Benzodiazepine, non-benzodiazepine, and antidepressant medications to cure insomnia
The main classes of medications used to treat insomnia are the sedatives and hypnotics, such as the benzodiazepines and the non-benzodiazepine sedatives.
Several medications in the benzodiazepine class have been used successfully for the treatment of insomnia, and the most common ones include:
- quazepam (Doral),
- triazolam (Halcion),
- estazolam (ProSom),
- temazepam (Restoril),
- flurazepam (Dalmane), and
- lorazepam (Ativan).
Another common benzodiazepine, diazepam (Valium), is typically not used to treat insomnia due to its longer sedative effects.
Non-benzodiazepine sedatives are also used commonly for the treatment of insomnia and include most of the newer drugs. Some of the most common ones are:
- zaleplon (Sonata),
- zolpidem (Ambien or Ambien CR [note that as of January 1, 2014 the FDA changed the recommended dosage and precautions], Zolpimist, Intermezzo), and
- eszopiclone (Lunesta).
Melatonin, a chemical released from the brain which induces sleep, has been tried in supplement form for treatment of insomnia as well. It has been generally ineffective in treating common types of insomnia, except in specific situations in patients with known low levels of melatonin. Melatonin may be purchased over-the-counter (without a prescription).
Ramelteon (Rozerem), which is an insomnia drug that acts by mimicking the action of melatonin, is a newer drug. It has been used effectively in certain groups of patients with insomnia.
Suvorexant (Belsomra), falls into a newer classification of medications for treating insomnia. It acts by decreasing the activity on orexin receptors in wake system (lateral hypothalamus) of our brain, rather than increasing the activity in the sleep centers of our brain. The medication is an orexin antagonist and has only recently become available. It is thought to be generally safe and well tolerated, but some patients may have side effects.
There are also other medications that are not in the sedative or hypnotic classes, which have been used in the treatment of insomnia. Sedative antihistamines, diphenhydramine (Benadryl) have been used as sleep aids because of their sedative effects; however, this is not a recommended use of these or other similar drugs due to many side effects and long-term drowsiness the following day.
Some anti-depressants (for example, trazodone [Desyrel], amitriptyline [Elavil, Endep], doxepin [Sinequan, Adapin]) can be used effectively to treat insomnia in patients who also may suffer from depression. Some anti-psychotics have been used to treat insomnia, although their routine use for this purpose is generally not recommended.
A doctor or sleep specialist is the best person to discuss these different medications, and to decide which one may be the best for each specific individual. Many of these drugs have a potential for abuse and addiction and need to be used with caution. None of these medications may be taken without the supervision of the prescribing physician.