In recent years, a newer class of medications has been developed often termed the "non-benzodiazepine, benzodiazepine receptor agonists." These newer medications appear to have better safety profiles and less adverse effects. These medications are associated with a lower risk of abuse and dependence than the benzodiazepines. Examples of medications in this class include:
- Ambien (Zolpidem)
- Sonata (Zaleplon)
- Lunesta (Eszopiclone, formerly known as Estorra)
These medications are known to reduce the time it takes to fall asleep and, thus, their effects are quite similar to those in the benzodiazepine class. These medicines appear to have different characteristics and may be used in different ways.
Again, although these medications are safer than the benzodiazepines, it is not recommended that they be used on a long term basis (except Lunesta which will be discussed subsequently).
Ambien. This sleeping pill has effects that persist later into the night and may help the individual stay asleep longer. Thus, it must be taken at bedtime and may be used when the individual has trouble falling asleep and/or staying asleep.
Sonata. This sleep aid is generally used for those individuals having trouble falling asleep. Therefore, it is often taken at bedtime or later such as when awakening during the night as long as there are at least four or more hours left to sleep.
Lunesta. This sleep aid was approved by the FDA in December of 2004 as a new, longer lasting sleeping pill. Clinical trials have demonstrated that Lunesta helps people get to sleep faster, similar to Ambien and Sonata. However, it appears that it also helps the individual stay asleep through the night.
The FDA has approved Lunesta for patients who have difficulty falling asleep as well as those who are unable to sleep through the night. Lunesta has about a six hour half life, so it is more likely to maintain sleep. Due to its long half life, Lunesta must be taken immediately before bedtime and the individual should make sure that he or she has a full eight hours devoted to sleeping before taking it.
As with the other medications, side effects can occur, including daytime drowsiness, dry mouth, and dizziness. Unlike the other medications in this class which are recommended only for use on a temporary basis, Lunesta is approved for longer term use.
Advantages of Non-benzodiazepine Sleeping Aids
Non-benzodiazepine hypnotics like Ambien, Sonata, and Lunesta have advantages over previous generations of sleep medication. These include such things as:
- A relatively short half life so one does not wake up with a "hangover" the following day
- Having little effect on sleep staging, allowing the individual to obtain approximately the same amount of time in each stage of sleep as one would without the medications
- Less likely to cause addiction, withdrawal, or tolerance relative to older sleeping medications.
However, it should be kept in mind that these medications will not address any underlying medical problems causing the insomnia, such as sleep-related breathing disorders (sleep apnea), restless legs syndrome, and of course, chronic pain. Therefore, they should only be used in conjunction with other treatments that are focusing on the primary medical problem.
