When You Just Can't Sleep

A better understanding of the physiology of sleep has led to the development of safer medications. Learn more and print a chart.

Medications certainly play an important part in the treatment of insomnia. They’ve helped many people catch up on their much-needed rest. But new insight into the psychology behind this common disorder has led to cognitive-behavioral treatments (CBT) that may be as effective.

“The behavioral aspect deals with a person’s sleep habits and focuses on things like stimulant control, not spending too much time in bed tossing and turning, and learning to associate the bed with sleep,” explains Sonia Ancoli-Israel, PhD, director of the sleep disorders clinic at the VA San Diego Health Care System. “The cognitive component deals with the maladaptive thoughts a person has. People think, If I don’t get exactly eight hours of sleep I’m going to be sick tomorrow. You may be a little tired, but you’ll still be able to function.” While medication works more quickly, the effects of CBT are longer-lasting, says Ancoli-Israel. She points out, however, that sometimes it’s hard to change people’s behavior when they are so tired, which is why a combination of the two approaches, medication and CBT, often works best.

Pharmacies filled 43 million prescriptions for insomnia drugs in 2005. The good news is that a better understanding of the physiology of sleep has led to the development of safer medications that come closer to mimicking the natural sleep process. One new drug, Rozerem (ramelteon), stimulates melatonin receptors in the brain (melatonin is a natural hormone that induces sleep). Others, like Lunesta (eszopiclone) and Ambien (zolpidem tartrate) work on the pathways in the brain that make us sleepy. These newer medications are shorter acting than their predecessors, and thus less likely to leave morning drowsiness in their wake.

“The older generation benzodiazepines work on many different pathways in the brain, including those that control muscle relaxation and sedation, giving us unwanted side effects,” says Gerard T. Lombardo, MD, director of the Sleep Disorders Center at New York Methodist Hospital in Brooklyn. “The newer agents work more exclusively on the pathways that induce sleep.” (View a chart on sleep drugs.)

Still, the FDA has recently called for a change in labeling for all 13 prescription medications currently approved for the treatment of insomnia, asserting that all such drugs pose potential risks, including the possibilities of severe allergic reaction and complex sleep-related behavior, like driving and eating while asleep. And the National Institutes of Health recently came out against herbal remedies for insomnia, claiming there has not been enough research to prove their safety or effectiveness, yet they have been shown to have side effects.

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• The Magic Power of Sleep
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• Improve Your Sleep
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• How to Deal With Insomnia
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• Best Remedies for Insomnia
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• Sleep Education
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• The National Sleep Foundation
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