There's no single "best" medication for anxiety and insomnia; it depends on the individual, but common prescription options include short-term benzodiazepines (like temazepam) for severe cases, Z-drugs (zolpidem, zopiclone), or newer options like suvorexant for longer use, while sedating antidepressants (doxepin, trazodone) or melatonin can also help, but a doctor must find the right fit due to risks like dependence.
Options for treating those who are having trouble falling asleep are:
Daridorexant is one of a relatively new class of drugs that have been developed for the treatment of insomnia. Its mechanism of action differs from many of the older insomnia treatments. Studies have shown that it can help people to fall asleep faster at night and stay asleep longer during the night.
Other benzodiazepine medications approved by the FDA for the treatment of anxiety, such as Lorazepam, Clonazepam, and Alprazolam, are sometimes prescribed for insomnia as well. Benzodiazepines are generally recommended for short-term use because tolerance and dependence can develop.
Top examples are metoprolol succinate (Toprol XL), carvedilol (Coreg), and propranolol. However, they can cause side effects — including sleep disturbances like insomnia and nightmares. If you're taking a beta blocker and are experiencing side effects like these, make sure to talk to your healthcare provider.
Common side effects
Beta-blockers may also affect your slumber by suppressing REM sleep (the stage when rapid eye movements and dreaming occur). Atenolol (Tenormin) and bisoprolol may be less likely to cause insomnia than other beta-blockers.
Unlike benzodiazepines and other short-acting anxiety medications, propranolol is non-addictive and not a controlled substance. This makes it a safer, more sustainable situational option for many people.
As of this writing, some of the anxiety medications with the fewest reported side effects and least risk of side effects include:
Furthermore, ramelteon was found to be about 10 times more potent than melatonin in promoting sleep.
Treatment
Research indicates that adults should get 7 to 9 hours sleep per night. Treatment often begins by reviewing any medicines or health problems that may be causing or worsen insomnia, such as: Enlarged prostate gland or any other medical condition, causing men to wake up at night to urinate.
Pharmacologic options for older adults include low-dose doxepin, melatonin, ramelteon, and the dual orexin receptor antagonists. A well-informed clinician can help patients navigate the risks and benefits of both pharmacologic and behavioral options.
Medical conditions. Examples of conditions linked with insomnia include ongoing pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), overactive thyroid, Parkinson's disease and Alzheimer's disease. Sleep-related disorders.
How to Manage Anxiety-Related Insomnia
If your insomnia is severe or chronic enough that it's affecting your quality of life, it's time to call a doctor. Your primary care provider may be able to treat your problem. However, a sleep-medicine specialist can likely dig deeper into the causes of your insomnia and offer more ways to resolve it.
Prozac. Prozac (fluoxetine) is another widely prescribed SSRI that is effective in treating depression, anxiety disorders, and certain types of OCD. Like Zoloft, it works by increasing the availability of serotonin in the brain, which can help improve mood and reduce anxiety symptoms.
Caruso's Anxiety Aid helps to ease the symptoms associated with mild anxiety, stress and nervous tension. The unique ingredient Cyracos® is an extract of the herb Melissa officinalis, commonly known as Lemon balm.
Propranolol is generally safe to take for a long time. If you're taking it for a heart condition, or to prevent migraines, it works best when you take it long term. If you're taking it for anxiety, there do not seem to be any lasting harmful effects if you take it for several months or years.
Serious side effects
You'll usually take bisoprolol once a day in the morning. Your doctor may advise you to take your very first dose before bedtime as it can make you feel dizzy. If you do not feel dizzy after having your first dose, take bisoprolol in the morning.
These are the two most common beta-blockers prescribed for anxiety. Other common beta-blockers that your doctor might suggest are acebutolol, bisoprolol, carvedilol, and metoprolol. Typically, however, doctors prescribe these only if neither propranolol nor atenolol is suitable.