What are the recommended sleep medications (hypnotics) for insomnia during flights?

From the Guidelines

For sleep medication during flights, I recommend eszopiclone (2-3mg) taken 30 minutes before your desired sleep time on the plane, as it is effective for both sleep onset and maintenance insomnia, according to the American Academy of Sleep Medicine clinical practice guideline 1. This recommendation is based on the most recent and highest quality study available, which suggests that eszopiclone is a suitable treatment option for adults with insomnia. Some key points to consider when using sleep medications during flights include:

• Avoiding alcohol consumption, as it can cause excessive sedation
• Staying hydrated to minimize the risk of dehydration and other complications
• Trying the medication at home first to understand how it affects you
• Considering the use of melatonin (1-5mg) as a non-prescription alternative, although its effectiveness for insomnia is not well established 1
• For longer flights, short-acting prescription options like zolpidem (5-10mg) or zaleplon (5-10mg) may be considered, but should be taken after boarding when you have at least 7-8 hours before landing
• If you have underlying health conditions or take other medications, consult your doctor before using any sleep aids for travel It's also important to note that the FDA has approved pharmacologic therapy for short-term use (4 to 5 weeks), and patients should not continue using the drugs for extended periods 1. Additionally, some studies suggest that melatonin may be useful in preventing jet lag, although more research is needed to confirm its effectiveness 1. Overall, the choice of sleep medication during flights should be based on individual needs and medical history, and should be discussed with a healthcare professional before travel.

From the FDA Drug Label

Ramelteon tablets are indicated for the treatment of insomnia characterized by difficulty with sleep onset. Zolpidem tartrate tablets are indicated for the short-term treatment of insomnia characterized by difficulties with sleep initiation.

The recommended sleep medications (hypnotics) for insomnia are:

• Ramelteon 2
• Zolpidem 3 However, there is no information about their use during flights.

From the Research

Recommended Sleep Medications for Insomnia During Flights

The following sleep medications are recommended for insomnia during flights:

• Melatonin: effective in preventing or reducing jet-lag, and occasional short-term use appears to be safe 4
• Ramelteon: a melatonin receptor agonist approved for the treatment of insomnia, improves latency to persistent sleep and is well tolerated 5
• Zolpidem: a nonbenzodiazepine hypnotic, effective in treating insomnia but should be used with caution due to potential risks such as reduced mobility and venous thrombosis 4, 6
• Eszopiclone: a nonbenzodiazepine hypnotic, effective in treating insomnia and can be combined with cognitive behavioral therapy for insomnia (CBT-I) for improved treatment outcomes 7

Important Considerations

When using sleep medications during flights, it is essential to consider the following:

• Timing of medication: melatonin should be taken close to the target bedtime at the destination, while other medications should be taken as directed by a healthcare professional 4, 6
• Dosage: daily doses of melatonin between 0.5 and 5mg are effective, while higher doses may not be more effective 4
• Potential side effects: melatonin can cause sleepiness and delay adaptation to local time if taken at the wrong time, while other medications may have adverse effects such as drowsiness, dependency potential, and rebound insomnia 4, 6, 8
• Individual factors: patients with epilepsy or those taking warfarin may need to exercise caution when using melatonin, and travelers crossing multiple time zones may require different treatment strategies 4, 6