Medications Used to Treat Sleep Disorders
Most adults experience the occasional sleepless night and this is usually nothing to be concerned about. In fact, as many as 25% of Americans report occasional sleeping problems. However, when sleeping problems become chronic this can be a sign of a severe sleep disorder. Chronic sleeping problems affect about 10% of people. The lack of restful sleep can affect your ability to carry out daily responsibilities because you are too tired or have trouble concentrating. Sleep issues can lead to daytime drowsiness and concentration with altered lifestyle issues such as work performance and social interactions.
Daytime drowsiness and alterations in lifestyle are frequent complaints of those with sleep apnea. Individuals with sleep apnea experience frequent interruptions in their normal sleep pattern. These interruptions occur as result of obstructive events. Arousals may occur several times an hour and limit the person from obtaining consistent restful sleep. Those with sleep apnea may also experience difficulties falling asleep similar to those with true insomnia.
In some cases, physicians will prescribe drugs for the treatment of the sleep disorders. Some of the medications are used to help patient fall asleep and also stay asleep. There are a number of sleep drugs available to treat everything from insomnia to restless leg syndrome. However, each of these sleep drug classes carries with it special considerations.
Listed below are some of the drugs that can be used to treat insomnia and other sleep disorders.
- Ambien (zolpidem) – a very effective drug that allows the individual fall asleep. The original version of Ambien allowed individuals to fall asleep within 15 to 30 minutes; however they tended to wake up in the middle of the night. The new extended-release Ambien CR allows individuals to get a full night’s sleep. However, the FDA warns that the blood levels of the drug may be high enough the next morning to affect activities that require alertness, such as driving.
- Lunesta (eszopiclone) – is another drug in the same classification as Ambien. Lunesta also helps individuals fall asleep quickly and stay asleep for 7 to 8 hours. This drug, like Ambien, can cause grogginess the following morning and can also affect alertness.
- Rozerem (ramelton) – is in a different classification from Ambien and Lunesta. Its method of action targets the sleep-wake cycle and does not depress the central nervous system. Rozerem can be prescribed for long-term use and the drug has shown no evidence of abuse or addiction potential.
- Sonata (zalepon) – is a sleep drug that stays active in the body for a very short period of time. Sonata can be taken during the middle of the night without concern of feeling drowsy the following morning
- Silenor (doxepine) – was recently released in 2010 for use in individuals that have trouble staying asleep. This should only be taken in patients that are unable to get a full 7 to 8 hours of sleep – again drowsiness and problems with alertness may occur the following morning.
- Benzodiazepines – These are the older sleeping pills (Halcion, Restoril) that stay in the system much longer. They have been used effectively to treat problems such as sleepwalking and night terrors. Xanax, Klonopin, Valium, Ativan and others are in this classification of benzodiazepines. These medications were meant to relieve anxiety, some work as relaxants or even anticonvulsants to treat seizures. The problem with this classification is several fold. These medications have a high potential for addiction. The drugs also cause muscle relaxation which can be a significant problem in patients with obstructive sleep apnea. In addition sedation results and in high enough doses the drug can cause respiratory depression. These are usually the drugs implicated in drug overdoses of “sleeping pills.”
- Over-the-counter sleep aids – Most of these medications contain antihistamines. They generally work well, however the drug remains in the system for longer period of time and results in drowsiness sometimes extending into midmorning. Even the use of these medications (antihistamines) can lead to dependence, tolerance, and over time may affect your memory.
- Trazodone – Trazodone was developed as an antidepressant 40 years ago. It is intriguing that it works fairly well in helping individuals fall asleep and also achieving a subjective restful night’s sleep. The drug does not extend the normal time of sleep but does increase the time spent in stage III and IV, the deepest stages of the sleep cycle. It has been shown to decrease REM sleep and must be used with caution in patients with neuropsychiatric illnesses such as bipolar disease.
Generally, sleeping medications are given to sleep apnea patients with caution. Occasionally, patients on CPAP require sleep medication to help them fall asleep. The two most commonly prescribed medications for treating these patients are Ambien and Lunesta. Benzodiazepines are definitely contraindicated in patients with sleep apnea. These medications can worsen sleep apnea by increasing the partial collapse of the airway through muscle relaxation. Patients with sleep apnea when placed on one of the medications need to have a full night sleep study to monitor side-effects.
The use of medications to treat insomnia and sleep disorders can be useful in certain situations, but there are potential risks especially in patients with undiagnosed sleep apnea.