Sleeping tablets

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. Check www.whelehans.ie for more information. If you have any health questions e-mail them to info@whelehans.ie

Sleeping medication should be absolute last resort. I discussed in a previous blog natural ways to help aid sleep; to read this click on: http://whelehans.blogspot.com/2015/01/insomnia-and-its-management.html

Quite often sleep disturbance is due to a medical condition. Examples include depression, asthma, ADHD or pain. Treating the medical condition is often the key to solving the sleep problem.

Natural Products

There are many natural products available. Their effectiveness is questionable and will only help mild insomnia (if at all). In Whelehans, we find that products containing Valerian (a natural sedative) aids sleep for some. Ask our staff for details of products we stock containing valerian.

Prescription medication

Prescription sleeping medication should only be used for short term use. It is easy to become dependent on them and they become less effective if used for more than 5 days. A doctor may consider the short term use of sleep medication if the symptoms are particularly severe, to ease short-term insomnia, or if the non-drug treatments failed. Doctors try to rule out other medical problems such as depression before prescribing sleeping tablets. Prescription sleeping tablets will temporarily relieve symptoms but do not tackle the cause. You should be given the lowest dose possible for the shortest length of time necessary (no longer than 5 days). The doctor may advise to only take the medication two or three nights a week, rather than every night.

Prescription hypnotic medicines cause side effects including a hungover feeling and drowsiness the next day. Sleeping medication are best taken half an hour before bedtime. In some, especially older people, the hangover effects may last well into the next day, so be cautious if driving or using machinery the next day. It is very easy to become dependent on these medicines, even in the short-term. If regularly taking sleeping tablets, you should consider reducing or stopping them. If you have been taking long term, do not stop them suddenly, as withdrawal symptoms can include panic attacks, shaking and rebound insomnia. Your doctor or pharmacist will give you advice safe withdrawal.

Types of prescription sleeping tablets

Benzodiazepines

Benzodiazepines are tranquillisers designed to reduce anxiety and promote calmness, relaxation and sleep. These medicines should only be considered if insomnia is severe or causing you extreme distress. All benzodiazepines make you feel sleepy and can lead to a dependency. If they are needed to treat insomnia, then only short-acting benzodiazepines (with short-lasting effects) should be prescribed, such as temazepam (Nortem^®, Insomniger^®), lormetazepam (Noctamid^®), flurazepam (Dalmane^®), triazolam (Halcion^®). As someone who has seen too often the terrible problems addiction to benzodiazepines cause, I advise they should be an absolute last resort.

Non benzodiazepines

The newer non benzodiazepine sleeping tablets such as zopiclone (Zimovane^®, Zimoclone^®) and zolpidem (Stilnoct^®, Zolnod^®) are less addictive than older varieties but it is still easy to become dependant on them. They tend to cause a metallic in the mouth. There is little difference (efficacy wise) between the non-benzodiazepines and older benzodiazepines, so if one does not work, it is unlikely that swapping to another will have a different effect. Sleeping tablets are best avoided in the elderly if possible as they cause confusion and increase the likelihood of falls.

Antidepressants
Some older antidepressants such as amitriptryline and trazodone are sometimes used to treat insomnia as they induce drowsiness. They should only be used in patients suffering from insomnia caused by depression. They are generally only prescribed under the supervision of a consultant psychologist. These older antidepressants can have more side effects than newer antidepressants such as dry eyes and mouth and constipation. Newer antidepressants that do not cause side effects such as drowsiness are more regularly used in depression. However in most cases, by treating the depression (combination of lifestyle changes, counselling, medication if need be), the sleeping pattern should then soon improve. 

Melatonin
Melatonin is a natural chemical produced by the pineal gland in the brain. Its key functions in the body are to induce sleep by causing drowsiness and lowering temperature. Melatonin has been available to purchase over the counter as a sleep aid in the US for over 15 years. However, it has only recently been launched on prescription in Ireland under the brand name Circadin^®. It can only be prescribed by a doctor and is only licensed for short term use in people over 55 and should not be taken for more than three weeks. It is not recommended for people with a history of kidney or liver disease. As Circadin^® can make you feel drowsy; you should not drive or operate heavy machinery after taking the medicine at night, or if you still feel drowsy the next morning. Side effects of Circadin are uncommon but include irritability, dizziness, migraines, constipation, stomach pain, and weight gain. Circadin^® does not have a GMS code meaning it is not allowed on the medical card or drug payment scheme.

Disclaimer: Consult a healthcare professional before making any changes recommended