Hypnotics (for Sleep) Medications

Hypnotics are drugs that are used to help people fall asleep. There are many types of hypnotic drugs, and doctors recommend and prescribe them based on the type of sleep problem you have. Lifestyle and sleep habit changes also are effective for treating certain types of sleep problems.

• If you have chronic insomnia or problems sleeping contact your doctor or other health care professional. Doctors specializing in sleep problems (sleep medicine) can help you determine the cause of your insomnia and treat it.
• Hypnotic drugs are also called sleep aids, sleeping pills, or soporifics.

The FDA has approved five types of hypnotic medications for the treatment of sleep problems, which include:

• Benzodiazepines
• Nonbenzodiazepine receptor agonists
• Melatonin receptor agonists
• Orexin receptor agonist
• Antidepressants

These medications are all effective for treating sleep problems, but they work in different ways. Some sleep medicines only last a few hours (short-acting medications) while others last longer in the body (long-acting medications). Doctors and other health care professionals choose sleep medications based on the type of sleep problem you have. For example, people who have trouble falling asleep will benefit from a short-acting sleep medicine. People who have trouble staying asleep will benefit more from long-acting sleep drugs.

Doctors prescribe hypnotics to treat insomnia. Insomnia is a sleep problem that may involve difficulty falling or staying asleep. Inadequate sleep affects mood, energy levels, health, and work performance.

Common causes of insomnia are stress, traumatic events, depression, anxiety, and medications. If you know the cause of your insomnia and treat it, it may reduce the need for sleep medications to aid or induce sleep.

Side effects of hypnotics depend upon the type of hypnotic used.

Some common side effects of some hypnotics include:

• Headache
• Nausea
• Short-term forgetfulness
• Rebound insomnia
• Dry mouth
• Hallucinations
• Dizziness
• Drowsiness
• Withdrawal symptoms (for example, anxiety, or insomnia)
• Unpleasant taste
• Confusion
• Dependence

Other side effects of hypnotics may include:

• Dizziness
• Cough
• Abnormal dreams
• Diarrhea
• Upper respiratory infections
• Stomach upset
• Loss of coordination
• Sleepiness
• Hair loss
• Dry skin
• Loss of appetite
• Nausea
• Fatigue

Possible serious side effects may include:

• Sleep paralysis
• Behavioral changes
• Abnormal thinking
• Suicidal thinking
• Worsening of depression
• Sleep driving and other complex behaviors
• Anemia
• Hives
• Exfoliate dermatitis

• Combining sleep medications or using other medications that also cause drowsiness will lead to severe drowsiness.
• Stimulants such as amphetamines or coffee may reduce the effect of sleep medicines.

There are over 40 different sedative/hypnotic drugs available. Talk to your doctor, pharmacist, or other health care professional for any additional information about the generic forms available.

Melatonin receptor agonists

• ramelteon (Rozerem)
• prexin receptor antagonist
• suvorexant (Belsomra)

Benzodiazepines

• estazolam (Prosom)
• flurazepam (Dalmane)
• quazepam (Doral)
• temazepam (Restoril)
• triazolam (Halcion)

Non-benzodiazepine receptor agonists

• eszopiclone (Lunesta)
• zaleplon (Sonata)
• zolpidem (Ambien, Ambien CR, Intermezzo, Zolpimist, Edluar)

Antidepressants

• doxepin (Selinor)
• mirtazapine (Remeron)
• trazodone (Oleptra)

The dose of these drugs varies. Talk to your doctor about the exact dose you need to fall asleep.

Diphenhydramine (for example, Benadryl) and doxylamine (for example, Unisom) are over-the-counter (OTC) drugs that can help people fall asleep. These drugs are antihistamines that cause drowsiness and sedation. Only use these medications for a few days. Talk with your doctor or other health care professional if you have insomnia for more than a couple of weeks.

You should read the instructions and warnings before taking OTC sleep medicine because they can have serious adverse effects if not used properly. They also may interfere with the action of other drugs.

Side effects reported by people taking diphenhydramine or doxylamine include:

• Dry mouth
• Blurred vision
• Constipation
• Grogginess
• Dizziness

• Synthetic melatonin capsules, pills, or tablets may help people fall asleep. Melatonin is most often used for treating jet lag. Melatonin takes a few days, up to a few weeks to work when it is used for treating sleep problems.
• Valerian is another supplement available to treat insomnia.

Talk with your doctor or pharmacist before taking herbal, natural, or other supplemental products for insomnia.

Do not drink alcohol before or after taking a sleep medication because drinking alcohol while using a sleep medication or sedative may lead to severe drowsiness.

Benzodiazepines are addictive hypnotics and are federally controlled substances. People can develop physical dependence after several days of taking them, and the risk is higher during long-term use.

Doctors should take care when prescribing benzodiazepine drugs to people with a history of drug abuse or alcoholism because they are more likely to become addicted to benzodiazepines.

• Researchers have not studied the effects of most hypnotics on pregnant women. Therefore, they should not be used if you are pregnant unless it is absolutely necessary. Pregnant women who have sleep problems should try improving their sleep hygiene, relaxation, and ways to reduce stress.
• Benzodiazepine use is harmful to the fetus when taken by pregnant women during their first trimester so you should avoid them if you are pregnant.
• Diphenhydramine may have a low risk of causing harm during pregnancy.

If you are pregnant discuss the use of these drugs with your doctor.