Insomnia Medications and My Experience
Sleep is essential for our health and well-being, but many people struggle with falling asleep or staying asleep at night. Insomnia, or the inability to sleep well, can affect our mood, energy, concentration, and overall quality of life. Fortunately, there are various medications that can help people with insomnia get some rest. However, these medications are not without risks and side effects, and they should be used with caution and under the guidance of a doctor. In this article, we will review some of the most commonly prescribed sleep aids, their benefits and drawbacks, and their sources.
Types of sleep aids
There are different types of sleep aids that work in different ways to help people sleep. Some of the most common ones are:
- Antidepressants: These are medications that are mainly used to treat depression and anxiety, but some of them can also have sedative effects that can help with insomnia. Examples of antidepressants that can be used as sleep aids are doxepin (Silenor), trazodone (Desyrel), and mirtazapine (Remeron). Antidepressants can help people who have insomnia related to mood disorders or chronic pain. However, they can also cause side effects such as weight gain, dry mouth, drowsiness, and sexual dysfunction. Antidepressants can also interact with other medications and substances, so they should be taken with care 1 2.
- Benzodiazepines: These are medications that belong to a class of drugs called central nervous system (CNS) depressants. They work by enhancing the activity of a neurotransmitter called gamma-aminobutyric acid (GABA), which reduces brain activity and induces relaxation and sleepiness. Examples of benzodiazepines that can be used as sleep aids are temazepam (Restoril), estazolam (Prosom), and triazolam (Halcion). Benzodiazepines can help people who have difficulty falling asleep or staying asleep, especially if they have anxiety or panic disorders. However, they can also cause side effects such as memory impairment, confusion, dizziness, and dependence. Benzodiazepines can also be addictive and cause withdrawal symptoms if stopped abruptly. Therefore, they are usually prescribed for short-term use only 1 2 3 4.
- Z-drugs: These are medications that are similar to benzodiazepines in their mechanism of action, but they have a different chemical structure. They also work by enhancing the activity of GABA in the brain, but they are more selective in targeting the receptors that are involved in sleep regulation. Examples of Z-drugs that can be used as sleep aids are zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta). Z-drugs can help people who have difficulty falling asleep or staying asleep, especially if they have insomnia that is not related to other conditions. However, they can also cause side effects such as headache, nausea, drowsiness, and complex behaviors such as sleepwalking or driving while asleep. Z-drugs can also be habit-forming and cause rebound insomnia if stopped suddenly. Therefore, they are also usually prescribed for short-term use only 1 2 3 5.
- Melatonin receptor agonists: These are medications that mimic the action of a hormone called melatonin, which is produced by the pineal gland in the brain and regulates the circadian rhythm or the body’s internal clock. Melatonin levels rise at night and fall during the day, signaling the body when to sleep and when to wake up. Examples of melatonin receptor agonists that can be used as sleep aids are ramelteon (Rozerem) and lemborexant (Dayvigo). Melatonin receptor agonists can help people who have difficulty falling asleep due to jet lag or shift work disorder. They can also help people who have insomnia related to aging or Alzheimer’s disease. However, they can also cause side effects such as headache, dizziness, fatigue, and nightmares. Melatonin receptor agonists do not seem to cause dependence or withdrawal symptoms, but they may interact with other medications and substances 1 2.
- Orexin receptor antagonists: These are medications that block the action of a neurotransmitter called orexin, which is involved in regulating wakefulness and arousal. Orexin levels are high during the day and low at night, keeping us alert and active during the day and sleepy at night. Examples of orexin receptor antagonists that can be used as sleep aids are suvorexant (Belsomra) and daridorexant (Quviviq). Orexin receptor antagonists can help people who have difficulty staying asleep due to frequent awakenings or early morning awakenings. They can also help people who have insomnia related to narcolepsy or other sleep disorders. However, they can also cause side effects such as headache, drowsiness, abnormal dreams, and sleep paralysis. Orexin receptor antagonists may cause dependence or withdrawal symptoms, but they are less likely to cause rebound insomnia than other sleep aids 1 2.
Other treatments
Sleep aids are not the only solution for insomnia. In fact, they are often not the best solution for long-term insomnia. Sleep aids can mask the underlying causes of insomnia and may lose their effectiveness over time. They can also cause side effects and dependence that can worsen the quality of sleep and health. Therefore, sleep aids should be used as a last resort and only under the supervision of a doctor.
There are other treatments that can help people with insomnia improve their sleep quality and quantity. Some of them are:
- Cognitive behavioral therapy for insomnia (CBT-I): This is a type of psychotherapy that aims to change the thoughts and behaviors that interfere with sleep. CBT-I involves various components such as stimulus control, sleep restriction, relaxation training, cognitive restructuring, and sleep hygiene education. CBT-I can help people identify and modify the factors that contribute to their insomnia and develop healthy habits that promote good sleep. CBT-I has been shown to be effective and durable in treating chronic insomnia 1 2.
- Lifestyle changes: There are many things that people can do to improve their sleep quality and quantity without using medications. Some of them are:
- Maintaining a regular sleep schedule: Going to bed and waking up at the same time every day can help the body establish a consistent circadian rhythm and facilitate falling asleep and staying asleep.
- Avoiding caffeine, alcohol, nicotine, and other stimulants: These substances can interfere with the production and action of melatonin and orexin in the brain and disrupt the sleep-wake cycle.
- Avoiding naps during the day: Napping can reduce the sleep pressure at night and make it harder to fall asleep or stay asleep.
- Exercising regularly: Physical activity can enhance blood circulation and oxygen delivery to the brain, which can support neurogenesis and synaptic plasticity. Exercise can also reduce inflammation and oxidative stress in the brain, which can protect against neuronal damage and degeneration. Exercise can also release endorphins and other neurotransmitters that can improve mood, energy, and well-being.
- Creating a comfortable and relaxing sleep environment: Making sure that the bedroom is dark, quiet, cool, and comfortable can help reduce external distractions and promote relaxation and sleepiness.
- Practicing relaxation techniques: Engaging in activities that calm the mind and body before bed can help reduce stress, anxiety, and arousal that can interfere with sleep. Examples of relaxation techniques are meditation, breathing exercises, yoga, progressive muscle relaxation, and guided imagery.
Conclusion
Sleep is vital for our health and well-being, but many people suffer from insomnia or poor sleep quality. There are various medications that can help people with insomnia get some rest, but they are not without risks and side effects. Therefore, they should be used with caution and under the guidance of a doctor. There are also other treatments that can help people with insomnia improve their sleep quality and quantity without using medications. These include cognitive behavioral therapy for insomnia and lifestyle changes that promote good sleep hygiene. By choosing the best treatment for their needs and preferences
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Breaking Free from Schizophrenia & Bipolar: Lurasidone's Impact
Lurasidone is a medication that belongs to the class of atypical antipsychotics. It is used to treat schizophrenia and bipolar depression, which are mental disorders that affect a person’s mood, thoughts, and behavior. Lurasidone is sold under the brand name Latuda and is available as tablets that are taken by mouth with food.
History
Lurasidone was first synthesized in 2003 by a Japanese pharmaceutical company called Dainippon Sumitomo Pharma. It was approved for medical use in the United States in 2010, in Canada and Europe in 2013, and in Japan in 2014. Lurasidone was developed as a novel antipsychotic with a unique pharmacological profile that differs from other atypical antipsychotics.
Mechanism of Action
Lurasidone works by affecting the activity of certain chemicals in the brain called neurotransmitters, such as dopamine and serotonin. These neurotransmitters are involved in regulating mood, cognition, and perception. Lurasidone acts as an antagonist of the dopamine D2 and D3 receptors, and the serotonin 5-HT2A and 5-HT7 receptors, which means that it blocks their effects. Lurasidone also acts as a partial agonist of the serotonin 5-HT1A receptor, which means that it stimulates it to a lesser extent than the natural neurotransmitter. By modulating these receptors, lurasidone may help to reduce the symptoms of schizophrenia and bipolar depression, such as hallucinations, delusions, mood swings, and suicidal thoughts.
Evidence for use
Lurasidone has been tested in several clinical trials for its efficacy and safety in treating schizophrenia and bipolar depression. The results of these trials have shown that lurasidone is effective in reducing the positive and negative symptoms of schizophrenia, such as psychosis, social withdrawal, and lack of motivation. Lurasidone has also been shown to improve the depressive symptoms of bipolar disorder, such as low mood, loss of interest, and hopelessness. Lurasidone has been compared to other antipsychotics, such as olanzapine, quetiapine, risperidone, and ziprasidone, and has been found to be similar or superior in terms of efficacy and tolerability.
Dosing
The recommended starting dose of lurasidone for schizophrenia is 40 mg once daily with food. The dose may be increased or decreased depending on the response and side effects of the patient. The maximum dose is 160 mg per day. The recommended starting dose of lurasidone for bipolar depression is 20 mg once daily with food. The dose may be increased up to 120 mg per day depending on the response and side effects of the patient. Lurasidone may be used alone or in combination with other mood stabilizers, such as lithium or valproate.
Side Effects/ Adverse reactions / Contradictions
Like all medications, lurasidone may cause some side effects. The most common side effects are sleepiness, movement disorders, nausea, and diarrhea. These side effects are usually mild and tend to decrease over time. Some serious side effects may occur rarely, such as neuroleptic malignant syndrome (a life-threatening condition characterized by fever, muscle rigidity, altered mental status, and high blood pressure), tardive dyskinesia (a potentially irreversible condition characterized by involuntary movements of the face, tongue, or limbs), high blood sugar levels (which may lead to diabetes or worsen existing diabetes), high cholesterol levels (which may increase the risk of heart disease), weight gain (which may increase the risk of obesity and metabolic syndrome), low blood pressure (which may cause dizziness or fainting), seizures (which may cause loss of consciousness or convulsions), allergic reactions (which may cause rash, itching, swelling, or difficulty breathing), and increased prolactin levels (which may cause breast enlargement or milk production in both men and women). Lurasidone should be used with caution in patients who have a history of heart disease, liver disease, kidney disease, epilepsy, diabetes, or low white blood cell count. Lurasidone should not be used in patients who are allergic to it or any of its ingredients. Lurasidone should not be used in combination with certain medications that may interact with it or affect its metabolism, such as strong inhibitors or inducers of an enzyme called CYP3A4. Examples of these medications include ketoconazole (an antifungal drug), ritonavir (an antiviral drug), rifampin (an antibiotic drug), grapefruit juice (a fruit drink), and St. John’s wort (an herbal supplement). Lurasidone should not be used in pregnant or breastfeeding women, as it may harm the unborn or nursing baby. Lurasidone should not be used in children or adolescents under 10 years of age, as its safety and effectiveness in this age group have not been established.
Positives or Pros
Lurasidone has several advantages over other antipsychotics, such as:
- It has a favorable metabolic profile, meaning that it is less likely to cause weight gain, diabetes, or high cholesterol levels than other antipsychotics.
- It has a low risk of causing sedation, cognitive impairment, or sexual dysfunction than other antipsychotics.
- It has a high affinity for the serotonin 5-HT7 receptor, which may contribute to its antidepressant and cognitive-enhancing effects.
- It has a low risk of causing QT prolongation, which is a potentially dangerous abnormality in the heart rhythm that may lead to cardiac arrhythmias or sudden death.
Negatives or Cons
Lurasidone also has some disadvantages over other antipsychotics, such as:
- It has to be taken with food, preferably a meal of at least 350 calories, to ensure adequate absorption and bioavailability. This may limit its convenience and adherence for some patients.
- It has a relatively long half-life, meaning that it takes a long time to be eliminated from the body. This may increase the risk of accumulation and toxicity if the dose is missed or changed.
- It has a high potential for drug interactions, as it is extensively metabolized by the CYP3A4 enzyme. This means that it may interact with many other medications that are either substrates, inhibitors, or inducers of this enzyme. This may require dose adjustment or avoidance of certain medications when using lurasidone.
- It has a moderate risk of causing extrapyramidal symptoms, such as tremor, stiffness, restlessness, or abnormal movements. These symptoms may be distressing and impairing for some patients.
Conclusion
Lurasidone is a novel atypical antipsychotic that has been shown to be effective and well-tolerated in the treatment of schizophrenia and bipolar depression. It has a unique pharmacological profile that may offer some advantages over other antipsychotics in terms of metabolic, cognitive, and cardiac effects. However, it also has some limitations in terms of dosing, elimination, and drug interactions that may require careful monitoring and management. Lurasidone may be a valuable option for patients who have not responded well to other antipsychotics or who have experienced intolerable side effects from them.
By Birk Gundersen RN, BSN.
Sources
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