The first thing to know is that not all sleeping pills are the same. “The myth is, ‘It doesn’t matter which one you choose, they all work the same way, they all do the same thing.’ They don’t,” said Dr. Andrew D. Krystal, a psychiatrist at the University of California, San Francisco who specializes in sleep disorders. Some medications, such as zaleplon (Sonata), decrease the time it takes to sleep. fall asleep, he said, while others, like suvorexant (Belsomra), block signals in the brain that wake you up. The hormone melatonin, as well as prescription drugs like ramelteon (Rozerem) which act on melatonin receptors, help regulate the body’s internal clock but do not necessarily help you stay asleep.
The best medication for you will largely depend on what is causing your insomnia. “It’s really about choosing the right drug for the patient,” said Dr. Aruna S. Rao, a neurologist at Johns Hopkins Medicine. If your problem is that you can’t fall asleep at bedtime, medication that keeps you from waking up in the middle of the night may not help. If you fall asleep easily but can’t sleep towards the end of the night, then drugs that wear off in a few hours, like zaleplon (Sonata), won’t do you much good either.
Many people also have sleep problems that cannot be solved by sleeping pills. One of those conditions is sleep apnea, which affects 22 million people in the United States and causes frequent awakenings, said Dr. Grace Pien, physician in pulmonary care, critical care and sleep medicine at Johns Hopkins. Medical. Sleep apnea is best managed with a machine that provides continuous positive airway pressure (CPAP), not with medication.
Another problem is that many sleeping pills do not come with convincing data. The over-the-counter antihistamines I used to take, which contain diphenhydramine, “have never really been systematically studied for their effects on sleep,” Dr. Krystal said. They’re known for their allergy benefits, but are often used as sleep aids because they cause drowsiness, he added. The few studies that have been done on diphenhydramine suggest that it doesn’t help at all: American Academy of Sleep Medicine clinical practice guidelines state that the benefits of the antihistamine, in terms of extra sleep, are “below the level of clinically significant improvement”. .”
Sleeping pills can also have side effects, some of which are serious. A 2017 study found that compared to seniors who did not take sleeping pills, those who took sleeping pills of any type recommended by their doctor were 34% more likely to fall, possibly because the drugs were affecting their balance. or incited clumsiness. . Another study found that people who had recently, for the first time, prescribed sleeping pills such as temazepam, trazodone or zolpidem (Ambien) were 90% more likely to be involved in car crashes and their increased risk was comparable to impaired driving drunk. Some research even suggests that long-term use of hypnotic drugs such as nordazepam, clonazepam (Klonopin), flurazepam (Dalmane), and zolpidem (Ambien) can more than double the risk of dementia.