From the Guidelines
Sleep medications should be used cautiously and only when necessary, with a preference for non-pharmacological interventions like cognitive behavioral therapy for insomnia (CBT-I) and good sleep hygiene practices. For occasional insomnia, over-the-counter options like diphenhydramine (Benadryl, 25-50mg) or doxylamine (Unisom, 25mg) taken 30 minutes before bedtime can help 1. For persistent insomnia, prescription medications include zolpidem (Ambien, 5-10mg), eszopiclone (Lunesta, 1-3mg), or temazepam (Restoril, 15-30mg), which should generally be used for 2-4 weeks maximum to avoid dependence 1.
Key Considerations
- Before trying medication, implement good sleep hygiene: maintain a regular sleep schedule, avoid screens before bed, limit caffeine and alcohol, and create a comfortable sleep environment.
- Melatonin (1-5mg) is a gentler option that helps regulate sleep cycles.
- Sleep medications work by enhancing inhibitory neurotransmitters in the brain, particularly GABA, which reduces brain activity and promotes sleep.
- Side effects may include morning drowsiness, dizziness, and rarely, complex sleep behaviors like sleepwalking.
- Consult a healthcare provider before starting any sleep medication, especially if you have other health conditions or take other medications 1.
Pharmacological Options
- Eszopiclone, zolpidem, and suvorexant have been shown to improve short-term global and sleep outcomes compared with placebo, although absolute effect sizes were small 1.
- Benzodiazepine hypnotics, melatonin agonists, and antidepressants have insufficient or low-strength evidence for their efficacy in treating insomnia.
- The FDA has reported risks for cognitive and behavioral changes, including driving impairment, and other adverse effects associated with pharmacotherapies for insomnia 1.
From the FDA Drug Label
What is BELSOMRA? BELSOMRA is a prescription medicine for adults who have trouble falling or staying asleep (insomnia).
What is triazolam? No direct information about what triazolam is, is found in the provided text, however it can be inferred that it is a sedative-hypnotic.
Sleep Medication:
- Suvorexant (Belsomra): is a prescription medicine for adults with insomnia.
- Triazolam: is a sedative-hypnotic, however the provided text does not explicitly state that it is used for insomnia, but rather lists warnings and potential side effects. It is important to note that these medications have potential side effects and risks, such as next-day impairment, sleep-driving, and complex behaviors, and should be used with caution and under the guidance of a healthcare provider 2, 3.
From the Research
Sleep Medication Overview
- Sleep medication is often used to treat insomnia, but it can have significant side effects, especially in older adults 4.
- Cognitive behavioral therapy for insomnia (CBT-i) is a non-pharmacological treatment that has been shown to be effective in treating insomnia, with no side effects and fewer episodes of relapse 5, 6.
- CBT-i is considered a first-line treatment for insomnia, but it is often underutilized due to a shortage of trained practitioners and lack of patient awareness 5.
Alternatives to Sleep Medication
- CBT-i is an effective alternative to sleep medication, with benefits including improved sleep quality, reduced sleep onset latency, and increased sleep duration 5, 6, 7.
- Other non-pharmacological interventions, such as sleep hygiene, stimulus control, and relaxation techniques, can also be effective in treating insomnia 5, 7.
- Cognitive behavioral therapy should always be considered as a first-line treatment for insomnia, with sleep medication used as a last resort 4.
Considerations for Sleep Medication Use
- Sleep medication can have significant adverse effects, including dementia, serious injury, and fractures, especially in older adults 4.
- Benzodiazepines are discouraged in the geriatric population, especially for long-term use, due to their potential for adverse effects 4.
- Non-benzodiazepine receptor agonists (non-BzRAs) have improved safety profiles compared to benzodiazepines, but can still have significant side effects, including somnolence and residual daytime sedation 4.
Treatment Approaches
- A clinical algorithm for diagnosis and treatment of insomnia in adults can be used to guide treatment decisions, including the use of non-pharmacological and pharmacological interventions 8.
- CBT-i can be delivered in various formats, including individual and group therapy, and can be effective in treating insomnia in adults, including older adults and adolescents 7.
- Treatment of insomnia should focus on addressing underlying comorbid conditions and using non-pharmacological interventions as a first-line treatment, with sleep medication used as a last resort 6, 4.