Sleep Disorders in Women (cont.)
Health care providers use short-term and long-term drug treatment to treat sleep disorders.
Sleep medications are a short-term drug treatment for insomnia. Other names for sleeping medications are hypnotics or sedatives. The goal is to reduce insomnia without sacrificing daytime alertness. Short-term treatment lasts 2-4 weeks. The health care provider treats the underlying cause of the sleep disorder during this period.
The most widely used sleep medications are the benzodiazepine and nonbenzodiazepine drugs. These medications are 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 sleep medications on a short-term basis. Examples are the benzodiazepines lorazepam (Ativan), triazolam (Halcion), and temazepam (Restoril) and the nonbenzodiazepines zolpidem (Ambien) and zaleplon (Sonata).
Ramelteon (Rozerem) is a prescription drug that stimulates melatonin receptors. Melatonin is a hormone produced by the pineal gland during the dark hours of the day-night cycle (circadian rhythm). Melatonin levels in the body are low during daylight hours. The pineal gland (located in the brain) 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.
Long-term treatment consists of treating medical and psychological conditions that underlie sleep disorders. In some cases, the sleep disorder is treated directly.
Hormone replacement therapy (HRT) improves sleep in menopausal women. HRT reduces hot flashes that disturb sleep. HRT may also improve sleep-related breathing disorders. HRT may be estrogen alone, or estrogen with progesterone. HRT is not for every woman, but it can markedly improve menopause symptoms. Long-term use of HRT involves risks. Make sure you understand the risks and benefits before you start HRT.
Antidepressant drugs are sometimes used for women with chronic (long-term) insomnia. These drugs usually work, even in people who have no other depression. They also help some premenstrual sleep problems, postpartum depression, anxiety-related sleep disorders, and clinical depression. They alter brain chemicals called neurotransmitters, such as serotonin and norepinephrine. These drugs do not cause dependency. Examples are sertraline (Zoloft), fluoxetine (Sarafem or Prozac), and mirtazapine (Remeron).
Stimulants are sometimes used to treat narcolepsy. These drugs promote wakefulness. An example is modafinil (Provigil).
Dopamine agonists are drugs that promote release of the neurotransmitter dopamine in the brain. These drugs may improve restless legs syndrome. An example is pramipexole (Mirapex).
For more information, see Understanding Insomnia Medications.
Carmel Armon, MD, MHS, MSc
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