Insomnia or trouble falling or staying asleep is a national problem with 50 % of people experiencing at some point and for many is an ongoing battle. Fewer than 6 hours of sleep nightly can negatively impact our health leading to daytime headaches, changes in mood and mental functioning and per the American Academy of Sleep Medicine says our chances of diabetes and getting high blood pressure goes up.
What questions should my doctor be asking me about Sleep?
Survey by the National Sleep Foundation showed that almost half of all patients have difficulty sleeping on a regular basis and yet only a handful shared this with their doctors. Also, many doctors are not asking the 2 sleep screening questions: (1) Do you have trouble staying or getting to sleep? and (2) Do you feel well rested after a night’s sleep? If you have trouble staying or getting to sleep and you do not feel well rested after a night’s sleep, you likely have a sleep problem.
What are the best medications to take for Sleep?
Best advice is to avoid sleep medications if possible and start to record your sleep habits in a sleep diary. You may discover a quick fix to your sleeping dilemma, such as, drinking coffee or alcohol too late at night, taking naps in the daytime, or using cell phones and computers right before sleep. All are clear “no-no’s,” to getting a good night sleep. If lack of sleep is a new problem important to get checked out by your doctor as may be a sign of a more serious medical condition.
If you discover that you do have a primary sleep problem after careful review, and a quick fix is desired, then medications may work in the short term, but cognitive behavioral therapy (CBT) is the gold standard of treatment that helps us develop new sleep habits but unfortunately takes time to work.
What is the best over the counter (OTC) sleep medication?
There are many sleep medications both prescription and over the counter (OTC). The safest OTC without significant daytime drowsiness are natural sleeping pills like Melatonin.
As we age, the amount of melatonin (hormone of sleep) in our body goes down making it harder to fall asleep and stay asleep so taking Melatonin supplements occasionally may make sense to improve sleep.
Melatonin is available OTC and also by prescription. Whichever you choose; meta-analysis (looking at many studies combined) says total sleep time is improved with Melatonin or prescription Melatonin enhancer, Ramelteon. It is especially effective improving sleep latency or time needed to fall asleep and increases sleep time by about 20 minutes.
Melatonin has no tolerance, dependence or “hangover effect,” unlike some of the other OTC sleep aides (such as Unison, or ZzzQuil) that use antihistamines as the “active,” ingredient, a drug that treats allergies but can also make you drowsy.
What are the most commonly prescribed Sleeping medications?
Prescription sleep medications are intended for quick fixes and not to be used long term. Part of the reason is that sleeping pills tend to work in the short term but are generally not effective over time as their effect on sleep wears out and can cause significant daytime drowsiness or a “hangover effect.”
The best sleep medication depends on your age, side effect profile, and sleep problem. The safest are Doxepin (Silenor), Melatonin enhancers (Ramelteon or Rozerem), and dual orexin binders (Suvorexant/Belsomra) compared with the “Z drugs,” including Zolpidem (Ambien) or Zaleplon (Sonata) that are central nervous system or brain depressants and can lead to dependence and serious safety concerns.
Another choice is Trazodone (Desyrel), an anti-depressant used off-label for sleep and is surprisingly widely prescribed with little evidence that it works well but some studies show that it may help with falling asleep quicker. Side effects may include dangerous health rhythms, dizziness, and prolonged erections or priapism.
Doxepil is a relatively safe choice and is the only FDA anti-depressant that is also approved for insomnia. The dose is 3 or 6 mg (even 1 or 3 mg) taken at bedtime and is a good choice for people with difficulty staying asleep or early morning awakening.
Suvorenxant (Belsoma) a newer class of FDA sleep medications called orexin binders works by blocking the “wake,” cycle. The newest is Daridorexant available in 25 mg and 50 mg doses that has a short-half-life to prevent daytime sleepiness. They show significant improvement with sleep quality especially with falling asleep sooner. Side effects include sleep paralysis and unusual dreams to list a few.
Zaleplon (Sonato), one of the Z drugs (Schedule IV controlled substance) is a capsule taken at bedtime. You can also take this after trying to fall asleep without it or in the middle of the night if needed. Unlike many of the others it is short acting, and you can take it as long as you need at least 4 hours of sleep. However, there are clear safety concerns as classified as a hypnotic with potentially serious side effects in older people including higher risk of falls, accidents and confusion.
There are so many Sleep medications, OTC, natural and prescription. How do I choose?
The choice of sleep medication depends on your type of sleep problem, if in response to a life stressor or more chronic in nature, side effect profile, and if interacts with any of your other medications.
Would recommend avoiding OTC medications outside of low dose melatonin as many of the antihistamines can give the “hanger over,” effect and make you more prone to falls, accidents, and daytime confusion.
Your best bet is to keep a sleep diary and try to pinpoint the cause of insomnia, too much caffeine, use of cellular devices or life stressors and to manage with lifestyle changes and or cognitive behavioral therapy (CBT) that focuses on better sleep hygiene. You can discuss this with your doctor and come up with the best plan for you.
If you need prescription sleep medications in the short-term safest choices are the Melatonin enhancers, low dose anti-depressants like Doxepin or one of the newer targeted sleep medications like Suvorexant. These specifically help with difficulty falling or staying asleep.
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