Sleep Aids and the Treatment of Bipolar Disorder
Doctors commonly prescribe sleep aids for the short-term treatment of insomnia, which is often associated with depression and bipolar mania. Benzodiazepines are often used to help with sleep, but a number of sedative hypnotic medications similar to benzos are used exclusively for insomnia and aren’t used to treat anxiety.
These medications aren’t usually combined with benzos because the combined sedative effects can be dangerous. Like benzos, these sedative hypnotic agents carry risks of addiction and dependence.
The following table lists the pros and cons of some common sleep aids.
|Generic Name||Brand Name||Average Adult Dose||Potential Benefits||Some Possible Side Effects*|
|Nonbenzodiazepine sleep aids|
|Eszopiclone||Lunesta||1 to 3 mg||Improved ability to sleep.||Dependence; headache; unpleasant taste; grogginess or hangover
effect the next day.
|Zaleplon||Sonata||5 to 10 mg/day||Improved ability to sleep; short acting so it can be taken in
the middle of the night if waking is a problem.
|Dependence; grogginess or hangover effect the next day.|
|5 to 10 mg/day for Ambien
6.25 to 12.5 mg/day for Ambien CR
|Improved ability to sleep.||Dependence; odd or dangerous behaviors while sleeping,
including sleepeating, sleepwalking, and sleepdriving; memory loss;
grogginess or hangover effect the next day.
|Benzodiazepine Sleep Aids|
|Flurazepam||Dalmane||15 to 30 mg/day||Improved ability to sleep.||Dependence/addiction; sedation; dizziness; respiratory
suppression at high doses or when combined with alcohol; grogginess
or hangover effect the next day.
|Temazepam||Restoril||7.5 to 30 mg/day||Improved ability to sleep.|
mg/day = milligrams per day.
* Other side effects may occur that aren‘t listed.
In addition to the benzos and sedative hypnotics, doctors use a variety of other medications to reduce insomnia, especially if they’re concerned about issues of dependence and addiction. The antidepressants trazodone, amitriptyline, and mirtazapine are often used in low doses for sleep because they’re extremely sedating (see the prior section on antidepressants for more details).
One antidepressant, doxepin, has been repackaged, in low doses, as a sleep aid called Silenor, and the FDA formally approved it to treat insomnia. Antihistamines, medications that are used to treat allergies such as diphenhydramine (Benadryl), are also used to treat insomnia because of their extremely sedating side effects.
A brand new medication on the market called suvorexant (Belsomra) works completely differently than the benzos and related medications. This medication blocks the binding of orexin to its receptors in the brain. Orexin is a group of proteins in the brain that promotes wakefulness. Blocking it helps to discourage being awake, therefore allowing sedation to occur.
All other medications used to treat insomnia work by increasing sedation, rather than decreasing wakefulness. It remains to be seen how well this medicine will work with large numbers of people and what the most common side effects will be, because it has only been used in studies and is just coming on the market in mid-2015.
Another sleep aid you may want to discuss with your doctor is ramelteon (Rozerem), which may be useful for people who’ve experienced addiction to benzos. It works through the melatonin system.
Melatonin is a chemical that the brain releases in response to changing light at the end of the day. It doesn’t carry risks of dependence and addiction and therefore isn’t a controlled substance like most other prescription sleep medications. It won’t make you feel groggy the next day and is safe to use with many prescribed medications. But it may not be safe for individuals who have a history of kidney or respiratory problems, sleep apnea, or depression, or for women who are pregnant or breast-feeding.
Ramelteon may interact with alcohol, and high-fat meals may slow the absorption of the medication.