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continued:

Prescription sleeping pills: What's right for you?

Side effects of prescription sleeping pills

Side effects associated with prescription sleeping pills include:

  • Dizziness
  • Headache
  • Gastrointestinal problems, such as diarrhea and nausea
  • Prolonged drowsiness, more so with drugs that help you stay asleep
  • Severe allergic reaction
  • Sleep behaviors, such as sleep-driving and sleep-eating
  • Daytime memory and performance problems

Medications to help you stay asleep may not be safe if you are pregnant, are breast-feeding or are an older adult. Sleeping pill use may increase the risk of nighttime falls and injury in older adults. If you're an older adult, your doctor may prescribe a lower dose of medication to reduce your risk of problems.

Sedating antidepressants

Sometimes prescription drugs used mainly to treat depression may ease insomnia when taken in lower doses. Although widely used, these are not approved by the Food and Drug Administration for insomnia only. Discuss alternatives with your doctor. When insomnia is secondary to depression or anxiety, antidepressants may improve both conditions at the same time.

Drugs for when you can't sleep and you're depressed
Drug May not be safe if you: Considerations
Amitriptyline

Are recovering from a heart attack or have a history of seizures, glaucoma, trouble urinating (urinary retention).

May interact with many other medications.
Doxepin Have a history of glaucoma, trouble urinating (urinary retention) or heart disease. May interact with many other medications.
Trazodone (Oleptro) Have a history of high blood pressure. May interact with many other medications.
Mirtazapine (Remeron)  

May cause weight gain.

May cause daytime sedation.

May interact with many other medications.

Side effects of sedating antidepressants

Side effects associated with sedating antidepressants include:

  • Dizziness
  • Headache
  • Prolonged drowsiness
  • Dry mouth
  • Nausea
  • Irregular heartbeats
  • Weight gain

Taking sleeping pills

If your best attempts to get a good night's sleep have failed, prescription sleeping pills may be an option. Here's some advice on how to use them safely.

  • Get a medical evaluation. Before you take sleeping pills, see your doctor for a thorough exam. Often your doctor may be able to find specific causes for your insomnia. Your doctor also likely will recommend trying nondrug approaches, such as cognitive behavioral therapy. Sleeping on a regular schedule, exercising regularly, avoiding caffeine and daytime naps, and keeping stress in check also are likely to help. In addition, if you're taking sleeping pills for more than a few weeks, be sure to schedule follow-up appointments with your doctor at least every six months.
  • Never take a sleeping pill until you're going to bed. Sleeping pills can make you less aware of what you're doing, increasing the risk of dangerous situations. Wait to take your sleeping pill until you've completed all of your evening activities, about 15 to 30 minutes before you plan on sleeping.
  • Plan to take your first sleeping pill when you can sleep in. Don't take a new sleeping pill the night before an important appointment or activity. Until you've taken the drug, you won't know how it affects you. So, make sure you take a sleeping pill for the first time on a night when you know you can sleep in the next day, such as on a Friday night if you work weekdays.
  • Avoid alcohol. Never mix alcohol and sleeping pills. Alcohol increases the sedative effects of the pills. Even a small amount of alcohol combined with sleeping pills can make you feel dizzy, confused or faint. And, alcohol can actually cause insomnia.
  • Quit carefully. When you're ready to stop taking sleeping pills, follow your doctor's instructions or the directions on the label. Some medications must be stopped gradually. Also, be aware that you may have some short-term rebound insomnia for a few days after you stop taking sleeping pills.
  • Watch for side effects. If you feel sleepy or dizzy during the day, talk to your doctor about changing your dose or weaning off your pills.

If you continue to have trouble sleeping, ask your doctor for additional help.

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References
  1. Clinical guideline for the evaluation and management of chronic insomnia in adults. Philadelphia, Pa.: University of Pennsylvania Health System. http://www.aasmnet.org/Resources/ClinicalGuidelines/040515.pdf. Accessed Sept. 28, 2011.
  2. Sullivan SS. Insomnia pharmacology. Medical Clinics of North America. 2010;94:563.
  3. Ahmed QA, et al. Effects of common medications used for sleep disorders. Critical Care Clinics. 2008;24:493.
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  5. Lunesta (prescribing information). Marlborough, Mass.:Sunovion Pharmaceuticals, Inc.; 2010. http://www.lunesta.com/PostedApprovedLabelingText.pdf. Accessed Sept. 28, 2011.
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  10. Ambien (prescribing information). Bridgewater, N.J.: Sanofi-Aventis; 2010. http://products.sanofi.us/ambien/ambien.pdf. Accessed Sept. 28, 2011.
  11. Estazolam (prescribing information). Corona, Calif.: Watson Laboratories, Inc.; 2008. http://pi.watson.com/data_stream.asp?product_group=1232&p=pi&language=E. Accessed Sept. 28, 2011.
  12. Restoril (prescribing information). Hazelwood, Mo.: Mallinckrodt Inc.; 2010. http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/018163s054lbl.pdf. Accessed Sept. 28, 2011.
  13. Ambien CR (prescribing information). Bridgewater, N.J.: Sanofi-Aventis; 2010. http://products.sanofi.us/ambien_cr/ambienCR.html. Accessed Sept. 28, 2011.
  14. Roth T, et al. Efficacy and safety of sleep-promoting agents. Sleep Medicine Clinics. 2008;3:175.
  15. Antidepressants. The Merck Manuals. The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/media/professional/pdf/Table_200-2.pdf. Accessed Oct. 2, 2011.
  16. Doghramji K. The evaluation and management of insomnia. Clinics in Chest Medicine. 2010;31:327.
  17. Remeron (prescribing information). Kenilworth, N.J.: Schering Corporation; 2010. http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020415s023s024.pdf. Accessed Oct. 27, 2011.
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