Herbie Murray
Sleep disorders such as insomnia, sleep apnea, and narcolepsy can be treated with a variety of medications. Doctors may prescribe sleeping pills, antidepressants, antianxiety medications, or hypnotics to help patients fall and stay asleep. Sleeping pills, however, are typically recommended for short-term use due to the risk of side effects, misuse, and dependency. Anticonvulsants and anti-Parkinsonian drugs can also be used to treat restless leg syndrome, nocturnal eating syndrome, and insomnia related to bipolar disorder. Additionally, antinarcoleptics can improve daytime wakefulness for shift workers or those with narcolepsy or sleep apnea.
| Characteristics | Values |
|---|---|
| Types of Medication | Sleeping Pills, Anticonvulsants, Anti-Parkinsonian Drugs, Benzodiazepines, Antinarcoleptics, Antidepressants, Antianxiety Medications, Hypnotics, Over-the-Counter Pills, Antihistamines |
| Purpose | To help people fall asleep, stay asleep, or both |
| Usage | Generally used for a short time, in combination with good sleep practices and/or behavioural treatments |
| Side Effects | Dependency, Misuse, Tolerance, Withdrawal, Grogginess, Memory Problems, Parasomnia, Addiction, Substance Use Disorder, CNS Impairments |
| Precautions | Consult a doctor before starting, especially if taking other medications, alcohol, vitamin supplements, antidepressants, or if pregnant or nursing |
| Treatment Approach | Address underlying reasons for insomnia, such as anxiety or panic disorder |
| Alternative Treatments | Continuous Positive Airway Pressure (CPAP), Electroconvulsive Therapy, Oxygen Therapy, Surgery, Dental Mouthpieces |
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What You'll Learn
Sleeping pills
There are numerous types of sleeping pills, including Benzodiazepines (BZD), a powerful class of sleeping pills that help people fall asleep, relieve anxiety, and improve learning and memory. These drugs raise levels of brain GABA neurotransmitters, causing sleepiness and allowing people to sleep better. This class of medications includes alprazolam, clonazepam, diazepam, lorazepam, and temazepam, available in short- and long-acting forms. Benzodiazepines can be addictive and lead to substance use disorders. To minimize this risk, healthcare providers prescribe these sleeping pills for short-term use only.
Non-benzodiazepine (Non-BZD) or Z-drugs are fast-acting sleeping pills that take effect 30 minutes after intake and last up to 8 hours. They induce sleepiness, calm anxiety, and promote sound sleep without leaving you feeling groggy or lightheaded in the morning. This class of medications includes Zolpidem, Ambien, and Zopiclone. Melatonin is another synthetic drug that mimics the same hormone in the brain, aiding the body's relaxation and helping people fall asleep.
Other prescription medications that can help with sleep include doxepin (Silenor) and Ramelteon (Rozerem). Suvorexant (Belsomra) may help a person fall asleep and maintain sleep, but it has a risk of misuse and dependence. Trazodone (Desyrel) is typically used to treat major depressive disorder, but it may be prescribed off-label to aid sleep since drowsiness is one of its side effects. Anticonvulsants such as gabapentin enacarbil (Horizant) and pregabalin (Lyrica) can also be used to treat nocturnal eating syndrome, restless legs syndrome, and insomnia related to bipolar disorder.
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Anticonvulsants
Some of the commonly prescribed anticonvulsants for sleep disorders include carbamazepine (Epitol, Tegretol, or Carbatrol), gabapentin enacarbil (Horizant), pregabalin (Lyrica), and valproate (Depakene, Depakote, or Depakon). These drugs are particularly useful in treating nocturnal eating syndrome, restless legs syndrome, periodic limb movement disorder, and insomnia related to bipolar disorder.
While anticonvulsants can be beneficial for sleep disorders, it is important to note that they may have varying effects on sleep architecture. For example, studies have shown that perampanel is associated with a low incidence of insomnia, while lacosamide is linked to a reduced risk of daytime sleepiness. On the other hand, clonazepam, felbamate, lamotrigine, oxcarbazepine, and phenobarbital have been found to worsen or have no effect on sleep. Lamotrigine, in particular, may increase the risk of insomnia, and phenobarbital may contribute to daytime sleepiness.
Additionally, it is worth mentioning that the effects of certain anticonvulsants on sleep are still unclear. For instance, the impact of zonisamide, oxcarbazepine, and topiramate on sleep and sleep disorders is yet to be fully understood. Furthermore, while cannabidiol, carbamazepine, and levetiracetam have been found to have no effect on sleep, epilepsy surgery may positively influence sleep in patients with favourable surgical outcomes.
In conclusion, while anticonvulsants can be prescribed to treat specific sleep disorders, it is crucial to carefully consider the potential benefits and risks associated with each drug. Clinicians should make informed decisions, especially for patients with comorbid sleep disorders, to ensure the selected treatment effectively improves sleep without causing unintended adverse effects.
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Antinarcoleptics
Some common antinarcoleptic medications include methylphenidate (Ritalin) and modafinil (Provigil). These drugs can enhance alertness and reduce the overwhelming urge to fall asleep during the day. They are particularly useful for shift workers or those with conditions like narcolepsy or sleep apnea, helping them stay awake and function effectively during their desired wakeful periods.
Pitolisant (Wakix), a histamine receptor antagonist, is another antinarcoleptic drug. It blocks specific chemicals in the body from attaching to cells, thereby controlling excessive daytime sleepiness. Pitolisant can be particularly beneficial for individuals with narcolepsy, helping them manage their condition and lead more productive lives.
Sodium oxybate (Xyrem, Xywav) is also used to treat narcolepsy by reducing excessive daytime sleepiness and improving sleep at night. Antidepressants are sometimes prescribed off-label to treat symptoms associated with narcolepsy, such as sudden loss of muscle control, hallucinations, and sleep paralysis. While their effectiveness in treating narcolepsy is uncertain, they can provide relief from specific symptoms.
While antinarcoleptics can be beneficial, they may also come with side effects. The specific side effects depend on the medication being taken. It is important to consult a doctor before taking any medication to ensure proper diagnosis and guidance on potential side effects and interactions with other substances or medications.
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Antidepressants
Trazodone (Desyrel) is a medication that modulates the neurotransmitter serotonin and is typically used to treat major depressive disorder. Doctors may prescribe it off-label to help a person fall asleep since one of its side effects is drowsiness. However, its sedative effects tend to wear off over time, and it comes with risks, including daytime fatigue, reduced recovery rates in depression, and dry mouth, which can interfere with sleep.
Doxepin (Silenor) is another antidepressant that can be used to treat insomnia. It may help a person fall asleep and stay asleep, and doctors may suggest people with insomnia use it for up to 3 months. However, it is not recommended for those taking monoamine oxidase inhibitors, a type of antidepressant, or people with glaucoma or urinary retention.
Mirtazapine is an antidepressant that is often used for insomnia. However, studies have shown that it may increase the risk of restless legs syndrome (RLS) compared to other antidepressants.
Bupropion is an antidepressant that appears to treat RLS, which is common in conditions like ADHD and PTSD that often co-occur with depression. It is surprisingly more favourable for sleep than SSRIs, as it causes no more insomnia and has neutral or positive effects on sleep architecture.
In summary, while antidepressants can be used to treat sleep disorders, they should be carefully selected and monitored due to their potential side effects on sleep quality. Doctors may prescribe them off-label to help with sleep, but it is important to consider the potential risks and benefits for each patient.
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Anti-Parkinsonian drugs
Sleep disorders are a common occurrence in Parkinson's Disease (PD) patients, with impaired sleep and alertness affecting the majority of patients. This can have a detrimental impact on their quality of life and safety. While the optimal treatment for insomnia in PD patients has not been established, anti-Parkinsonian drugs, which are dopamine agonists, can be used to treat sleep disorders such as restless legs syndrome and periodic limb movement disorder. These include:
Gabapentin enacarbil (Horizant)
This drug is an anticonvulsant and can be used to treat nocturnal eating syndrome, restless legs syndrome, and periodic limb movement disorder.
Pramipexole (Mirapex)
Ropinirole (Requip)
Rotigotine (Neupro)
These anti-Parkinsonian drugs may be prescribed to treat sleep disorders, but it is important to note that medications are typically used for a short time and in conjunction with good sleep practices and behavioural treatments.
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Frequently asked questions
There are various medications that can be used to treat sleep disorders, including:
- Sleeping pills
- Anticonvulsants
- Antinarcoleptics
- Antidepressants
- Antianxiety medications
- Anti-Parkinsonian drugs
- Hypnotics
Some examples of sleeping pills include:
- Doxepin (Silenor)
- Ramelteon (Rozerem)
- Trazodone (Desyrel)
- Suvorexant (Belsomra)
Hypnotics are a class of drugs that include benzodiazepines. Some types of benzodiazepines include:
- Alprazolam (Xanax)
- Clonazepam (Klonopin)
- Diazepam (Diastat, Valium)
- Estazolam (Prosom)
- Lorazepam (Ativan)
- Temazepam (Restoril)
Sleep medications can have various side effects, including:
- Misuse
- Dependency
- Interactions with other substances
- Central nervous system (CNS) depression
- Memory problems
- Withdrawal symptoms
Yes, in addition to medications, there are also non-pharmacological treatments for sleep disorders. For example, continuous positive airway pressure (CPAP) therapy is often used to treat obstructive sleep apnea. Other non-pharmacological approaches include:
- Electroconvulsive therapy
- Lifestyle changes
- Sleep habit changes
- Behavioural treatments
