Gina Johnson
Sleep is an essential part of our lives, and when we can't sleep, it can be tempting to turn to sleeping pills. Sleeping pills can be a short-term solution for insomnia, but they are not without their risks. Side effects can include memory problems, falls, and even death. It is important to understand the risks and to consult a healthcare professional before taking any sleep medication. With that in mind, here are 10 of the most commonly prescribed sleeping pills.
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What You'll Learn
The benefits of Doxepin (Silenor)
While I cannot provide a ranked list of the 10 best sleeping pills, I can provide information on the benefits of Doxepin (Silenor).
Doxepin (Silenor) is a tricyclic antidepressant that helps adults with insomnia stay asleep. It is a tablet that is taken by mouth 30 minutes before bedtime. It is available in 3 and 6 mg doses, with the lower dose being recommended for patients older than 65 years, and the higher dose being recommended for younger adults. Doxepin is not a controlled substance and has not been shown to cause dependence in studies. It is generally safe when used at low doses, with no reports of suicide among patients taking low-dose doxepin.
The main benefit of Doxepin (Silenor) is that it helps people with insomnia fall asleep and stay asleep. It slows down brain activity to promote sleep, and blocks histamine receptors in the brain, helping people stay asleep during the night and preventing them from waking up too early. In sleep studies, total sleep duration increased by 25 to 38 minutes compared to a placebo. Doxepin is also available as a capsule and liquid to treat depression and anxiety.
It is important to note that Doxepin (Silenor) can cause sleepiness and tiredness, so it should only be taken when one is ready to fall asleep for the night. It should not be taken within three hours of a meal, as food can cause the effects of the medication to linger until the next day, leading to daytime sleepiness. Additionally, it should not be taken with alcohol, as it can increase the risk of doing activities like driving or cooking while not fully awake, which can be dangerous.
Doxepin (Silenor) may not be suitable for everyone. It should not be taken by those with severe urinary retention or by those who take or have recently taken monoamine oxidase inhibitors. Pregnant or breastfeeding women should consult a doctor or obstetrician-gynaecologist before taking Doxepin (Silenor), as it can be found in breast milk and potentially cause side effects in the baby.
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Zolpidem for short sleep windows
Zolpidem is a sedative-hypnotic medication used for the short-term treatment of insomnia in adults. It is a non-benzodiazepine compound that exhibits a rapid-onset, short-duration hypnotic effect by binding to benzodiazepine receptors. Zolpidem is one of the so-called "Z-drugs", which were originally developed as safer alternatives to benzodiazepines. It is available in both immediate and extended-release forms, with the immediate-release preparations used to treat symptoms related to delayed sleep onset.
The standard adult dose is 10mg daily for up to four weeks, taken at bedtime. However, the recommended dose for women is 5mg, while men can take 5 or 10mg. Zolpidem is a fast-acting medication, usually making the user feel sleepy within an hour. It is considered a short-acting hypnotic, meaning it may help users fall asleep quicker, but may not help them stay asleep longer as its effects wear off fairly quickly.
Zolpidem has a good safety profile compared to benzodiazepine-class drugs and is effective when taken at the recommended dosage. However, it is known to interact with other drugs, especially those with sedative properties. It also has a wide variety of adverse effects, including an increased risk of falls and hip fractures in patients. Due to concerns over tolerance, dependence, and withdrawal effects, it should not be used for more than four weeks.
Zolpidem is a useful medication for those needing rapid sleep onset or short-duration effects, such as shift workers and travellers. It is only available on prescription, and patients should be closely monitored for adverse effects, especially in the case of elderly or debilitated patients.
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Mirtazapine and Trazodone
Trazodone is a medication prescribed to treat depression, anxiety, and insomnia related to depression. It belongs to a class of medications called serotonin modulators and works by increasing serotonin levels in the brain to maintain mental balance. The common starting dosage for Trazodone for sleep is 150 mg per day, sometimes divided into multiple doses. It may take two weeks or more to feel the full effects of Trazodone.
In a study of Mirtazapine versus Trazodone for insomnia, both medications were effective for over 60% of participants. Approximately 53% of Mirtazapine users reported drowsiness after use. Studies have shown that Mirtazapine improves total time spent sleeping and provides better sleep quality. Mirtazapine may also help decrease depressive symptoms and enhance sleep. Treating sleep problems could potentially improve depression symptoms simultaneously. In multiple clinical trials, Trazodone has shown to be effective in improving sleep latency (time to fall asleep) and sleep quality. Trazodone has also been shown to improve daytime cognitive functioning by improving sleep quality.
Because both Mirtazapine and Trazodone increase serotonin levels in the brain, it is generally not advised to take the two drugs together. This can put you at higher risk for serotonin syndrome, a rare but serious condition. Symptoms of serotonin syndrome include confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering, shaking, blurred vision, muscle spasms, tremors, incoordination, stomach cramps, nausea, vomiting, and diarrhea. Side effects for both drugs are similar and include drowsiness, anxiousness, increased weight and appetite, constipation, changes in appetite or weight, weakness or tiredness, and nervousness.
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The risks of sleeping pills
While sleeping pills can be effective in treating insomnia, they also come with certain risks. Firstly, sleeping pills can cause side effects such as daytime sleepiness, dry mouth, blurred vision, constipation, dizziness, confusion, memory issues, and balance problems. Some pills may also lead to complex sleep behaviours, such as sleepwalking, sleep driving, or engaging in activities like eating or making phone calls while asleep. These behaviours can be dangerous and may result in injuries or accidents.
Sleeping pills also carry a risk of misuse, addiction, and dependence. Tolerance can develop over time, leading to a need for higher doses to achieve the same effects. This can result in psychological dependence, making it difficult to fall asleep without the medication. Additionally, stopping the medication too quickly can lead to withdrawal symptoms and rebound insomnia, where sleep problems return and worsen.
Certain sleeping pills may interact with other medications, especially those affecting the central nervous system. Consuming alcohol with sleeping pills can enhance sedation, leading to dangerous consequences. Mixing sleeping pills with opioids, other sedatives, or alcohol can increase the risk of overdose, especially in teens and young adults.
Sleeping pills are not recommended for long-term use, as they are not a cure for insomnia. Older adults and pregnant individuals are at a higher risk of adverse effects, and non-drug treatments are often recommended for these populations. Additionally, individuals with a history of substance abuse, depression, or mood problems should exercise caution when considering sleeping pills.
It is important to consult a healthcare provider before taking any sleeping medication to ensure safe and appropriate use, especially when considering prescription pills or combining them with other substances.
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Non-prescription options
Non-prescription sleeping pills, also known as over-the-counter (OTC) drugs, are available without a prescription from a doctor. They are typically recommended for short-term use and occasional sleep problems, and should be used with caution. While non-prescription sleeping pills are generally weaker than prescription medications, they can still carry risks and side effects.
One option for non-prescription sleeping pills is antihistamines, which cause drowsiness as a side effect. While these can be helpful for occasional sleep issues, they are not intended for long-term use. Melatonin is another non-prescription option, which is particularly useful for shift workers and travellers who need rapid sleep onset or short-duration effects. Melatonin is a naturally occurring substance in the body, and it can help promote sleep and positively affect circadian rhythms.
It is important to note that even non-prescription sleeping pills can have side effects, and they may not be suitable for everyone. For example, older adults may be more sensitive to sedative effects and side effects, and should exercise caution when taking sleeping pills. Additionally, women who are pregnant or nursing should consult a doctor or healthcare provider before taking any sleep aids, as there may be safety concerns.
While non-prescription sleeping pills can be helpful in the short term, it is recommended to combine their use with cognitive-behavioural therapies and lifestyle modifications, sometimes referred to as "sleep hygiene". Making improvements to sleep habits and hygiene can help address underlying causes of sleep issues and lead to more long-lasting results.
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Frequently asked questions
Over-the-counter sleeping pills are typically antihistamines, which take advantage of drowsiness as a side effect. They are not recommended for long-term use. Melatonin is another common over-the-counter sleep aid.
Prescription sleeping pills include Doxepin (Silenor), Estazolam (Prosom), Eszopiclone (Lunesta), Zaleplon (Sonata), Zolpidem, Triazolam (Halcion), Clonazepam (Klonopin), Mirtazapine, Trazodone, and Ramelteon (Rozerem).
Side effects vary depending on the medication but may include daytime sleepiness, dry mouth, dizziness, blurred vision, constipation, abnormal dreams, CNS depression, and increased heart rate. Some prescription sleeping pills can also be habit-forming and cause withdrawal symptoms.
Pregnant or nursing mothers, the elderly, and those with a history of substance abuse, depression, or other mood problems should exercise caution when taking prescription sleeping pills. It is important to consult a healthcare provider before starting any sleep aid.
