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Drugs used to treat insomnia
Posted Tue, 30 May 2000
There are several types of drugs used to treat insomnia, some of them effective, and others pretty useless, and potentially addictive.
Hypnotic medications
The drugs most commonly used to treat insomnia are the benzodiazepines, for example diazepam (Valium®). These come in short-acting and long-acting preparations.
They should only be used for short periods of time, since they are highly addictive. However, many people with insomnia, particularly if it is combined with anxiety, use these drugs chronically. Never stop these drugs abruptly, since that will lead to withdrawal symptoms. People can be weaned off them slowly, in consultation with their doctor.
The main side effects, apart from addiction, are short-term memory loss, and residual day-time drowsiness in the longer-acting preparations.
These drugs should really be used for a few days at a time, to try to break a pattern of sleeplessness, while trying to get to the root cause of the problem.
Antidepressants
The sedating antidepressants are commonly prescribed for insomnia in low doses. There is little evidence that they are effective in pure insomnia.
When patients with depression use these drugs, they certainly help with the insomnia which is one of the signs of depression, and poor sleep is one of the first symptoms which is relieved.
The tricyclic antidepressants have a wide range of unpleasant side-effects, although these are less of a problem in very low doses. The most common side effect is a dry mouth.
These, and the newer serotonin reuptake inhibitors, can exacerbate restless leg syndrome and periodic limb movement disorder in some patients.
Both can affect libido.
Antihistamines
Certain types of antihistamines are sedative, and most over-the-counter remedies for insomnia contain antihistamines.
The antihistamines most commonly used in the treatment of insomnia are diphenhydramine and hydroxyzine.
They appear to be effective in the short-term, but there are no studies of their efficacy in the long-term.
Adverse effects include daytime sedation, problems with reasoning and thought, and some of the same side effects as the tricyclic antidepressants. Some people report that they become less effective with time, and that they suffer withdrawal symptoms when they stop the drugs.
Melatonin
The main way in which melatonin may help insomnia is in shifting the phases of our circadian rhythms (see Biological rhythms: how do they affect us?)
It also causes sleepiness when taken during the day.
So far, the role of melatonin in treating insomnia is equivocal. Some people say that it works, and others find that it has no effect at all. There have been few clinical studies of its efficacy in treating insomnia.
Other drugs
There are a variety of barbiturates such as chloral hydrate, methyprylon and meprobamate still available.
They are not recommended, since they are highly addictive, rapidly become less effective over time, and have severe complications on withdrawal.
Alternative medication
There are many herbal preparations (e.g. valarian root, herbal teas), and "nutritional substances" (e.g. 1-tryptophan) promoted for the relief of insomnia. None of these have been tested, so it is difficult to say whether or not they work. In general with alternative medication, you will have to see if there is something which suits you.
However, it is important to remember that, simply because something is advertised as an alternative medication, it may not be free of side effects, and that anything which has a pharmacological effect on the body is a drug.
See Insomnia: a common problem.
