What are the best medications to help me sleep? I’ve tried all the natural remedies, I need something stronger!


— V.E.,
Sacramento, Calif.

A: Why, as a nation, do we have trouble sleeping? It should be such a natural act. I urge you to find the underlying cause of your chronic insomnia and to change your sleep habits because you can’t rely on medication forever.

Chronic insomnia may be caused by sleep apnea, and sleeping pills, in this case, are dangerous. For some of you, a deficiency of your sleep hormone, melatonin, causes you to wake up very early. The point is that sleep disorders aren’t always related to neurotransmitter imbalances, so sleeping pills are not a cure-all like everyone thinks. You can take them for awhile, but they just mask the underlying problem. Here are the most popular medications:

Ambien (zolpidem): Introduced in 1992, this helps put you to sleep, and keep you asleep. Many people reported having morning grogginess, so the makers came out with a controlled-release version in 2005 that works longer. Ambien usually puts you to sleep within 15 to 30 minutes. There are other brand names containing the same chemical ingredients such as a sublingual low-dose tablet called “Intermezzo” that you can take in the middle of the night. There’s “Zolpimist,” an oral spray. Every now and then you hear a report of someone sleep-driving, having sex, making phone calls, sleep-walking and cooking meals.

Lunesta (eszopiclone): Everything I said about Ambien applies to this drug; it is similar in mechanism of action, as well of duration of action.

Sonata (Zaleplon): Again, similar to Ambien, however, it has a very short duration of action. The advantage is you won’t have morning grogginess. The disadvantage is you may be staring at the alarm clock by 3 a.m.

Rozerem (Ramelteon): This is my favorite sleep medication because it affects your melatonin receptors, increasing the length of time you sleep. You can start and stop as often as you wish, since there is no physical dependence. The drug may affect prolactin and testosterone levels, so if you use it long-term (longer than three or four months), have these levels evaluated.

Silenor (Doxepine): Introduced in 2010, this medication blocks histamine receptors. It contains the same active ingredient as a popular antidepressant, but in a much lower dose. I like that it does not have addictive potential.

Benzodiazepine drugs (temazepam, alprazolam, clonazepam, lorazepam and others): Very affordable, and used for decades, these drugs have strong addictive potential and may cause daytime drowsiness. This category helps with some seizures.

Insurance companies may have restrictions on which sleeping pills are covered, and will obviously expect you to buy generic; they often require you to try other approaches to your insomnia first. If anyone is interested in natural herbs or vitamins to help you sleep, I’ll send you an expanded version of this article. Just sign up for my free newsletter at www.DearPharmacist.com.

This column is not intended to treat, cure or diagnose you. To submit a question, visit www.DearPharmacist.com.