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Medical Author:

Siamak T. Nabili, MD, MPH

Siamak T. Nabili, MD, MPH

Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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There are numerous prescription medications to treat insomnia. Generally, it is advised that they should not be used as the only therapy and that treatment is more successful if combined with non-medical therapies. In a study, it was noted that when sedatives were combined with behavioral therapy, more patients were likely to wean off the sedatives than if sedatives were used alone. The most commonly used sleeping pills are listed in the following sections including over-the-counter medications and natural sleep aids.

Prescription Sleep Aids

• Benzodiazepine sedatives: Six of these sedative drugs have been used to treat insomnia. There are reports of subjective improvement of quality and quantity of sleep when using these medications. Examples include temazepam (Restoril), flurazepam (Dalmane), triazolam (Halcion), estazolam (ProSom, Eurodin), lorazepam (Ativan), and clonazepam (Klonopin).
• Nonbenzodiazepine sedatives: Examples include eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien or Intermezzo).
• Ramelteon (Rozerem) is a prescription drug that stimulates melatonin receptors. Ramelteon promotes the onset of sleep and helps normalize circadian rhythm disorders. Ramelteon is approved by the US Food and Drug Administration (FDA) for treatment of insomnia characterized by difficulty falling asleep.
• Some antidepressants (for example, amitriptyline [Elavil, Endep] and trazodone [Desyrel]) have been used for the treatment of insomnia in patients with co-existing depression because of some sedative properties. Generally, they may not be helpful for insomnia in people without depression.

Over-the-Counter (OTC) Medications

• Antihistamines with sedative properties [for example, diphenhydramine (Benadryl) or doxylamine] have also been used in treating insomnia as they may induce drowsiness, but they do not improve sleep and should not be used to treat chronic insomnia.
• Melatonin: Melatonin is secreted by the pineal gland, a pea-sized structure at the center of the brain. Melatonin is produced during the dark hours of the day-night cycle (circadian rhythm). Melatonin levels in the body are low during daylight hours. The pineal gland responds to darkness by increasing melatonin levels in the body. This process is thought to be integral to maintaining circadian rhythm. At night, melatonin is produced to help your body regulate your sleep-wake cycles. The amount of melatonin produced by your body seems to decrease as you get older. Melatonin supplements may be beneficial in patients with circadian rhythm problems.

Herbal Remedies for Insomnia

• Valeriana officinalis (Valerian) is a popular herbal medication used in the United States for treating insomnia with possibly some benefit in some patients with chronic insomnia.
• St. Johns Wort and chamomile have not shown any real benefit in treating insomnia.
• Other natural herbal sleeping aids such as, dogwood, kava kava, and L-tryptophan, may be associated with potential adverse effect when used for insomnia.

Benzodiazepines have been shown to be useful. Melatonin, a hormone secreted by the pineal gland that regulates our sleep-wake cycles, has also been used.

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