Prescription sleeping pills: What's right for you?

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If you're regularly having problems sleeping, ask your doctor for an evaluation. Treatment is available but it depends on what's causing your insomnia. For occasional sleepless nights, prescription sleeping pills may be helpful. Although sleeping pills don't treat the underlying cause of insomnia, they may help you get some much needed rest.

Today's prescription sleeping pills don't carry the same risks of dependence and lethal overdoses as sleeping pills of the past. But risks remain — especially for people who have certain medical conditions, including liver and kidney disease. Here's the lowdown on some of the most common types of sleeping pills used today.

Types of prescription sleeping pills

Sleeping pills that help you fall asleep

The following medications are used mainly to help you fall asleep. They're typically taken for less than two weeks at a time.
Various side effects can occur with each, but all may cause:

• Dizziness
• Facial swelling
• Headache
• Prolonged drowsiness, though less so than with drugs that help you stay asleep
• Severe allergic reaction
• Sleep behaviors such as sleep-driving and sleep-eating

These medications may not be safe if you're an older adult. Some reports suggest that sleeping pill use is associated with an increased risk of nighttime falls and injury in older adults. Other important considerations are listed below.

Drugs that help you fall asleep

• Eszopiclone (Lunesta)
• Ramelteon (Rozerem)
• Triazolam — a benzodiazepine derivative (Halcion)
• Zaleplon (Sonata)
• Zolpidem (Ambien)

Sleeping pills that help you stay asleep

The following prescription medications are used mainly to help you stay asleep. They are also typically taken for less than two weeks at a time.

Various side effects can occur with each, but all may cause:

• Dizziness
• Facial swelling
• Headache
• Prolonged drowsiness
• Severe allergic reaction
• Sleep behaviors such as sleep-driving and eating

These medications may not be safe if you're pregnant, breast-feeding or are an older adult. Some reports suggest that sleeping pill use is associated with an increased risk of nighttime falls and injury in older adults. Other important considerations are listed below.

Drugs that help you stay asleep

• Estazolam — a benzodiazepine derivative
• Eszopiclone (Lunesta)
• Temazepam — a benzodiazepine (Restoril)
• Zolpidem (Ambien CR)

Sedating antidepressants

Sometimes prescription drugs used mainly to treat depression may ease insomnia when taken in lower doses. Although widely used, these are not Food and Drug Administration-approved for insomnia only. Discuss alternatives with your doctor. When insomnia is secondary to depression or anxiety, antidepressants can improve both conditions at the same time.

Various side effects can occur with each, but all may cause:

• Blurred vision
• Constipation
• Dizziness
• Headache
• Prolonged drowsiness
• Weight gain

These medications may not be safe if you're pregnant or breast-feeding or have a history of heart problems. And they may lead to suicidal thoughts or worsen existing depression, particularly in children and adolescents. Other important considerations are listed below.

Drugs for when you can't sleep and you're depressed

• Amitriptyline — a tricyclic antidepressant
• Nortriptyline (Pamelor)
• Trazodone (Desyrel)

Taking sleeping pills

If your best attempts to get a good night's sleep have failed, prescription sleeping pills may be an option. Use them safely.

• Get a medical evaluation. Before you take sleeping pills, get a thorough medical evaluation of your problem. Often your doctor may be able to identify specific causes for your insomnia. Nondrug approaches including cognitive behavioral therapy may be effective. Sleeping on a regular schedule, exercising regularly, avoiding caffeine and daytime naps, and keeping stress in check are helpful foundations to an effective treatment.
• Never take a sleeping pill until you're going to bed. Taking a sleeping pill and then trying to complete other activities may lead to dangerous situations in which you're not aware of what you're doing.
• Avoid alcohol. Never mix alcohol and sleeping pills. Alcohol increases the sedative effects of the pills. Even a small amount of alcohol combined with sleeping pills can make you feel dizzy, confused or faint. Alcohol alone can cause insomnia.
• Quit carefully. When you're ready to stop taking sleeping pills, follow your doctor's instructions or the directions on the label. Some medications must be stopped gradually.
• Watch for side effects. If you feel sleepy or dizzy during the day, talk to your doctor about changing the dosage or discontinuing the pills.

Everyone deserves a good night's sleep. If you continue to have trouble sleeping, consult your doctor for help.

By Mayo Clinic Staff Dec 8, 2007
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