Prescription sleeping pills fall into three general categories. The specific drugs differ primarily in how fast they kick in and how long the sedative effect lasts. Most are available in generic versions.
Benzodiazepines are the classic sleep aids. Temazepam (Restoril is one brand) and triazolam (Halcion) are most often prescribed for insomnia; most are shorter-acting. In addition, some doctors prescribe “anti-anxiety“ benzodiazepines such as lorazepam (Ativan) and alparazolam (Xanax). These stay in the blood longer and are more likely to cause next-day impairment. Benzodiazepines slightly reduce REM and deep sleep.
Non-benzodiazepines include zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata) and ramelteon (Rozerem). Most start working quickly. Only eszopiclone and ramelteon are approved by the Food and Drug Administration (FDA) for long-term use. Zolpidem is also available in extended release, sublingual and oral spray formulations. These drugs tend to produce milder side effects than benzodiazepines, but this varies from person to person.
Each non-benzodiazepine has its advantages and disadvantages. For instance, eszopiclone and extended-release zolpidem should be used only when you expect to sleep for eight hours. Zaleplon wears off after four hours and can be taken in the middle of the night, as can low-dose sublingual zolpidem (Intermezzo). Low doses of some benzodiazepines can be used like this, too. Ramelteon, which works on melatonin receptors, has been shown to be safe in older adults, but tends to be only somewhat effective.
Certain antidepressants, notably doxepin (Silenor), are sometimes prescribed for insomnia, usually at much lower doses than for depression. Doxepin doesn’t help you fall asleep, but is good for middle-of-the-night insomnia.