WHAT ABOUT SLEEP MEDICATIONS? ARE THEY SAFE?

Over-the-counter medications promoted as sleep aids are primarily anti-histamines & work well for many with mild sleep disorders (especially if you have a chronic sinus allergies). Some people experience side effects of daytime drowsiness, disorientation, blurred vision or dry mouth, which makes this otherwise safe medication too difficult to tolerate. They do not provide effective and sustained relief for more severe sleep disorders.

The "benzodiazepines" are the most widely used prescription medications indicated for short-term treatment of anxiety and/or insomnia. These prescription medications bind to the GABA receptor complex reducing anxiety, inducing muscle relaxation and inhibiting convulsions as well as promoting sleep.

They are generally safe and effective for short-term use. They include Temazepam (Restoril), Triazolamm (Halcion), & Lorazepam (Ativan). Their possible side effects include decreased daytime alertness, energy, concentration, and/or memory functioning, and possibly even depressed mood. With regular use for more than several weeks at a time, these medications may significantly reduce time spent in REM sleep, resulting in these and other side effects including mood swings, irritability, temper outbursts, anxiety, and (ironically) insomnia.

Because they are potentially habit-forming or addictive, regular use of benzodiazepines for more than several weeks at a time should be avoided, except in rare cases. In addition to the side effects noted above, the negative consequences long-term daily use include the need for increased dose to achieve the desired effects (becoming "immune" to the medication or "tolerance"); the urge to take more medication than is prescribed ("abuse"); and the uncomfortable and potentially dangerous withdrawal symptoms on attempts to discontinue the medication (due to "physiologic dependence").

Care should be taken when by anyone with liver and kidney disease to those who are heavy snorers, and to the elderly. These medications have been associated with birth defects when taken by pregnant women. It is extremely important for women of childbearing age to use the most reliable methods of contraception possible when taking these medications.

Zaleplon (Sonata) & Zolpidem (Ambien) are non-benzodiazepine prescription medications for insomnia. They have minimal adverse effects on sleep architecture, and no evidence of rebound insomnia at recommended doses. Side effects can include memory impairment, sleepwalking, and morning drowsiness.

For chronic insomnia associated with other symptoms of Clinical Depression, I have had excellent results with the so-called "anti-depressant" medications. They are not habit-forming, restore sleep architecture to normal, have minimal to no side-effects when properly selected and dosed. They tend to improve all symptoms of the syndrome of Clinical Depression, as well as reducing a wide variety of aches & pains. Examples include Trazodone (Desyrel), Amitriptyilne (Elavil), and Remeron (Mirtazapine).

Regarding “anti-depressant” medications, talk to your healthcare provider about trying the lowest dose possible and about gradual increase of the dose until your symptoms are resolved. These agents can potentially have a wide variety of side effects, including daytime drowsiness & decreased impaired daytime energy, which are usually minor and temporary. In some individuals, these medications can actually worsen sleep disturbance & mood.

Remember: what counts is how you feel, not how many hours of sleep you've had. If you are alert, feel rested, and function well during the day, chances are you're getting enough sleep.

Sweet Dreams!

For more information: National Sleep Foundation http://www.sleepfoundation.org