What if I'm not sleeping while taking Lunesta (eszopiclone)?

Managing Ineffective Response to Lunesta (Eszopiclone)

If you're not sleeping while taking Lunesta (eszopiclone), you should try an alternative medication within the same class or consider cognitive behavioral therapy for insomnia as recommended by clinical guidelines. 1

Why Lunesta May Not Be Working

• Eszopiclone (Lunesta) is a non-benzodiazepine hypnotic that should reduce sleep latency and increase total sleep time, but individual response varies 1
• Lack of response could be due to:
  • Inadequate dosing (standard doses are 2-3 mg for adults, 1-2 mg for elderly) 2
  • Taking medication with food (should be taken on an empty stomach) 2
  • Not allowing for a full 7-8 hours of sleep opportunity 2
  • Possible tolerance development (though studies show efficacy for up to 12 months without tolerance) 3, 4

Next Steps for Management

1. Evaluate Current Medication Usage

• Ensure proper administration:
  • Take Lunesta immediately before bedtime, not earlier 2
  • Take on an empty stomach 2
  • Avoid alcohol and other CNS depressants 2
  • Allow for 7-8 hours of sleep opportunity 2

2. Consider Dose Adjustment

• If currently on 1 mg, discuss increasing to 2 mg (adults) 2
• If on 2 mg, discuss increasing to 3 mg (maximum dose) 2
• Elderly patients should use lower doses (1-2 mg) due to longer half-life 2, 5

3. Try Alternative Medications

• Switch to another medication in the same class (BzRA) as recommended by guidelines 1:
  • Zolpidem (Ambien): 5-10 mg for sleep onset issues 6
  • Zaleplon (Sonata): 5-10 mg for sleep onset issues 1
  • Temazepam: For sleep maintenance issues 1
• Consider orexin receptor antagonists like suvorexant (Belsomra) as an alternative class 7

4. Implement Non-Pharmacological Approaches

• Cognitive behavioral therapy for insomnia (CBT-I) is the gold standard first-line treatment 1, 7
• Key CBT-I components include:
  • Stimulus control: Only go to bed when sleepy, leave bed if not asleep within 20 minutes 1
  • Sleep restriction: Limit time in bed to actual sleep time 1
  • Relaxation training: Progressive muscle relaxation to reduce arousal 1

Important Safety Considerations

• Eszopiclone can cause CNS depression and next-day impairment even when used as prescribed 2
• Serious side effects include:
  • Abnormal thinking and behavioral changes (aggressiveness, hallucinations) 2
  • Complex sleep behaviors like sleep-driving or sleep-eating 2
  • Memory impairment 2, 8
• Persistent insomnia after 7-10 days of treatment may indicate an underlying physical or psychiatric disorder that should be evaluated 2

When to Seek Additional Help

• If insomnia persists after trying alternative medications and CBT-I 2
• If you experience any unusual behaviors during sleep 2
• If depression or anxiety symptoms worsen 2
• If daytime functioning is significantly impaired 3, 4