Medications

Medications

According to a major 2003 survey, about 20% of American older adults use some form of sleep aid, including prescription or over-the-counter drugs, or alcohol. Furthermore, 15% use such aids every night.

It should be stressed that only behavioral or psychologic techniques can actually cure insomnia, whereas prolonged use of sleeping pills can only result in dependency.

In general, the following precautions are important:

• Start with non-prescription medication.
• Drugs used specifically for improving sleeping are called sedative hypnotics. If these prescription drugs are required, start with as low a dose as possible. Discuss with the doctor the benefits and risks of benzodiazepines versus non-benzodiazepine drugs. Until recently benzodiazepines were most commonly prescribed, but newer non-benzodiazepines may be better tolerated and have less risk of dependency.
• For adults over age 60 years, studies suggest that the risks of sedative hypnotics may far outweigh their benefits.
• As a general rule, do not take either prescription nor non-prescription sleeping pills on consecutive days or for more than 2 - 4 days a week.
• If insomnia is still a problem after stopping the drug and continuing with good sleep hygiene, this pattern can be repeated again, but for only up to 4 weeks.
• Medication should be withdrawn gradually and the patient should be aware of the possibility of rebound insomnia after stopping medication.
• Alcohol intensifies the side effects of all sleeping medication and should be avoided.
• If chronic insomnia is a companion to depression or anxiety, treating these problems first may be the best approach.

Common Non-Prescription Drugs

Brands with Antihistamines. Many over-the-counter sleeping medications use antihistamines, which cause drowsiness. Diphenhydramine is the most common antihistamine used non-prescription sleep aids. Some drugs contain diphenhydramine alone (Nytol, Sleep-Eez, Sominex) while others contain combinations of diphenhydramine with pain relievers (Anacin P.M., Excedrin P.M., Tylenol P.M.). Doxylamine (Unison) is another antihistamine used in sleep medications. Certain antihistamines indicated only for allergies, such as chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), or hydroxyzine (Atarax or Vistaril) may also be used as mild sleep-inducers.

Unfortunately, most of these drugs leave patients feeling drowsy the next day and may not be very effective in providing restful sleep. Side effects include: