1. Slideshow Pictures: Insomnia -- 10 Tips to Avoid Insomnia
2. Sleep Slideshow: Foods That Help or Harm Your Sleep
3. Sleep Quiz: Test Your Medical IQ

Medical Author:

Aparna Ranjan, MD

Coauthor:

Angela Gentili, MD

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.

View Full Profile

Antidepressants

Antidepressants are indicated for use in persons with insomnia associated with psychiatric disorders or persons who have a previous history of substance abuse. Sedating (sleep inducing) antidepressants, such as trazodone and nefazodone, are sometimes used at bedtime in small doses (50 mg). They are not associated with tolerance or withdrawal.

Melatonin stimulants

Ramelteon (Rozerem) is a prescription drug that stimulates melatonin receptors. Melatonin is a hormone produced by the pineal gland (located in the brain) 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. Ramelteon promotes the onset of sleep and helps normalize circadian rhythm disorders. Ramelteon is approved by the FDA for insomnia characterized by difficulty falling asleep.

Over-the-counter drugs

The active agent in many of the over-the-counter medications is one of the sedating antihistamines (drugs used for the treatment of allergy). They are generally safe but have side effects such as dry mouth, blurred vision, urinary retention, and confusion in older persons. They are also only mildly effective in inducing sleep and may reduce sleep quality. Therefore, these drugs should not be used on a routine basis.

There is no scientific evidence that herbal or "natural" substances are effective at promoting sleep.

Melatonin is a hormone that is thought to induce sleep. Studies have shown that melatonin may be useful for short-term adaptation to jet lag or other circadian rhythm sleep disorders. This hormone is produced by the pineal gland (located in the brain) in response to darkness, and it may be an important part of an individual's "biologic clock." Melatonin may be particularly useful for individuals with conditions that do not produce sufficient melatonin in response to darkness, such as blindness. The effectiveness of melatonin for long-term sleeplessness is less clear. Melatonin is sold over the counter and, therefore, is not controlled by the FDA. The optimal dose and its long-term adverse effects are also not known.

For more information, see Insomnia Medications.

Must Read Articles Related to Primary Insomnia

Disorders That Disrupt Sleep (Parasomnias) Parasomnias are disruptive sleep-related disorders. They are characterized by undesirable physical or verbal behaviors or experiences. Parasomnias occur in asso...learn more >>

Insomnia Insomnia affects most people at some point in their lifetime. Insomnia is actually a symptoms of a condition, disease, or situation. Non-medical treatment of in...learn more >>

Narcolepsy Narcolepsy is a sleep disorder that causes overwhelming and severe daytime sleepiness that often occurs at inappropriate times and places. The daytime sleep att...learn more >>

See the Entire Primary Insomnia Topic Guide »