Herbie Murray
Sleep is an essential part of our lives, and for those who struggle with sleep disorders, sleeping pills can be a solution. Psychiatrists are the second-largest prescribers of sleep aids, and they are often used to treat insomnia and other sleep disorders. While sleeping pills can be beneficial, they are typically used in conjunction with other treatments and are usually prescribed for a short period. This is because, for most people, they become less effective over time and can have side effects such as blurred vision and constipation. This article will explore the various types of sleeping pills prescribed by psychiatrists and the reasons behind their use.
| Characteristics | Values |
|---|---|
| Psychiatrists prescribe sleeping pills | Yes |
| Psychiatrists are the largest prescribers of sleep aids | No, they are the second largest after primary care physicians |
| Sleeping pills are prescribed for general symptoms | Rarely, only 11% of sleep aid use by psychiatrists is for general symptoms |
| Sleeping pills are prescribed for central nervous system (CNS) conditions | Yes, they are mostly used for CNS conditions |
| Types of sleeping pills | Benzodiazepines, antihistamines, melatonin agonists, anti-Parkinsonian drugs, antinarcoleptics, antidepressants, antianxiety medications, orexin receptor antagonists |
| Sleeping pills are typically used for a short time | Yes, they are usually prescribed for a short duration |
| Sleeping pills are combined with other treatments | Yes, they are often used in conjunction with good sleep practices and/or behavioral treatments |
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What You'll Learn
Psychiatrists are the second-largest prescribers of sleep aids
Data from Verispan's Prescription Drug and Diagnosis Audit (PDDA) from September 2005 to August 2006 revealed that only 11% of sleep aid use by psychiatrists is for general symptoms like insomnia, while 87% of primary care physicians prescribe sleep aids for these reasons. Instead, the majority of sleep aids prescribed by psychiatrists (83%) are used in conjunction with psychiatric medication to treat central nervous system (CNS) conditions such as affective psychoses, neurotic disorders, and depressive disorders.
Psychiatrists may prescribe sleep aids to patients with insomnia, especially those with mood or anxiety disorders. Modern psychiatrists tend to prescribe benzodiazepines such as diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin). These medications are hypnotics that can help induce sleep. However, it is important to note that the effectiveness of benzodiazepines may not be dependent on FDA approval, and older versions may have disadvantages like long half-lives or side effects like amnesia.
Additionally, other types of sleep aids, such as melatonin agonists, can be considered. Ramelteon (Rozerem), a melatonin agonist, does not have the same GABA-agonist side effects as benzodiazepines and may be safer for older patients or those with substance abuse issues. While it may take several weeks for patients to notice the benefits, it can be a good choice for those with sleep phase disorders or insomnia associated with shift work or travel across multiple time zones.
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Sleeping pills are often used to treat insomnia
Sleeping pills can be an important option for patients with insomnia. While cognitive behavioural therapy (CBT-I) can benefit any patient, some may require the additional help of sleeping pills. For example, a patient with an acute, but likely transient, bout of insomnia accompanying an event such as a death, birth, moving house, or starting a new job might benefit from a short course of hypnotics. Patients with insomnia comorbid with a psychiatric disorder, mood disorder, or anxiety may also benefit from sleeping pills.
Benzodiazepines are a class of drugs included in hypnotics and are commonly prescribed for insomnia. Only five older benzodiazepines are formally FDA-approved for insomnia: flurazepam (Dalmane), temazepam (Restoril), triazolam (Halcion), estazolam (Prosom), and quazepam (Doral). However, these medications are no longer commonly prescribed. Instead, modern psychiatrists tend to prescribe other benzodiazepines such as diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin). These medications are especially useful for patients with mood or anxiety disorders.
Other types of sleeping pills include sedating antihistamines, melatonin agonists, anti-Parkinsonian drugs, antinarcoleptics, antidepressants, antianxiety medications, and orexin receptor antagonists. Sedating antihistamines, such as diphenhydramine (Benadryl), are popular over-the-counter (OTC) choices. Melatonin agonists, such as ramelteon (Rozerem), do not have the same GABA-agonist side effects as benzodiazepines and may be a good choice for patients with sleep phase disorders, insomnia associated with shift work, or those with substance abuse problems. Anti-Parkinsonian drugs, such as gabapentin enacarbil (Horizant) and pramipexole (Mirapex), can be used to treat restless leg syndrome and periodic limb movement disorder. Antinarcoleptics, such as methylphenidate (Ritalin) and modafinil (Provigil), can improve daytime wakefulness in shift workers or those with narcolepsy or sleep apnea. Antidepressants and antianxiety medications, such as mirtazepine (Remeron) and trazodone, may be used for sleep due to their drowsy side effects. Orexin receptor antagonists alter the action of orexin, a chemical involved in regulating the sleep-wake cycle, in the brain.
It is important to note that sleeping pills are typically used for a short time and work best in combination with good sleep practices and behavioural treatments. Healthcare guidelines recommend that sleeping pills only be taken for a short period, as they can become less effective over time.
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Sleep aids are also used to treat central nervous system conditions
Sleep aids are often used to treat insomnia and other conditions that consistently keep individuals awake. Psychiatrists may prescribe sleeping pills depending on a patient's specific situation, such as insomnia comorbid with a psychiatric disorder, acute stress-induced insomnia, or substance abuse.
Sleeping pills are not the only option for treating insomnia and other sleep disorders. Cognitive behavioral therapy for insomnia (CBT-I) is recommended for patients with sleep apnea, substance abuse, chronic insomnia, or acute stress-induced insomnia. CBT-I can help individuals develop skills and habits to improve their sleep.
When considering sleep aids, it is important to consult a medical professional, especially for individuals with existing conditions, medications, family history, or current symptoms. Sleep aids can have side effects, and natural sleep aids may not be safe for everyone, especially those with certain allergies, conditions, or other medications.
Sleep aids can be classified into prescription medication, over-the-counter medication, and non-medicated methods. Prescription medication includes benzodiazepines such as diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin). These drugs are often prescribed for insomnia, especially in patients with mood or anxiety disorders. Older benzodiazepines like flurazepam (Dalmane), temazepam (Restoril), triazolam (Halcion), estazolam (Prosom), and quazepam (Doral) are formally FDA-approved for insomnia but are less commonly prescribed due to disadvantages like long half-lives or side effects like amnesia. Over-the-counter sleep aids include natural sleep supplements, which tend to have fewer side effects than prescription medications. Sedating antihistamines, such as diphenhydramine (Benadryl) and doxylamine, are also available over the counter and can be effective, but they may have next-day hangover effects, and patients may develop a tolerance.
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Benzodiazepines are a common hypnotic sleeping pill
Benzodiazepines are a class of psychoactive drugs that function as hypnotics/sleeping pills. They are commonly prescribed for the short-term treatment of insomnia and other sleep disorders. In the United States, for example, it is estimated that at least 30.5 million people took benzodiazepines prescribed by a healthcare provider over a 12-month period.
Benzodiazepines work by temporarily blocking the formation of new memories (anterograde amnesia) and by “loosening" the hold of anxiety. They improve sleep-related problems by shortening the time taken to fall asleep, prolonging sleep time, and reducing wakefulness. They are also used to treat conditions like muscle spasms, seizures, and catatonia, which is often associated with mental health conditions like schizophrenia or bipolar disorder.
Despite their widespread use, benzodiazepines do have drawbacks. They are habit-forming, and their use beyond 2 to 4 weeks is not recommended due to the risk of dependence. Other adverse effects include tolerance to their effects, rebound insomnia, reduced slow-wave sleep, and a withdrawal period marked by rebound insomnia, anxiety, and agitation.
Due to these side effects, physicians may recommend non-pharmacological interventions before prescribing benzodiazepines, such as improving sleep hygiene, avoiding caffeine and alcohol, or behavioural interventions like cognitive behavioural therapy for insomnia (CBT-I).
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Sleeping pills are recommended for short-term use only
Furthermore, there are often alternative methods to improve sleep that are recommended as a first line of treatment. Healthcare providers typically advise trying other approaches before resorting to sleeping pills. These can include changes to your sleeping environment, improving your sleep hygiene, or trying cognitive behavioral therapy (CBT). Sleep issues can be caused by various factors, such as caffeine consumption, shift work, stress, or underlying medical conditions. Addressing these underlying causes through lifestyle modifications or therapy may provide more sustainable improvements to sleep quality without the risks associated with long-term sleeping pill use.
In certain cases, however, sleeping pills can be beneficial for short-term relief. They can be helpful if you are going through a difficult or stressful period and are temporarily finding it hard to sleep. When used in conjunction with good sleep practices and behavioural treatments, sleeping pills can assist in getting your sleep patterns back on track. Additionally, for patients with sleep phase disorders, insomnia associated with shift work, or those with substance abuse problems, certain types of sleeping pills like ramelteon (Rozerem) may be a safer choice.
It is important to consult your healthcare provider before taking any sleeping pills, whether prescription or over-the-counter. They can assess your individual situation, consider any potential side effects, and determine if sleeping pills are appropriate for your specific needs. If sleeping pills are recommended, your healthcare provider will typically suggest a short-term course to minimise the risks associated with long-term use.
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Frequently asked questions
Psychiatrists are the second-largest prescribers of sleep aids outside of primary care. However, they are more likely to prescribe them for central nervous system conditions, such as neurotic disorders, depressive disorders, and affective psychoses, rather than general symptoms of insomnia.
Psychiatrists may prescribe benzodiazepines such as diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin) for insomnia, especially in patients with mood or anxiety disorders. Other options include antidepressants, antianxiety medications, and antinarcotics.
Yes, alternatives to sleeping pills include cognitive behavioural therapy (CBT), sedating antihistamines (e.g. diphenhydramine), and melatonin agonists such as ramelteon (Rozerem).
