Getting A Good Night Sleep and Medication

The definition of insomnia, according to the American Sleep Disorders Association (ASDA), is difficulty falling asleep or staying asleep. If it occurs every night or most nights for an extended time, it’s called chronic insomnia.

According to ASDA estimates, more than 35 million Americans suffer from this long-lasting type of insomnia, with 20 to 30 million others suffering shorter-term sleeplessness. Men and women of all ages experience insomnia, but it is more common in the elderly and in women, especially after menopause.

Like a headache or fever, insomnia may be a symptom of another problem. It can result from something as simple as anticipating a stressful event, like a test or meeting, or from a longer-lasting stressful circumstance, such as a sick child or troubled marriage. Even worrying about having a tough time falling asleep may itself prevent a person from drifting off.

Other common causes of nighttime wakefulness include environmental disturbances, such as noise from traffic or television, an uncomfortable temperature, or light from the sun or other source; use of alcohol or stimulants, such as caffeine or nicotine; and erratic hours, like those of shift workers and people whose air travel takes them across time zones.

Sometimes short-term insomnia may go away on its own or with simple changes in daytime or sleep-time habits.

A doctor can help choose an appropriate medicine. One factor to consider is the drug’s half-life, or the time it takes to be cleared from the body. Drugs with shorter half-lives are less likely to have carry-over sedation that affects daytime functioning.

A second factor is the drug’s toxicity. Because of their lower risk of overdose, the newer benzodiazepines and benzodiazepine-like drugs are used more often to treat insomnia than barbiturates and other older drugs. Among the most commonly prescribed benzodiazepine sleep-aids are flurazepam (Dalmane), estazolam (ProSom), quazepam (Doral), temazepam (Restoril), and triazolam (Halcion). The prescription sleep-aid zolpidem (Ambien) is in the imidazopyridine class of drugs.

As a rule, these sleeping pills should be used only for short periods because of the risk of developing dependency and withdrawal symptoms when the drugs are stopped. So, while they may help with short-term insomnia induced by jet lag, shift work schedule changes, or short-term stress, they should generally not be used for chronic insomnia because of their potential addictiveness and because they can mask underlying medical problems.

Some other sleep-aids are available without a prescription, including diphenhydramine (in Nytol, Sleep-Eze, and Sominex) and doxylamine (in Unisom Nighttime). These products contain a sedating antihistamine and, like prescription drugs, must be used with care. Even if taken at night, they can cause daytime drowsiness, which can make driving and other tasks risky.