Medications to Help You Get a Good Night's Sleep

More and more Americans are taking medications to help them fall asleep. Spending on drugs to treat insomnia and related disorders surged by 20% last year, according to Medco Health Solutions.

Insomnia is defined as trouble falling asleep or staying asleep for three or more nights per week for one month or longer, accompanied by daytime fatigue.

Don't let insomnia go on for days, weeks or months. The sooner you get episodes of insomnia under control, the less likely you will be to develop chronic insomnia.

Sleeping pills can provide relief from occasional insomnia and can help prevent chronic insomnia. Here's what you need to know about today's sleep medications...

Nonbenzodiazepines

This class of sleeping pills was introduced in the US in 1992 with the drug zolpidem (Ambien). These drugs target receptors in the brain that trigger the release of gamma-amino butyric acid (GABA), a chemical that reduces brain activity and induces sleep.

Compared with previous classes of sleeping pills, nonbenzodiazepines are more effective and cause fewer side effects, such as daytime drowsiness. Also, unlike the older class of benzodiazepines they are not addictive. (If you are addicted to medication, you get an adverse reaction when you stop taking it, such as an increase in anxiety, irritability or heart rate) Nonbenzodiazepines can be taken safely long-term.

Some people worry that if they take a sleeping pill, they won't be able to wake up if there is an emergency-but in the usual doses, that should not be a problem.

You should not take these medications with alcohol. However, if you have a glass or two of wine with dinner several hours before bedtime, there should be no adverse effects.

Zolpidem (Ambien) is the most widely prescribed sleeping pill in the US. It works quickly and induces sleepiness for approximately six hours. It has a low rate of very mild side effects, such as headache and nausea. (See the preceding article on page 107 for information on the recent controversy about Ambien.)

Best you: Have difficulty falling asleep and/or tend to wake up in the middle of the night and are not able to fallback asleep. Take at bedtime.

Zaleplon (Sonata) also works quickly, but only lasts for two to four hours.

Best if you: Wake up in the middle of the night and don't intend to get up for at least four hours. For example, take it at 4 am if your rising time is 8 am. It's also good if you just have trouble falling asleep but don't have trouble sleeping through the night.

Eszopiclone (Lunesta) was approved by the US Food and Drug Administration (FDA) in 2004. Research indicates that Lunesta maybe the most effective nonbenzodiazepine for preventing nighttime waking. It lasts eight hours-two hours longer than Ambien-but it's still too soon to tell if daytime drowsiness is a commonly experienced side effect.

Best if you:  Need help increasing the amount of time you sleep to a full seven or eight hours.

Benzodiazepines

This class of drugs includes temazepam (Restoril), estazolam (ProSom), triazolam (Halcion) and flurazepam (Dalmane). They relax muscles and reduce anxiety-but can have serious side effects, including daytime drowsiness. They are potentially addictive, causing rebound insomnia, a worsening of sleeplessness when you stop taking them, as well as anxiety and nightmares.

Restoril is the most widely used benzodiazepine, but most doctors prefer to prescribe nonbenzodiazepines.

Antidepressants

The so-called sedating antidepressants-nefazodone (Serzone), trazodone (Desyrel) and amitriptyline (Elavil)-are prescribed for people who are depressed and also have insomnia. Taken at night, they induce sleep and relieve depression during the day.

Downside: Serious side effects, such as cardiac irregularity, low blood pressure in the elderly and/or impotence.

Best if you: Have mild depression along with sleeping problems.

Another option: Use a newer, safer antidepressant during the day, such as sertraline (Zoloft), and a nonbenzodiazepine, such as Ambien, at night. Studies show that this combination is safe and effective.

Nonprescription Sleeping Aids

Antihistamines, including diphenhydramine (Benadryl, Nytol, Sleep-eze, Sominex, Tylenol PM) and doxylamine (Unisom) have drowsiness as a side effect. Unfortunately, it can last into the day. Also, antihistamines are not as effective as nonbenzodiazepines.

Best if you: Experience occasional insomnia.

Caution: If you start to experience insomnia regularly, discontinue antihistamines. See your doctor for a prescription medication that treats insomnia effectively and quickly.

Melatonin is a hormone that affects the body's sleep-wake cycle. A recent review by the National Institutes of Health (NIH) showed that it is not an effective sleeping pill but is useful in changing the timing of sleep.

Best if you: Have trouble getting to sleep before 3 am or 4 am and then sleep until noon. This is most common among the elderly, adolescents who have insomnia and travelers who have jet lag. Melatonin can help bring bedtime back toward 11 pm. Take melatonin following the dosage recommendation on the label around 6 pm or 7 pm.

Valerian. The research on this herb is mixed. Some studies indicate that valerian can reduce stress and help more quickly...others have shown no benefit. It is unlikely to cause side effects at the doses recommended on labels. Higher doses have been linked to blurred vision and changes in heart rhythm.

Best if you: Want to try an herbal remedy for occasional insomnia.

Herbal tea/warn milk. Teas believed to be calming include chamomile, lemon balm and lavender. The active ingredients in these and other teas don't appear to have significant effects on insomnia. The same is true for milk. However, the nighttime ritual of a cup of tea or a glass of warm milk may reduce stress and help some people fall asleep more easily.

Even Better Sleep

Insomnia medications are even more effective if you..

Don't stay in bed too long. People who don't get enough sleep tend to go to bed earlier and get up later, trying to catch up. Over time, the sleep period spreads out over a larger portion of the day, which disturbs the normal sleep pattern. Never stay in bed longer than eight hours, no matter how you have slept.

Go to bed and get up at the same time everyday. This will help restore normal sleeping patterns.

Take medication at the right time. The medication has to work in conjunction with a sleep-wake cycle, at a time when there is a physiological drive to sleep. If you had a good night's sleep and took the pill at 10 am, you would not sleep for the next eight hours.