms of insomnia by having an antagonistic effect on histamine and serotonin receptors.
6. Barbiturates
Barbiturates are approved by the FDA to be used as prescribed for treating acute insomnia, although they also come with the highest risk potential for tolerance, dependence, abuse, and overdose.
Barbiturates are central nervous system (CNS) depressants that induce extreme drowsiness and can also decrease daytime tension and anxiety. In addition to insomnia, they are also prescribed for pre-anesthesia, euthanasia, anxiety, epilepsy, and seizures.
7. Antihistamines
Antihistamines such as Benadryl (diphenhydramine) and Unisom (doxylamine) are available over-the-counter without a prescription. Antihistamine prescription drugs such as hydroxyzine (Vistaril) are also available to treat insomnia as well as symptoms of co-occurring anxiety.
Over-the-counter and prescription antihistamines are considered one of the safer options for the longer-term treatment of chronic insomnia, mainly because they are at low risk of dependence and abuse. However, their sedative effects can be amplified when mixed with other prescription drugs and alcohol.
Sources:
https://www.sleepfoundation.org/insomnia
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634348/
https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/sleeping-pills/art-20043959
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