Insomnia is the inability to fall asleep or stay asleep and can be either transient or chronic. The cause of it can be far-ranging and includes psychiatric causes such as anxiety/depression. It can also be caused by other medical conditions or be secondary to medications. This article discusses pharmacological treatments only rather than the non-pharmacological which is quite successful.

Generally speaking treating insomnia involves treating the underlying cause if possible. If insomnia is due to psychiatric causes such as depression or anxiety, the individual may be put on anti-depressants or anti-anxiety medications.

If insomnia is due to an underlying medical condition such as fibromyalgia, gastroesphophageal reflux, restless leg syndrome, sleep apnea etc, then treating the cause often leads to successful outcomes.

For those whose insomnia doesn’t fit the above, I consider several drug categories that have been used in the past as sleep aids. These include:

• antihistamines (older, first generation ones)
• benzodiazepines
• antidepressants or
• sedatives

Antihistamines

Older antihistamines such as Benadryl (diphenhydramine)  are noted for their sedating side effects. These medications are sold over-the-counter and are often used for transient episodes of insomnia. Many people who first take the medication report a “hangover” effect the next day meaning that they feel groggy hours later.

This is a transient side-effect that generally dissipates the longer one takes the medication. In the event that fatigue continues, taking 1/2 a tablet (12.5 mg) often solves the problem.

By the way, Tylenol P.M. is used as a sleep aid and is a combination of Tylenol and diphenhydramine. If all you’re looking for is something to help you sleep, you can skip the Tylenol component and buy diphenhydramine. It’s cheaper.

Benzodiazepines

Benzodiazepines are generally referred to as sedative/hypnotics and are used to induce calmness in the awake patient thereby to induce sleep. They are mainly used to treat anxiety but are often used as sleep aides. The drawback to this class of meds is their potential for abuse and withdrawal symptoms if stopped abruptly. I am not an advocate of keeping patients on this and use it only for the short term because of the strong likelihood of dependence.

Antidepressants

Some antidepressants such as Trazadone are noted for their sedating side effects and are therefore given in low doses which would not be therapeutic for treating depresssion. Seroquel, a medication used to treat schizophrenia, is also prescribed in small doses to treat insomnia. In patients struggling with depression, this can be a good alternative.

Sedatives

Health insurance companies put a limit on the number of sedatives that can be prescribed in a month usually limiting the number of pills to around 12. Why? Again, it is very easy to grow dependent on medications to induce sleep and given that many Americans look to medications to solve their problems, it’s easy to understand why there is a limit.

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