Prescription sleeping pills: What's right for you?

Prescription sleeping pills: What's right for you?

Sleeping pills may help when stress, travel or other disruptions keep you awake. For long-term insomnia, behavior changes learned in behavioral therapy is usually the best treatment.
By Mayo Clinic Staff

If you're regularly having trouble either falling or staying asleep (insomnia), make an appointment with your doctor. Treatment depends on what's causing your insomnia. Sometimes, an underlying cause, such as a medical condition or sleep disorder, can be found and treated — a much more effective approach than just treating the symptom of insomnia itself.

Behavior changes learned through cognitive behavioral therapy are generally the best treatment for persistent insomnia. Sleeping on a regular schedule, exercising regularly, avoiding caffeine and daytime naps, and keeping stress in check also are likely to help. But there are times when the addition of prescription sleeping pills may help you get some much needed rest.

All prescription sleeping pills have risks, especially for people with certain medical conditions, including liver or kidney disease. Always talk with your doctor before trying a new treatment for insomnia.

Here's information on some of the most common types of prescription sleeping pills used today. Types of prescription sleeping pills

Prescription sleeping pills may help you fall asleep easier or stay asleep longer — or both. The risks and benefits of various prescription sleeping pills can differ. To find the right prescription medication to help you sleep, your doctor generally should:

Ask questions to get a clear picture of your sleep patterns
Order tests to rule out any underlying conditions that may be causing difficulty sleeping
Discuss options for taking prescription sleeping medication, including how often and when to take it and in what form, such as pills, oral spray or dissolving tablets
Prescribe a sleeping pill for a limited period of time to determine the benefits and side effects for you
Have you try a different prescription sleeping pill if the first medication you take doesn't work after the full prescribed course
Help you determine whether there is a generic version, which is typically less expensive than brand-name drugs

Insurance companies may have restrictions on which sleeping pills are covered, and they may require that you try other approaches to your insomnia first.

Side effects of prescription sleeping pills

Always ask your doctor about potential side effects before deciding which sleeping pills to consider taking. Depending on the type, prescription sleeping pills may include side effects such as:

Dizziness or lightheadedness, which may lead to falls
Headache
Gastrointestinal problems, such as diarrhea and nausea
Prolonged drowsiness, more so with drugs that help you stay asleep
Severe allergic reaction
Sleep-related behaviors, such as driving or eating when not fully awake
Daytime memory and performance problems
Antidepressants with a sedating effect

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. When insomnia is secondary to depression or anxiety, antidepressants may improve both conditions at the same time.

Examples include:

Amitriptyline
Mirtazapine (Remeron)
Trazodone

Side effects of antidepressants with a sedating effect

Antidepressants that have a sedating effect may include side effects such as:

Dizziness and lightheadedness
Headache
Prolonged drowsiness
Dry mouth
Nausea
Irregular heartbeat
Weight gain
Daytime memory and performance problems
Constipation

Safety considerations

Prescription sleeping pills (and even some nonprescription sleeping pills) as well as certain antidepressants may not be safe if you are pregnant, breast-feeding or 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.

Some health conditions — for example, kidney disease, low blood pressure, heart rhythm problems (arrhythmias) or a history of seizures — may limit your options. Also, prescription drugs and over-the-counter sleep aids may interact with other medications. And taking certain prescription sleeping pills can lead to drug abuse or drug dependence, so it's important to follow your doctor's advice.
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. If you're taking sleeping pills for more than a few weeks, talk to your doctor about an appropriate follow-up schedule to discuss your medications.
Read the medication guide. Read the medication guide for patients so that you understand how and when to take your medication and what the major potential side effects are. If you have any questions, ask your pharmacist or your doctor.
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, immediately before you plan on sleeping.
Take your sleeping pill when you can get a full night's sleep. Only take a sleeping pill when you know you can get a full night's sleep of at least seven to eight hours. A few short-acting sleeping pills are intended for middle of the night awakenings, so you may take them when you can stay in bed for at least four hours.
Watch for side effects. If you feel sleepy or dizzy during the day or if you experience any other significant side effects, talk to your doctor about changing your dose or weaning off your pills. Don't take a new sleeping pill the night before an important appointment or activity because you won't know how it affects you.
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. Combining alcohol with certain sleeping pills can lead to dangerously slowed breathing or unresponsiveness. And alcohol can actually cause insomnia.
Take sleeping pills strictly as prescribed by your doctor. Some prescription sleeping pills are for short-term use only. Be sure to contact your doctor for advice. Also, don't take a higher dose than prescribed. If the initial dose doesn't produce the intended effect on sleep, don't take more pills without first talking to your doctor.
Quit carefully. When you're ready to stop taking sleeping pills, follow your doctor's or pharmacist'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.
If you continue to have trouble sleeping, ask your doctor for additional help.