Traditionally, when patients needed more help falling asleep than they were able to get from over the counter medications or home remedies, physicians turned to antidepressants. Just as antihistamines began to be used as hypnotics because they had a profound and marked side effect of making patients drowsy, the same was true for antidepressants. In addition to having a sedative effect, they also had the benefit of reducing anxiety, which also helped patients fall asleep more easily.
The most commonly prescribed types of antidepressant sleeping aid are benzodiazepines. Valium is probably the most recognizable of these drugs, though there are about three dozen in use. They are considered safe, they’re inexpensive and they are effective; they also have the advantage of not causing any kind of slowdown of the brain’s functioning in the way that their predecessors, barbiturates did.
Benzodiazepines both make you sleepy and relax your muscles. Some are more effective than others, but they all work the same way; they inhibit a chemical action within the brain that makes information flow, and which is moving too quickly in patients suffering from anxiety. This inhibition serves to calm the patient. Though benzodiazepines can come in short, medium and long-acting forms, the ones that are most useful for patients suffering from insomnia are the ones that move most quickly, allowing the patient to fall asleep rapidly and wake up refreshed in the morning.
In terms of quality of sleep, benzodiazepines main advantages are that they shorten the amount of time it takes for insomniacs to fall asleep and minimizes awakenings in the middle of the night. Overall time spent sleeping is improved. But the sleep that is increased is not deep sleep – in fact, benzodiazepines shorten deep sleep and lengthen twilight sleep. They also delay REM sleep. Despite these differences, patients who take benzodiazepines find them helpful, at least until their bodies develop a tolerance to them. This is very common, and results in patients requiring higher and higher doses. There is also a problem of patients becoming dependent on these drugs, and having a hard time stopping them. Withdrawal symptoms can be significant, and include tremors, lightheadedness, loss of appetite and a return to sleeping problems.
Benzodiazepines have negative side effects that include a slow down in the overall thought process and a loss of strength and coordination. This is most markedly seen in the morning after awakening. In some insomniacs the symptoms are quite severe, particularly in older patients, who experience confusion. All of these problems are exacerbated by the use of alcohol and other sedatives, so cold and allergy medicines should be avoided.
Chloral hydrate is a very old medication – it was first used in 1869, and is still used, though infrequently, in some elderly patients today. As an early sleep aid its appeal was in its ability to help people fall asleep quickly and stay asleep. It also did not create a groggy feeling in the morning, but it is a powerful brain depressant and can cause confusion. It is also common for it to irritate the stomach and to cause rashes.