Anti-Insomnia Drugs

Definition

Anti-insomnia drugs are medicines that help people fall asleep or stay asleep.

Purpose

Physicians prescribe anti-insomnia drugs for short-term treatment of insomnia—a sleep problem in which people have trouble falling asleep or staying asleep or wake up too early and can't go back to sleep. These drugs should be used only for occasional treatment of temporary sleep problems and should not be taken for more than a week or two at a time. People whose sleep problems last longer than this should see a physician. Their sleep problems could be a sign of another medical problem.

Description

The anti-insomnia drug described here, zolpidem (Ambien), is a classified as a central nervous system (CNS) depressant. CNS depressants are medicines that slow the nervous system. Physicians also prescribe medicines in the benzodiazepine family, such as flurazepam (Dalmane), quazepam (Doral), triazolam (Halcion), estazolam (ProSom), and temazepam (Restoril), for insomnia. Benzodiazepine drugs are described in the essay on antianxiety drugs. Zaleplon (Sonata) is another anti-insomnia drug that is not related to other drugs with the same effect. The barbiturates, such as pentobarbital (Nembutal) and secobarbital (Seconal) are no longer commonly used to treat insomnia because they are too dangerous if they are taken in overdoses. For patients with mild insomnia, some antihistamines, such as diphenhydramine (Benadryl) or hydroxyzine (Atarax) may be used, since these also cause sleepiness.

Zolpidem is available only with a physician's prescription and comes in tablet form.

Recommended dosage

The recommended dose for adults is 5-10 mg just before bedtime. The medicine works quickly, often within 20 minutes, so it should be taken right before going to bed.

For older people and others who may be more sensitive to the drug's effects, the recommended starting dosage is 5 mg just before bedtime.

Zolpidem may be taken with food or on an empty stomach, but it may work faster when taken on an empty stomach. Check with a physician or pharmacists for instructions on how to take the medicine.

Precautions

Zolpidem is meant only for short-term treatment of insomnia. If sleep problems last more than seven to 10 days, check with a physician. Longer-lasting sleep problems could be a sign of another medical problem. Also, this drug may lose its effectiveness when taken every night for more than a few weeks.

Some people feel drowsy, dizzy, confused, lightheaded, or less alert the morning after they have taken zolpidem. The medicine may also cause clumsiness, unsteadiness, double vision, or other vision problems the next day. For these reasons, anyone who takes these drugs should not drive, use machines or do anything else that might be dangerous until they have found out how zolpidem affects them.

This medicine has caused cause behavior changes in some people, similar to those seen in people whose behavior changes when they drink alcohol. Examples include giddiness and rage. More extreme changes, such as confusion, agitation, and hallucinations, also are possible. Anyone who starts having strange or unusual thoughts or behavior while taking this medicine should get in touch with his or her physician.

Zolpidem and other sleep medicines may cause a special type of temporary memory loss, in which the person does not remember what happens between the time they take the medicine and the time its effects wear off. This is usually not a problem, because people go to sleep right after taking the medicine and stay asleep until its effects wear off. But it could be a problem for anyone who has to wake up before getting a full night's sleep (seven to eight hours). In particular, travelers should not take this medicine on airplane flights of less than seven to eight hours.

KEY TERMS

Asthma— A disease in which the air passages of the lungs become inflamed and narrowed.

Bronchitis— Inflammation of the air passages of the lungs.

Emphysema— A lung disease in which breathing becomes difficult.

Hallucination— A false or distorted perception of objects, sounds, or events that seems real. Hallucinations usually result from drugs or mental disorders.

Sleep apnea— A condition in which a person temporarily stops breathing during sleep.

Withdrawal symptoms— A group of physical or mental symptoms that may occur when a person suddenly stops using a drug to which he or she has become dependent.

Because zolpidem works work on the central nervous system, it may add to the effects of alcohol and other drugs that slow down the central nervous system, such as antihistamines, cold medicine, allergy medicine, medicine for seizures, tranquilizers, some pain relievers, and muscle relaxants. Zolpidem may also add to the effects of anesthetics, including those used for dental procedures. The combined effects of zolpidem and alcohol or other CNS depressants (drugs that slow the central nervous system) can be very dangerous, leading to unconsciousness or even death. People who take zolpidem should not drink alcohol and should check with their physicians before taking any other CNS depressant. Anyone who shows signs of an overdose or of the effects of combining zolpidem drugs with alcohol or other drugs should have immediate emergency help. Warning signs include severe drowsiness, severe nausea or vomiting, breathing problems, and staggering.

Anyone who takes zolpidem for more than 1-2 weeks should not stop taking it without first checking with a physician. Stopping the drug abruptly may cause rebound insomnia; increased difficulty falling asleep for the first one of two nights after the drug has been discontinued. In rare cases, withdrawal symptoms, such as vomiting, cramps, and unpleasant feelings may occur. Gradual tapering may be necessary.

Older people may be more sensitive to the effects of zolpidem. This may increase the chance of side effects, such as confusion, and may also increase the risk of falling.

In people with breathing problems, zolpidem may worsen the symptoms.

Special conditions

People with certain other medical conditions or who are taking certain other medicines can have problems if they take zolpidem. Before taking this medicine, be sure to let the physician know about any of these conditions:

ALLERGIES. Anyone who has had unusual reactions to zolpidem in the past should let his or her physician know before taking the drugs again. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.

PREGNANCY. Women who are pregnant or who may become pregnant should check with their physicians about the safety of using zolpidem during pregnancy.

BREASTFEEDING. Women who are breastfeeding should check with their physicians before using zolpidem.

OTHER MEDICAL CONDITIONS. Before using zolpidem, people with any of these medical problems should make sure their physicians are aware of their conditions:

• Chronic lung diseases (emphysema, asthma, or chronic bronchitis)
• Liver disease
• Kidney disease
• Current or past alcohol or drug abuse
• Depression
• Sleep apnea

USE OF CERTAIN MEDICINES. Taking zolpidem with certain other drugs may affect the way the drugs work or may increase the chance of side effects.

Side effects

The most common minor side effects are daytime drowsiness or a "drugged" feeling, vision problems, memory problems, nightmares or unusual dreams, vomiting, nausea, abdominal or stomach pain, diarrhea, dry mouth, headache, and general feeling of discomfort or illness. These problems usually go away as the body adjusts to the drug and do not require medical treatment.

More serious side effects are not common, but may occur. If any of the following side effects occur, check with the physician who prescribed the medicine as soon as possible:

• Confusion
• Depression
• Clumsiness or unsteadiness

Patients who take zolpidem may notice side effects for several weeks after they stop taking the drug. They should check with their physicians if these or other troublesome symptoms occur:

• Agitation, nervousness, feelings of panic
• Uncontrolled crying
• Worsening of mental or emotional problems
• Seizures
• Tremors
• Lightheadedness
• Sweating
• Flushing
• Nausea or abdominal or stomach cramps
• Muscle cramps
• Unusual tiredness or weakness

Other rare side effects may occur. Anyone who has unusual symptoms after taking zolpidem should get in touch with his or her physician.

Interactions

Zolpidem may interact with other medicines. When this happens, the effects of one or both of the drugs may change or the risk of side effects may be greater. Anyone who takes zolpidem should let the physician know all other medicines he or she is taking. Among the drugs that may interact with zolpidem are:

• Other central nervous system (CNS) depressants such as medicine for allergies, colds, hay fever, and asthma; sedatives; tranquilizers; prescription pain medicine; muscle relaxants; medicine for seizures; barbiturates; and anesthetics.
• The major tranquilizer chlorpromazine (Thorazine).
• Tricyclic antidepressants such as imipramine (Tofranil) and amitriptyline (Elavil).

Anti-insomnia drugs

Definition

Anti-insomnia drugs are medicines that help people fall asleep or stay asleep.

Purpose

Physicians prescribe these medications for short-term treatmet for people who have trouble falling or staying asleep, or wake up too early and can't go back to sleep. They are intended only for occasional, short-term treatment of temporary sleep problems. People who have longer term difficulty with sleeping may have emotional, psychological, or other medical problems interfering with sleep.

Description

Anti-insomnia drugs are central nervous system (CNS) depressants, hypnotics, some are members of the benzodiazepine family of tranquilizers, and antidepressants. Some antihistamines that can be purchased over the counter, like diphenhdramine and hydroxyzine (Atarax) may be used to as sleep aids.

Barbiturate drugs, like pentobarbital or secobarbital are no longer used for sleep. Commonly used products includ quazepam (Doral), triazolam (Halcion), estazolam (ProSom), temazepam (Restoril), zolpidem (Ambien), zalopon (Sonata) and Lunesta.

Recommended dosage

Anti-insomnia medications are normally taken shortly before going to bed.

When taking these drugs, seniors, especially the very elderly, should begin with the lowest dose of the particular medication that is available.

Anti-insomnia medications may be taken with or without food, but they may work faster when taken on an empty stomach. Check with a physician or pharmacists for specific instructions.

Precautions

Hallmarks of aging include progressive, barely noticeable losses of balance, strength and muscle coordination and greater liklihood for becominng disoriented and confused. Anti-insomnia drugs increase risks of bad dreams, becoming agitated, confused, and falling. These drugs can produce a hangover effect lasting up to 18 hours. Under the influence of these medications, some people have said and done things, like driving cars, without remembering them later.

Alcohol and many medicines like antihistamines in cough and cold medications, anti-anxiety, anti-seizure, anti-depressant, blood pressure, pain relievers and some muscle relaxant medications can increase the effects of anti-insomnia medicines. People who have excessive drowsiness, staggering gait or slowed and difficult breathing should receive emergency treatment.

Drug interactions

The liver removes anti-insomnia medicines, and many other classes of drugs, fromthe body. Other classes of drugs include antibiotics , antifungal drugs, heart and blood pressure medications, and grapefruit juice, Their effects on one another are not well understood and cannot be accurately predicted in individual cases.

ALLERGIES Anyone who has had an adverse reaction to one anti-insomnia medicine might be able to safely use a different one, but caution is warranted.

Information for patients and caregivers Almost all seniors have periods where they have difficulty getting to sleep, staying asleep, or awakening early. Worrying about sleeping makes the periodic sleep-problems worse. Simple lifestyle adjustments from time to time, like taking periodic, short daytime naps, staying up later at night, getting up earlier, or reading in the middle of the night can tide people over. Talking about troublesome thoughts or life problems with a trusted friend or counsellor can be an important aid to removing barriers to sleep. When anti-insomnia medications are used, seniors should have well lit sleeping areas and be monitored for safety.

Questions for the doctor Before starting any medication program, especially anti-insomnia medication, a plan should be established with the doctor that includes why the drug is being used, what benefits are sought and expected, when to evaluate the effects, and what the next step will be regardless of how well the medication works.

• liver disease
• kidney disease
• current or past alcohol or drug abuse
• depression
• sleep apnea
• depression
• clumsiness or unsteadiness

Patients who take zolpidem may notice side effects for several weeks after they stop taking the drug. They should check with their physicians if these or other troublesome symptoms occur:

• agitation, nervousness, feelings of panic
• uncontrolled crying
• worsening of mental or emotional problems
• seizures
• tremors
• lightheadedness
• sweating
• flushing
• nausea or abdominal or stomach cramps
• muscle cramps
• unusual tiredness or weakness

Nancy Ross-Flanigan

SLEEPING PILLS

This is a general term applied to a number of different drugs in pill form that help induce sleep, i.e. sedative-hypnotic agents. There is a wide range of such medication and many require a doctor's prescription, but some can be purchased as Over-the-Counter drugs at a pharmacy. These latter preparations generally contain an antihistamine such as chlorpheniramine maleate, which produces drowsiness.

The prescription medications are much stronger. They include barbiturates, benzodiazepines, and a number of other compounds. However, due to the risk for fatal overdose, especially in combination with alcohol or other CNS depressants, the barbiturates are no longer widely prescribed for this indication. In general, the shorter-acting sleeping pills are used to help one relax enough to get to sleep, while the longer-acting ones are used to help prevent frequent awakenings during the night. Long-term or inappropriate use can cause Tolerance and Physical Dependence.

(See also: Sedative-Hypnotic ; Sedatives: Adverse Consequences of Chronic Use )

BIBLIOGRAPHY

Hobbs, W. R., Rall, T. W., & Verdoorn, T. A. (1996) Hypnotics and sedatives; ethanol. In J. G. Hardman et al. (Eds.), The pharmacological basis of therapeutics, 9th ed. (pp. 361-396). New York: McGraw-Hill.

Scott E. Lukas