The first-choice drug for insomnia often depends on the type (short-term vs. chronic) and patient factors, but Z-drugs (like zolpidem/Ambien, zopiclone, eszopiclone/Lunesta) and certain benzodiazepines are common starting points, especially for sleep-onset issues, with Z-drugs favored for their shorter duration and lower residual effects compared to older benzos, though personalized choice involves considering side effects and underlying conditions like anxiety.
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.
Benzodiazepines are a group of structurally-related compounds that reduce anxiety when given at low doses and induce sleep at higher doses. Clinical guidelines generally recommend to prescribe benzodiazepines to treat anxiety or insomnia that is severe, disabling and causing extreme distress.
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.
The choice of a hypnotic agent in the elderly is symptom-based. Ramelteon or short-acting Z-drugs can treat sleep-onset insomnia. Suvorexant or low-dose doxepin can improve sleep maintenance. Eszopiclone or zolpidem extended release can be utilized for both sleep onset and sleep maintenance.
Common causes of middle insomnia include stress, poor sleep hygiene, diet, sleep disorders, and even certain medical conditions. One sleepless night won't cause too much trouble, but if you're awake night after night, you'll probably begin to feel it.
Furthermore, ramelteon was found to be about 10 times more potent than melatonin in promoting sleep.
Treating Insomnia with Medications
How to Manage Anxiety-Related Insomnia
Antidepressants: Certain antidepressants can be effective in treating anxiety and racing thoughts. Selective serotonin reuptake inhibitors (SSRIs) are commonly used. Antihistamines: Some over-the-counter antihistamines, such as diphenhydramine (Benadryl®), can have a sedating effect and may be used to help with sleep.
Changing sleep habits and taking care of any issues related to insomnia, such as stress, medical conditions or medicines, can result in restful sleep for many people. If these steps do not work, your doctor may recommend cognitive behavioral therapy (CBT), medicines or both to improve relaxation and sleep.
Common choices and the potential side effects include:
Belsomra has an average rating of 3.9 out of 10 from a total of 549 ratings on Drugs.com. 28% of reviewers reported a positive effect, while 62% reported a negative effect. Trazodone has an average rating of 6.3 out of 10 from a total of 1455 ratings on Drugs.com.
The 3-2-1 bedtime method is a simple sleep hygiene strategy: stop eating 3 hours before bed, stop working 2 hours before bed, and stop using screens (phones, tablets, TVs) 1 hour before sleep, helping your body transition to rest by reducing stimulants and digestive load for better sleep quality. A more detailed version adds 10 hours (no caffeine) and 0 (no snoozing) for a 10-3-2-1-0 rule.
Research shows that vitamin D deficiency is associated with sleep issues like: Frequent nighttime awakenings. Daytime sleepiness. Shorter sleep duration.
Cortisol naturally rises in the early hours, typically around 3am, in a healthy sleep cycle. Think of this as pouring cortisol into your cup.
Physiologic changes of aging, environmental conditions, and chronic medical illnesses contribute to insomnia in the elderly. Sleep disturbance in the elderly is associated with decreased memory, impaired concentration, and impaired functional performance.
Talk to your doctor to see if prescription sleep aids are right for you. In elderly individuals, prescription nonbenzodiazepines, such as zolpidem, eszopiclone, zaleplon, and ramelteon, may generally be prescribed as a last-ditch effort to treat insomnia.
Benzodiazepines, Z-drugs (zaleplon, eszopiclone, zolpidem, and others), and antihistamines such as diphenhydramine and chlorpheniramine are all included in the Beers Criteria list of medications that should be avoided or pose a higher risk in older adults.
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.
Alcohol, narcotic pain relievers, or sleeping pills may cause you to feel more lightheaded, dizzy, or faint when used with this medicine. Tell your doctor if you are drinking alcohol or using pain relievers or sleeping pills. Do not take other medicines unless they have been discussed with your doctor.