From the Guidelines
For patients struggling with staying asleep, the most effective medication is eszopiclone (1-3mg), as it is particularly effective for sleep maintenance with a longer half-life than other Z-drugs 1. This recommendation is based on the clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults by the American Academy of Sleep Medicine. Other options include low-dose doxepin (3-6mg) and suvorexant, which have also been suggested as treatments for sleep maintenance insomnia 1. It's essential to use these medications short-term (2-4 weeks) while addressing underlying causes of insomnia. For optimal results, combine medication with good sleep hygiene practices such as:
- Maintaining a consistent sleep schedule
- Avoiding screens before bedtime
- Keeping the bedroom cool and dark
- Limiting caffeine and alcohol Cognitive behavioral therapy for insomnia (CBT-I) is also highly recommended as a long-term solution 1. Start with the lowest effective dose and discuss with your healthcare provider, as individual factors like age, other medications, and medical conditions will influence which option is best for you. It's crucial to avoid using benzodiazepines, trazodone, antihistamines, and antipsychotics for treating chronic insomnia disorder due to their adverse effect profiles and limited evidence supporting their efficacy 1.
From the FDA Drug Label
Zolpidem Tartrate Tablets USP are indicated for the short-term treatment of insomnia characterized by difficulties with sleep initiation.
The clinical trials performed in support of efficacy were 4 to 5 weeks in duration with the final formal assessments of sleep latency performed at the end of treatment.
The best medication to use for insomnia, specifically for patients having trouble staying asleep, is not directly answered by the provided drug labels. Eszopiclone and zolpidem are both used for insomnia, but the labels do not specifically address staying asleep.
- Eszopiclone has warnings about complex sleep behaviors and CNS depressant effects, but does not specify its use for staying asleep 2.
- Zolpidem is indicated for sleep initiation, not specifically for staying asleep 3.
The FDA drug label does not answer the question.
From the Research
Medications for Insomnia
To address insomnia, particularly trouble staying asleep, several medications have been studied and recommended. The key is to find a medication that improves sleep maintenance without causing significant side effects or dependency.
Non-Benzodiazepine Hypnotic Agents
- Eszopiclone is a non-benzodiazepine hypnotic agent that has been approved for the treatment of insomnia, including difficulty staying asleep 4, 5, 6.
- It has been shown to significantly improve objective and subjective sleep measures in adults with transient and chronic insomnia.
- Eszopiclone is well-tolerated, with no evidence of pharmacological tolerance, rebound insomnia, or dependence in clinical trials up to 12 months in duration.
Other Recommended Medications
- Low-dose doxepin is recommended for patients who have difficulty staying asleep 7.
- Controlled-release melatonin can be considered for the general population with difficulty falling asleep, and for older adults as a first-line agent 7, 8.
- Ramelteon, a selective MT1, MT2 receptor agonist, has been found effective in improving sleep quality, sleep efficacy, and reducing sleep onset time 8.