From the Guidelines
The most effective sleep aid is a nonbenzodiazepine BZRA, such as zolpidem, zaleplon, eszopiclone, or zopiclone, which should be administered at the lowest effective dose and for the shortest possible duration, due to the potential risks of adverse events and withdrawal symptoms. When considering sleep aids, it's essential to weigh the benefits and harms of each option. Nonbenzodiazepine BZRAs have been shown to improve sleep efficiency, sleep onset latency, sleep quality, total sleep time, and wake after sleep onset compared with placebo 1. Some key points to consider when using nonbenzodiazepine BZRAs include:
- Administering the lowest effective dose to minimize adverse events
- Using the medication for the shortest possible duration
- Counseling patients on the potential risks, including serious injuries caused by sleep behaviors such as sleepwalking, sleep driving, and other activities while not fully awake
- Avoiding the use of benzodiazepines or trazodone for treatment of chronic insomnia disorder due to the widely known harms and adverse effects, including risk for dependency and diversion, falls and cognitive impairment in older patients, hypoventilation in patients with respiratory conditions, and neuromuscular diseases 1. Additionally, establishing good sleep hygiene is crucial, including maintaining a consistent sleep schedule, creating a dark and cool bedroom environment, avoiding screens before bed, limiting caffeine and alcohol, and engaging in relaxation techniques like deep breathing or meditation. If sleep problems persist beyond a few weeks, it's essential to consult a healthcare provider as sleep issues may indicate other health conditions requiring different treatment.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Effective Sleep Aids
The most effective sleep aids can be categorized into nonpharmacologic and pharmacologic treatments.
- Nonpharmacologic treatments, such as cognitive-behavioral therapies, have been shown to be highly effective in treating insomnia, with the added benefits of few or no adverse effects and no risk of abuse or dependence 2.
- Pharmacologic treatments, including non-benzodiazepine hypnotics like zolpidem, can be effective in treating insomnia, but may have adverse effects such as increased risk of falls, hip fractures, and complex sleep-related behaviors 3.
Comparison of Sleep Aids
A comparison of newer agents for insomnia, including zolpidem, zaleplon, and ramelteon, found that these compounds are generally well tolerated and present favorable safety profiles compared to older benzodiazepines and barbiturates 4.
- Ramelteon, a melatonin receptor agonist, has been shown to improve sleep latency and total sleep time, with minimal adverse effects and no association with withdrawal symptoms, rebound insomnia, or abuse potential 5.
- A review of safety and efficacy of sleep medicines in older adults found that ramelteon has a minimal adverse effect profile and is effective for sleep-onset latency and increased total sleep time, making it a valuable first-line option 6.
Considerations for Sleep Aid Selection
When selecting a sleep aid, it is essential to consider the individual's specific needs and health status.
- Cognitive behavioral therapy should always be the first line of treatment for insomnia 6.
- Pharmacologic treatments should be used with caution, especially in older adults, due to the risk of adverse effects and interactions with other medications 3, 6.
- Nonpharmacologic treatments, such as relaxation strategies and complementary and alternative medicine approaches, may be effective for some individuals, but more research is needed to support their use 2.