For the millions of Americans who struggle with sleep issues, prescription sleep aids may provide relief. Along with helping to treat insomnia, they can help people fall asleep faster, and sleep more soundly. There are many types that your doctor can prescribe: Each contains different ingredients and can vary in its effects. While you should always seek the advice of your doctor when deciding which sleep aid or lifestyle adjustment is the best course of action to improve your sleep, this quick guide highlights the differences between common prescription sleep aids and how they work to help you sleep better.
Orexin Receptor Antagonists
The most recent class of insomnia drugs approved by the FDA, orexin receptor antagonists work very differently than the sleep aids that came before them. While many traditional prescription sleep aids increase levels of the neurotransmitter GABA, this new class works by inhibiting the activity of the chemical orexin in the brain. Orexin plays an important role in keeping people awake and alert, so blocking it may help promote sleep. Importantly, this new class of sleep medication targets a localized area of the brain; as such, it may have fewer side effects than other drugs. Currently, Suvorexant is the only FDA-approved orexin receptor antagonist available.
Prescribed by physicians since the 1960s, benzodiazepines work by enhancing the action of GABA, a neurotransmitter that slows activity in the brain helping people fall asleep more quickly and stay asleep longer. Although they have been found to be effective in the short-term, long-term use of benzodiazepines may not be advisable as they can have side effects, including a reduced duration of deep sleep and a gradual building of tolerance that may require people to increase dosage over time. Flurazepam, Triazolam, Temazepam, Diazepam, Alprazolam, and Lorazepam are all commonly prescribed benzodiazepines.
Although structurally different than benzodiazepines, non-benzodiazepine hypnotics work in a similar way, by binding to benzodiazepine-like receptors in the brain that increase the levels of GABA. This in turn, slows activity in the brain, inducing sleepiness. Rather than affecting multiple brain receptors as benzodiazepines do, nonbenzodiazepines act only on a few, and therefore tend to have fewer side effects and limited impact on deep sleep. Nevertheless, these drugs are known to contribute to memory loss and next-day fatigue. Common medications include the so-called Z class of Zolpidem, Eszopiclone, and Zaleplon.
Until relatively recently, insomnia was thought to be a side effect of the depression: By treating the mental health condition with antidepressants, doctors believed it could benefit insomnia as well. In theory, the drugs can work as sleep aids because they alter brain chemicals such as serotonin and norepinephrine, which can have a sedating effect. However, more recent research suggests that antidepressants may actually contribute to a person’s insomnia, and many studies are inconclusive about how much this class of medication helps or hurts the sleep process. The most commonly prescribed antidepressant for sleep is Trazadone. Other medications include Doxepine and Amitriptyline.
Discovered in the 1950s and first explored as a prescription sleep aid in the 1990s, melatonin is a hormone that regulates your circadian cycle of sleep and wakefulness. Levels of melatonin naturally rise at night, making you feel sleepier. If you are having trouble falling asleep, increasing melatonin via medication before bed may help. Unlike other sleeping aids, melatonin has relatively few known side effects, and it is not believed to be addictive. However, the effectiveness of melatonin as a sleep aid is moderate at best. Ramelteon is a common prescription melatonin. Synthetic melatonin is also available as an over-the-counter supplement but it may be even less effective than prescription melatonin.
Talk with your doctor about the available options, as well as lifestyle changes you can explore that will make falling—and staying—asleep easier.
Chart: Sleep Aids at a Glance
|Drug type||Common names||How it works|
|Orexin receptor antagonists||Suvorexant||Inhibits chemical that increases alertness.|
|Benzodiazepines||Flurazepam, Triazolam||Slows brain activity by enhancing GABA activity.|
|Non-benzodiazepine hypnotics||Zolpidem, Eszopiclone||Enhances GABA to slow brain activity.|
|Antidepressants||Trazadone, Doxepine||Sedates by altering serotonin and norepinephrine levels.|
|Melatonin||Ramelteon||Increases chemical responsible for sleep/wake cycle.|