Health & Medicine
Different drugs work better on different kinds of insomnia. Sonata, for instance, spikes quickly and then falls off steeply, so it may be best suited to insomniacs who need help falling asleep but don't wake up after that. This month, Sanofi-Aventis launched a slower-acting, longer-lasting version of Ambien, the top-selling prescription sleep medication. Ambien CR (for controlled release) is aimed at those who toss and turn all night or who wake up and can't go back to sleep. A slow-release version of Indiplon will be marketed for the same purpose.
Zero abuse. Rozerem, which became available late last month, is the first prescription sleep drug that has no potential for abuse and thus isn't listed as a controlled substance. It binds to receptors on cells in the brain's master clock, called the suprachiasmatic nucleus, triggering the cells to stop sending out the signal that keeps the brain awake. The drug is probably more useful for falling asleep than staying asleep, says psychiatrist Daniel Buysse, who studies sleep at the University of Pittsburgh Medical Center, but it will take a while to see how well it works compared with other drugs.
Many physicians resist prescribing sleep drugs because how patients will react over the long haul is unknown--the clinical trials that lead to a medication's approval last only a few months, while people may take the drug for years. "There's just kind of a disconnect," says Buysse.
The medication most commonly prescribed for insomnia is not a sleep drug at all but low-dose trazodone, an antidepressant. It's a legal but "off label" use, since the drug was approved for depression, not insomnia, and, again, its long-term effects on insomnia patients are an open question. "We just don't know anything," says Thomas Roth, a sleep researcher at Henry Ford Hospital in Detroit. He notes that because of side effects at high doses, the drug is rarely prescribed now for depression.
Dosing insomnia with over-the-counter products like Benadryl and Tylenol PM often produces next-day grogginess (the active ingredient is usually the same antihistamine that the manufacturer uses in its cold products), not to mention occasional constipation and, in some elderly people, delirium. And taking such medications for a long time has unknown effects.
A synthetic version of melatonin, a hormone that is part of the body's sleep mechanism, is a popular alternative therapy for insomnia. But a recent research review found that it doesn't seem to work for insomnia. Valerian root, an herbal supplement, supposedly has sleep-inducing qualities, but the evidence is shaky. (A current trial may give answers next year.)
Booze for a snooze? The good ol' nightcap has a long tradition of fighting insomnia--or trying to. Alcohol, a depressant, might induce sleepiness initially, but it will most likely wake you up later. "As it clears your system, you rebound," Roth says, and your sleep gets worse. "If I put an IV line and put alcohol in your system all night long, you'd do fine." (Your doctor may not agree.)
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