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If you have been suffering from sleep problems for a long time, the first thing that comes to your mind when thinking about how to overcome these problems most probably is the use of sleep aids. However, scientific studies have shown that sleep aids cannot resolve chronic
insomnia,
and that
cognitive behavioral therapy
is more effective. Despite these findings, sleep medication is often the first choice in treating insomnia - even though international recommendations for physicians state that sleep aids should be prescribed only in emergencies and for short periods of time, i.e. for no longer than 2 weeks.
Sleep aids do not resolve sleep complaints; they only disguise them and do not address the cause of the problem.
There are many types of sleep aids, varying from herbal and homeopathic substances to prescription medications. Here, you can find a short overview of these substances. |
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Prescription sleep medications |  |
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Physicians often prescribe so called benzodiazepines. Benzodiazepines stimulate GABA-receptors in the brain. GABA, which stands for gamma-aminobutyric acid, is a neurotransmitter conveying nerve signals. GABA inhibits the transport of messages from one nerve cell to another, and benzodiazepines enhance this effect. As a result, benzodiazepines can reduce consciousness, anxiety, muscle tension and epileptic activity. Therefore, benzodiazepines are described for sleep complaints, anxiety disorders or epilepsy.
The various benzodiazepines differ in how fast they can induce sleep and how long their effects last. These differences are important to determine what medication to use to treat a specific sleep complaint. Long-acting substances are often prescribed for sleep maintenance problems, but may have unwanted side effects during the day, such as increasing the risk of car accidents. Moreover, the dose of the previous night might not be eliminated the next evening when another dose is taken, so that effects can add up.
Using benzodiazepines my lead to drug dependency, that is
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As your body gets used to the drug, its effects diminish so that you need a higher dose after some time
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Psychological addiction
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Abrupt benzodiazepine withdrawal may lead to withdrawal symptoms and rebound insomnia
Benzodiazepines are relatively ‘save’ drugs. During the first week of use, the risk of accidents increases due to increased reaction times, coordination problems, and muscle weakness, among other things. Furthermore, side effects include fatigue, sleepiness and drowsiness.
Examples of benzodiazepines:
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Generic name
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Brand names
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DiazepamStesolid |
Atenex, Ducene, Stesolid, Valium |
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Flunitrazepam |
Rohypnol |
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Flurazepam |
e.g. Dalmadorm, Dalmane |
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Loprazolam |
Dormonoct |
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Lorazepam |
Ativan |
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Lormetazepam |
e.g. Dilamet, Ergocalm, Loramet, Loretam, Noctamid, Nocton, Pronoctan, Stilaze |
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Midazolam |
e.g. Doricum, Dormixal, Dormonid, Flormidal, Sorinor |
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Nitrazepam |
e.g. Insoma, Mogadon, Nitrados, Nitrazadon, Paxadorm, Somnite |
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Temazepam |
e.g. Norkotral, Normison, Remestan,Restoril, Temtabs, Tenox |
“Z” sleep medications
For a number of years, additional sleep medications have been released that have similar effects as benzodiazepines but do not belong to the same family. The earlier claim that these substances are not addictive has been weakened lately.
Examples include:
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Generic name
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Brand names
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Zolpidem |
e.g. Ambien, Zolpimist |
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Zopiclon |
e.g. Amoban, Imovane, Novo-zopiclone, Nu-Zopiclone, Sopivan, Zimovane |
Other substances
Melatonin
is a hormone that is produced by pineal gland. It has important effects on the function of the biological clock that regulates, among other things, our sleep-wake rhythm. Melatonin production peeks before we go to sleep. Synthetic melatonin is used to reduce jet lag and as sleep aid. Using melatonin as sleep aid is only recommended if a lack of natural melatonin production has been detected by means of a saliva test. Such a melatonin test is the only proper way to determine IF and at what time of the day melatonin should be taken.
In the U.S., Canada and most EU-countries, melatonin is available without prescription. In the U.S., melatonine is sold as dietary supplement, meaning that the safety and effectiveness of melatonin supplements is not evaluated before the products enter the market. The first melatonin supplement that has been approved as prescription medication by the European Medicines Agency is Circadin, a sustained-release agent. Short-term use of Circadin is recommended only for people age 55 or above. Taking melatonin supplements is only useful if you suffer from a melatonin deficiency, and as we get older, the pineal gland produces less melatonin, making a melatonin deficiency more likely.
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Over-the-counter sleep aids | |
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Many over-the-counter substances, such as herbal or homeopathic substances or food supplements, claim to have sleep-promoting effects. Again, as sleep medications, these substances address only the symptoms - not the cause of sleep problems.
An important disadvantage of
herbal substances
includes the lack of independent quality and safety control. The fact that a substance is composed of natural herbs does not necessarily mean that it is save to use, and that it does not have side effects! There is hardly any research on the effects of most herbal substances. Knowledge on herbal substances is generally based on the experience of users.
Homeopathic substances
are based on the assumption that you can cure a disease by giving the patient a very small dose of a substance that would cause the symptoms of the disease in question if a higher dose was taken. Only registered homeopathic remedies may be sold and prescribed in the United States, meaning e.g. that all ingredients in a remedy must be listed. The registration regulations for homeopathic remedies are however very simple compared to the registration regulations for regular medications
Examples of herbal and homeopathic substances:
St John’s wort, mainly used against mild depression
Valerian, sedating effect on the central nervous system
Passion flower, calming effect
Tryptophan
Tryptophan
is an amino acid produced by our brain. It affects sleep rhythm regulation and has sleep promoting effects. Warm milk with honey or aniseed, a drink that is often used as natural sleep aid, actually contains tryptophan. After contaminated batches of synthetic l-tryptophan led to 30 deaths and 1500 cases of eosinophilia myalgia syndrome (EMS), the substance had been banned by the U.S. Food and Drug Administration. Currently, synthetic tryptophan is available again as over-the-counter as well as prescription sleep aid, but it may have severe side effects, such as drowsiness, nausea, anorexia, and sometimes maniac behavior.
More information?
Here, you can find more information on a
cognitive behavioral therapy for insomnia – without sleep aids.
Also check out our pages about
sleep disorders,
sleep and women,
sleep in elderly,
shift work/jet lag
and
sleep and children.
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