Insomnia is the most common type of sleep disorder and it involves problems falling asleep or staying asleep despite adequate opportunity to do so. One of the most common treatments for insomnia is sleeping pills.
When used properly, sleeping pills can help people fall asleep or stay asleep. However, people do not always use sleep aids such as sleeping pills properly, which can cause unwanted side effects. The American College of Physicians and the American Academy of Sleep Medicine recommend trying other techniques to get to sleep before using sleeping pills.
Sleeping pills, especially over-the-counter (OTC) sleep aids, are generally not meant to be taken every night. They work best for short-term problems that interfere with sleep, such as jet lag and other similar sleep issues.
Reasons why sleeping pills are not recommended for long-term use include:
- There is limited evidence on the safety and effectiveness of using sleeping pills for more than four weeks
- Daily use of sleep aids may be linked to a higher risk of mortality
- Sleeping pills may affect the stages of sleep and diminish sleep quality
- Many people can develop a tolerance to sleeping pills, needing a higher dose for the same effects
- Addiction and withdrawal symptoms can occur, such as rebound insomnia, anxiety, irritability, and strange dreams
For those who have treatment-resistant insomnia, sleep medicine may be prescribed for regular use, but it may still be recommended to only use the medication for a few nights per week to lower the risk of addiction.
Sleep medications, both over-the-counter (OTC) and prescription include:
- Over-the-counter sleep aids: generally not recommended to treat chronic insomnia
- Antihistamines such as doxylamine or diphenhydramine (Benadryl, Nytol, ZzzQuil)
- Melatonin, a hormone normally produced by a gland in the brain marketed as a dietary supplement in the U.S.
- Prescription sleep medications
- Benzodiazepines: quazepam (Doral), triazolam (Halcion), estazolam (ProSom), temazepam (Restoril), and flurazepam (Dalmane)
- Nonbenzodiazepines: zaleplon (Sonata), eszopiclone (Lunesta), zolpidem (Ambien), zolpidem extended release (Ambien CR), zolpidem dissolving tablet (Edluar), zolpidem oral liquid spray (Zolpimist), and zolpidem dissolving tablet at a lower dose for middle of the night use (Intermezzo)
- Dual orexin receptor antagonists (DORAs): lemborexant (DayVigo) and suvorexant (Belsomra)
- Histamine receptor antagonist: low-dose doxepin (Silenor)
- Melatonin receptor agonist: ramelteon (Rozerem)
What Are Symptoms of Insomnia?
Symptoms of insomnia include:
- Difficulty falling asleep or staying asleep
- Variable sleep
- Persistent worry about sleep
- Daytime fatigue or sleepiness
- Decreased motivation or energy
- Difficulty concentrating
- Irritability
- Forgetfulness
- Anxiety
- Depression
- Increased errors or accidents
Why Can't I Sleep at Night?
Insomnia is usually caused by multiple factors. The main cause of insomnia is believed to be a state of mental and/or physical hyperarousal that interferes with falling asleep or staying asleep.
Causes of insomnia include:
- Changes in sleeping environment
- Poor sleep habits
- Stress
- Illnesses, especially those that cause stress or difficulty breathing
- Surgery
- Pain
- Unhealthy lifestyle habits
- Use of or withdrawal from certain medications and illegal drugs
- Irregular sleep schedules that disrupt the circadian rhythm
- Mental health problems
- Neurological disorders
- Other sleep disorders
- Pregnancy
- Genetics
- Age: teenagers and elderly experience insomnia more frequently
- May not have a known cause
What Is the Treatment for Insomnia?
The American College of Physicians and the American Academy of Sleep Medicine recommend using other techniques to get to sleep before using sleeping pills.
Treatment for insomnia includes good sleep hygiene. This includes:
- A consistent sleep routine
- Make your bedroom a calm sanctuary
- Keep the room cool: 65°F/18.3°C is considered ideal
- Use blackout curtains or sleep masks to reduce light
- Wear ear plugs or use white noise to block outside noises
- Don’t stress if you can’t fall asleep right away
- Sleep in comfortable loose-fitting pajamas or sleep naked to help regulate body temperature
- Stimulus control
- Don’t go to bed until you feel sleepy
- Don’t watch TV or read in bed
- Only use the bed for sleep and sex
- Avoid daytime napping
Other treatments for insomnia include:
- Cognitive behavioral therapy for insomnia (CBT-I)
- Sleep education
- Sleep restriction
- Sleep compression
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https://www.uptodate.com/contents/insomnia-beyond-the-basics?search=insomnia&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3
https://www.uptodate.com/contents/insomnia-treatments-beyond-the-basics?search=insomnia&topicRef=7717&source=see_link
http://sleepeducation.org/
https://www.sleepfoundation.org/sleep-aids/how-to-use-sleep-medications-safely
https://www.sleepassociation.org/
https://www.sleep.org/