Sleep Disorders and Aging (cont.)
The goal of drug therapy is to reduce insomnia without sacrificing daytime alertness. Other names for sleeping medications are hypnotics or sedatives. Usually, a sleeping medication is given only on a 2- to 4-week short-term basis. The underlying cause of the insomnia is treated during this period.
The most widely used sleep medications are the benzodiazepines and benzodiazepinelike drugs. These medications are relatively safe because they are difficult to overdose. Tolerance develops quickly, and over time, a higher dose is required to get the same effect as the initial dose. The risk of becoming dependent on these medications is high. These medications may cause withdrawal symptoms. These are the reasons for using these sleep medications on a short-term basis. Examples are zolpidem (Ambien), lorazepam (Ativan), triazolam (Halcion), temazepam (Restoril), and zaleplon (Sonata).
Antidepressant drugs are sometimes used for people with chronic (long-term) insomnia. These drugs usually work even in people who have no depression. These drugs do not promote dependence. Examples are trazodone (Desyrel) and nefazodone (Serzone).
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 Food and Drug Administration (FDA) for insomnia characterized by difficulty falling asleep.
For more information on insomnia medications, see Understanding Insomnia Medications.
Carmel Armon, MD, MHS, MSc
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