Sleep Disorder Medications

Reviewed on7/5/2022

Things to know about sleep disorder (Sedative-Hypnotic) medications

Asleep disorder(insomnia), a disorder in which there is difficulty sleeping, occurs occasionally in most people but usually lasts only a few days. The body then "corrects" itself naturally, and people return to a normal pattern of sleep. Insomnia may be short-term (less than three weeks) or chronic, lasting longer than three weeks. Contributing factors include, but are not limited to,

  • poor sleeping habits,
  • stress,
  • jet lag,
  • medications,
  • disease, and
  • depression.

Chronic insomnia may warrant the use ofsedative/hypnotic medications; however, it is important that the treating physician perform a complete diagnostic evaluation as well as take medication andsubstance abusehistories, to determine if it is secondary insomnia due to other conditions that may require treatment. Studies have shown that the best treatment strategies for insomnia include behavioral modifications.

Hypnotic and sedative medications (henceforth referred to as hypnotics) work, in general, by increasing the activity of gamma-aminobutyric acid (GABA), aneurotransmitterin the brain. Neurotransmitters are chemicals made and released by nerves that attach to receptors on other nerves and serve as a means of communication between nerves.

  • Increases in GABA activity in the brain produce drowsiness and facilitate or maintain sleep.

For what conditions are hypnotics used?

Hypnotics are used for the treatment of insomnia which is characterized by difficulties with falling asleep or maintaining sleep.

  • Specific hypnotics such asIntermezzo(zolpidemtartrate) can be used for insomnia involving middle-of-the-night waking followed by difficulty returning to sleep.

Are there differences among hypnotics?

There are a variety of hypnotics that are used for treating insomnia. The main difference among the various hypnotics is their half-life, that is, how long the drug is active in the body.

  • The half-life determines the type and duration of hypnotic effects and the unwanted side effects.
  • When hypnotic drugs have long half-lives, the drug itself or the chemicals that the body makes from the drug tend to accumulate with nightly use, and the accumulation can cause impairment of normal day-time functions involving thought and motor skills.

There also is a larger risk of interactions with other drugs due to a carry-over effect of the hypnotic drug. In contrast, when hypnotic drugs with short half-lives are taken, the drugs are cleared from the body before the next dose is ingested or other drugs are taken, hence the carry-over effects are minimal or absent and do not affect thought and motor skills.

What are the side effects of hypnotics?

Side effects of hypnotics include:

  • Headache
  • Nervousness
  • Nausea
  • Talkativeness
  • Apprehension
  • Irritability
  • Confusion
  • Euphoria
  • Relaxed feeling
  • Weakness
  • Tremor
  • Lack of concentration
  • Disorders of coordination
  • Depression
  • Dreaming/nightmares
  • Insomnia
  • Palpitations
  • Chest pains
  • Rapid heart rate
  • Abnormal behaviors during sleep including sleepwalking and other sleep-related activities

Side effects involving the stomach and intestines include:

  • Heartburn
  • Nausea
  • Vomiting
  • Diarrhea
  • Constipation
  • Abdominal pain
  • Loss of appetite
  • Alterations in taste
  • Dry mouth
  • Excessive salivation (rare)

如果有任何的ese side effects persist or worsen, a physician should be notified promptly.

What are the drug interactions of hypnotics?

If a patient has a history of depression, or liver, kidney, and respiratory disease, it is advisable to communicate this to the treating physician in order to be certain that commencing treatment with hypnotics is safe.

  • Benzodiazepines, when taken with alcohol and other types of depressants of brain and body function such as prescription pain medicines and some over-the-counter cold andallergymedications, can have additive depressant effects (additional slowing of brain and body function) that can lead to slow heart rate and reducedrespirationand even death.
  • Oral contraceptives,Tagamet(cimetidine),Antabuse(disulfiram),或者Nydrazid (isoniazid), may reduce the elimination of benzodiazepines by the liver, which, in turn, increases the blood levels of benzodiazepines. This causes an increase in the depressant effects of benzodiazepines.
  • When selectiveserotoninreuptakeinhibitors (SSRIs) are taken withValium(diazepam), they may increase diazepam blood levels and the depressant effects of diazepam.
  • Serzone(nefazodone) taken withXanax(阿普唑仑) may increase alprazolam blood levels and its depressant effects.
  • Smoking could increase the elimination of benzodiazepines from the body. This may reduce the effects of benzodiazepines.
  • Benzodiazepines will increase blood levels ofDigitek,Lanoxin(digoxin), and digoxin toxicity may occur.
  • Antifungals, for example,Diflucan(fluconazole),Sporanox(itraconazole), andNizoral,Xolegel(ketoconazole), may increase the blood levels and effects of zolpidem by reducing the activity of the enzymes that break down zolpidem in the liver. Therefore, it is important to monitor and adjust zolpidem doses as needed when antifungals are taken. Conversely,Rifadin(rifampin) may reduce the concentration of zolpidem by increasing the activity of the enzymes that break down zolpidem.
  • Opiates (such ascodeine) can impair the thinking and physical abilities required for driving or operating machinery. Alcohol and other sedatives such as alprazolam can produce further brain impairment and even confusion when combined with codeine. Therefore, alcohol and other sedatives should be limited when taking codeine.
  • 抗惊厥药物such asCarbatrol,Epitol,Equetro,Tegretol, Tegretol XR (carbamazepine) can increase the breakdown of the hormones inbirth control pillsand can reduce the effectiveness of birth control pills. Unexpected pregnancies have occurred in patients taking both carbamazepine and birth control pills. It is important to use the second form of birth control when taking carbamazepine.
  • Anti-narcoleptics (drugs that prevent drowsiness) such asProvigil(modafinil) should be carefully monitored if taken with certain drugs such as Gengraf,Neoral,Sandimmune(cyclosporine),Elixophyllin,Theo-24, TheoCap, Theochron, Theo-Time,Uniphyl(theophylline), and hormonal contraception as modafinil may reduce their effectiveness. Use of anti-Parkinson drugs such ascarbidopa-levodopa with monoamine oxidase inhibitors (MAOI's)antidepressants, for example,Marplan(isocarboxazid),Nardil(phenelzine), can result in severe and dangerous elevations in blood pressure. MAOI's should be stopped 2-4 weeks before starting carbidopa-levodopa therapy.

What are some examples of hypnotic medications?

There are seven different types of hypnotic medications:

  1. Nonbarbiturates
  2. Barbiturates
  3. Nonprescription sleep aids
  4. Anti-Parkinson drugs (DopamineAgonists)
  5. Opiates
  6. 抗惊厥药物
  7. Antinarcoleptics

1. Nonbarbiturates

Benzodiazepines

Benzodiazepines have a variety of uses, which include inducing sedation and sleep, relieving anxiety, agitation, and muscle spasms, and prevention of seizures. In general, they help in increasing total sleep time. With benzodiazepines, there may be issues of dependence, toxicity and abuse.

Examples of benzodiazepines:

Non-benzodiazepines

This is a newer class of drugs that is used for the short-term treatment of insomnia. They cause the onset of sleep to occur faster and allow for a longer period of sleep throughout the night. Non-benzodiazepines have a short half-life and have less chance of causing dependency, tolerance, and impairment of daytime activities due to carry-over effects.

Examples of non-benzodiazepines:

Another class of medications that helps with insomnia has become recently available. It acts by decreasing the activity in the wake system (lateralhypothalamus) of our brain, rather than increasing the activity in the sleep centers of our brain.Suvorexant(Belsomra), is an orexinantagonistwhich decreases activity in the wake center and therefore promoting sleep. It is thought to be generally safe and well tolerated, but some patients may have side effects.

2. Barbiturates

Barbiturates are used to treat anxiety, insomnia, andseizure disorders. They are not, however, prescribed as often due to the availability of benzodiazepines and non-benzodiazepines. Barbiturates can be addictive and have strongwithdrawal symptomsand rebound (exaggerated) effects on rapid eye movement (REM) sleep when they are abruptly stopped and can interfere with sleep. It is advisable, therefore, to stop barbiturates by slowly lowering their dose over a period of more than five or six days. It also is important to use the correct dose of barbiturates since a relatively small overdose may lead to coma or death.

The main differences among barbiturates are their half-lives (duration of their effects). Drugs such as secobarbital sodium andpentobarbitalsodium are short-acting, while others such as amobarbital sodium and butabarbital sodium are intermediate-acting, andphenobarbitaland mephobarbital are long-acting.

Examples of barbiturates:

3. Nonprescription sleep aids

It is advisable to talk to the local pharmacist for advice on any of the various medication options purchased in a pharmacy.

Examples of non-prescription sleep aids:

  • Unisom Nighttime Sleep-Aid
  • Dormin
  • Nytol
  • Simply Sleep
  • Sominex
  • Extra StrengthTylenolPM
  • Diphenhydraminehydrochloride
  • Excedrin P.M.
  • Over the counter formulations of melatonin

4. Anti-Parkinson drugs (dopamine agonists)

These drugs may be used to treat conditions that contribute to sleep disruption such asrestless leg syndromeand periodic limb movement disorder (nocturnalmyoclonussyndrome).

Examples of anti-Parkinson's drugs:

5. Opiates

These drugs may be used to treat conditions that contribute to sleep disruption such asrestless legssyndrome as a second line drug.

6.抗惊厥药物

These drugs may be used to treat conditions that contribute towards sleep disruption such as restless legs syndrome, nocturnal eating syndrome, periodic limb movement disorder, and insomnia related tobipolar disorder.

Examples of anticonvulsants:

7. Antinarcoleptics

These drugs may be used to improve daytime wakefulness and to control excessive daytime sleepiness and loss of muscle control in people withnarcolepsy.

Examples of antinarcoleptics:


REFERENCE: FDA Prescribing Information.

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Reviewed By:
Peter O’Connor, M.D.
American Board of Otolaryngology with subspecialty in Sleep Medicine

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