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Go to Sleep: Which Pill Is Right for You

Beth Greenfield
Illustrations by Jayme Perry

Earlier this year, the FDA issued a wake-up call to manufacturers of the popular sleep aid Lunesta: It required that the recommended starting dose be cut in half, from 2mg to 1mg, in light of data showing that people who took it at night experienced "severe next-morning psychomotor and memory impairment" and might not be alert enough to drive safely. The mandate came more than one year after an FDA requirement that manufacturers of zolpidem-containing sleep aids, like Ambien, reduce bedtime doses due to similar problems. Still, a whopping 9 million Americans — or 4 percent of the adult population — pop sleeping pills from time to time, according to a 2013 Centers for Disease Control and Prevention study, with many more using natural remedies, or suffering silently through nights of insomnia. Here’s a look at what else we’re taking:

Go to Sleep: Which Pill Is Right for You

Ambien
Generic name: zolpidem

How it works: As a sedative-hypnotic class of drug, it helps the brain produce calming feelings.

Pros: Works quickly (users fall asleep within 15 to 30 minutes). Plus, the extended-release version promotes longer sleep.  

Cons: Can be addictive, loses its effectiveness over time, and can cause dangerous behaviors such as sleep eating syndrome.

Rozerem

Generic name: Ramelteon

How it works: Targets the sleep-wake cycle, similar to the natural remedy of melatonin.

Pros: No evidence of abuse.

Cons: Can cause sleepwalking and can’t be used with the anti-depressant fluvoxamine.

Sonata

Generic name: Zaleplon

How it works: It’s a hypnotic and relaxes the central nervous system.

Pros: Stays in the body for a short time so it’s safe to pop one at 2 a.m. after trying to fall sleep naturally.

Cons: Preceding it with a heavy meal can make it less effective. May cause sleep-driving, sleep-eating or other behaviors that often won’t be recalled the following morning.

Silenor

Generic name: Doxepin

How it works: It’s a tricyclic antidepressant and operates by blocking histamine receptors.

Pros: Unlike some of the other drug families, this one promotes immediate and long-lasting sleep.

Cons: Can cause weight gain.

 

Xanax

Generic name: aplrazolam

How it works: This older-class, general sedative is a benzodiazepine (like Valium).

Pros: Stays in the system longer than many other non-benzodiazepines, and can therefore be helpful in treating sleepwalking, for example.

Cons: Prevents users from spending lots of time in the deepest sleep stages (three and four) depriving them of solid rest. It can also cause hangover-like effects and can more easily lead to dependence. 

Klonopin

Generic name: clonazepam

How it works: A benzodiazepine often used to control seizures or panic attacks, it calms the brain and nerves.

Pros: Very effective in preventing REM behavior disorder, in which people to ‘act out’ their dreams (shouting, moving their limbs, walking around).

Cons: Can be addictive.

Desyrel

Generic name: Trazodone

How it works: Mainly an antidepressant, it acts by releasing the calming neurotransmitter serotonin and evokes drowsiness.

Pros: Not an FDA-controlled substance, so it’s easier to nab a ’scrip.

Cons: Though “very unlikely,” it can cause priapism (prolonged erections) in men.

Valerian

How it works: This root acts as a natural sedative.

Pros: No prescription is needed and its effectiveness intensifies the more often it’s used.

Cons: Can sometimes cause insomnia.

 

Melatonin

How it works: This natural hormone helps regulate sleep-wake cycles (the circadian cycles).

Pros: There’s evidence it can help reduce jetlag.

Cons: May be risks of bleeding or seizure.