Sleep medications help patients fall asleep more quickly and stay asleep. For patients who are struggling with chronic pain or suffering because of insomnia, medication may give them short-term relief while they work on making the necessary changes for long-term results.
Most of today’s prescribed sleep medications are classified as either benzodiazepine hypnotics (the same benzodiazepines used for anxiety) or nonbenzodiazepine hypnotics. Their core chemical structures are different, but they both are used to treat insomnia.
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Research indicates that some nonbenzodiazepines may be more effective and slightly safer than benzodiazepines; however, there is a wide range of patient response to individual drugs. Benzodiazepines are associated with falls in the elderly, which may make them unsuitable for older patients unless used under close physician monitoring.
Common examples of benzodiazepine hypnotics: alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan).
Common examples of nonbenzodiazepine hypnotics: eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien, Stilnox, Stilnoct), and zopiclone (Imovane, Zimovane).
These hypnotics have the potential for side effects, including sleepwalking, less time in deep sleep, daytime drowsiness, dependency, and withdrawal syndrome. Research indicates that longer-term use of sleeping pills is associated with higher rates of dependency and complications than shorter-term use of sleeping pills.
Other classes of medications are also used for sleep problems, but less commonly. These medications are described below.
These drugs are used off-label to treat insomnia, thanks to their tendency to be sedating and induce sleep. Second-generation antihistamines (such as Allegra) are less likely to cause drowsiness, so first-generation antihistamines (such as Benadryl) are preferred when used as a sleeping pill substitute. Due to their safety, antihistamines are often recommended first for short-term help with sleep. Other alternatives to hypnotics include melatonin-agonists and sedating antidepressants, used at a low dose.
Melatonin receptor agonists
Another class of sleep medicine is the melatonin receptor agonist (it affects the melatonin receptors in the brain). The most common of these is Rozerem. The receptors affected by Rozerem are the same as those affected by over-the-counter melatonin, but in a more powerful way. Rozerem is not habit forming and is in a class of its own since its mechanism of action is different from any other prescribed sleep medication.
Low doses of sedating anti-depressant medications have been used for years as a sleep aid. When taken at doses much lower than would be used to treat depression, these medications have been found to help with sleep and chronic pain. Examples include doxepin, trazadone, and amitriptyline.
Individuals with a personal or family history of addiction, or for whom hypnotic drugs are contraindicated, may be prescribed one of these alternative medications. These medications are often preferred for longer-term use to avoid dependence or tolerance.
Medication as Part of a Combination of Treatments
Many patients and doctors decide to use medications, cognitive therapy, and behavioral techniques together, especially if the problem is severe and immediate relief is necessary. Individuals coping with chronic pain can work with their doctors to find the right medication levels and relaxation techniques that work best for them over the long term.