Medications that treat anxiety and insomnia

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Rebecca Davis

ANXIETY AND INSOMNIA CAN BE LINKED. LEARN WHICH MEDICATIONS WORK BEST FOR TREATING ANXIETY AND INSOMNIA.

If you experience insomnia and anxiety, you’re not alone. Many adults struggle with sleep problems each year, and insomnia remains one of the most common sleep disorders in the United States, affecting around 30% to 40% of adults annually, according to the American Journal of Managed Care.

Insomnia can be short-term (lasting less than three months) or chronic (happening at least three nights a week for three months or longer). Anxiety is also common, affecting millions of people each year. These two conditions are often connected, as anxiety can make it harder to sleep, while poor sleep can increase stress and anxious feelings.

The good news is that both anxiety and insomnia can be treated. Options may include lifestyle changes, relaxation techniques, therapy, and prescription medications when recommended by a healthcare professional.

KEY TAKEAWAYS

Anxiety and insomnia frequently occur together, as stress and anxious thoughts can make it harder to sleep, while poor sleep may worsen anxiety symptoms.
Medications used for anxiety and insomnia may include benzodiazepines, sedative-hypnotics, certain antidepressants, melatonin receptor agonists, and orexin receptor antagonists, depending on a person’s condition and healthcare provider’s recommendation.
Do not stop anxiety or sleep medications suddenly. Abruptly discontinuing these medications may cause withdrawal symptoms and can be unsafe. Always work with your healthcare provider on a gradual tapering plan if stopping treatment.

THE BEST MEDICATION FOR ANXIETY AND INSOMNIA

Before prescribing medication for anxiety or insomnia, healthcare providers consider several factors, including your age, symptoms, medical history, family history, current medications, and possible drug interactions.

Certain people, such as older adults or those with specific health conditions, may need lower doses or may not be suitable candidates for certain medications. Your provider may also perform a medical evaluation to identify any underlying causes of anxiety or sleep problems before recommending the best treatment approach.

Because treatment is highly individualized, the right medication for one person may not be the best option for another. You can also use a SingleCare prescription discount card to help reduce medication costs and apply savings to refills.

Common medication categories used to help manage anxiety and insomnia symptoms include:

Benzodiazepines
Sedative-hypnotic drugs, including “Z-drugs”
Certain antidepressants
Melatonin receptor agonist
Orexin receptor antagonists

There are also several over-the-counter (OTC) sleep aids available, but many contain antihistamines such as diphenhydramine or doxylamine.

If you have existing health conditions or take other medications, it’s important to check with your healthcare provider or pharmacist before using OTC sleep aids. These products may help with occasional sleeplessness, but tolerance can develop quickly.

OTC sleep medications may also cause side effects, especially in older adults, including dizziness, confusion, and next-day drowsiness, which can increase the risk of falls and injuries.

The following are prescription medications that may be used to help manage symptoms of anxiety and/or insomnia.

Ambien (zolpidem) or Ambien CR (zolpidem extended-release)

Ambien (zolpidem) and Ambien CR (zolpidem extended-release) are sedative-hypnotic medications used to treat insomnia. Ambien helps people fall asleep, while Ambien CR is designed to help with both falling asleep and staying asleep.

These medications are generally intended for short-term use and may cause side effects such as dizziness, dry mouth, and next-day drowsiness.

They also carry a black box warning due to the risk of complex sleep behaviors, such as sleepwalking or other activities performed while not fully awake. Always use these medications only as directed by a healthcare provider.

Belsomra (suvorexant) and Dayvigo (lemborexant)

Belsomra (suvorexant) and Dayvigo (lemborexant) are orexin receptor antagonists that help promote sleep by blocking signals in the brain that keep you awake.

Common side effects may include unusual dreams and fatigue. These medications should be used according to your healthcare provider’s instructions to help ensure safe and effective treatment.

Elavil (amitriptyline)

Although Elavil (amitriptyline) is FDA-approved to treat depression, this tricyclic antidepressant may also be prescribed off-label to help with sleep because of its sedating effects.

Like other antidepressants, amitriptyline carries a black box warning regarding the potential risk of suicidal thoughts and behaviors. It should only be used under the guidance and monitoring of a healthcare provider.

Lexapro (escitalopram)

Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) antidepressant used to treat anxiety and depression.

Some people may experience improved sleep while taking Lexapro, while others may experience insomnia as a side effect. Like other antidepressants, Lexapro carries a black box warning regarding the potential risk of suicidal thoughts and behaviors, so it should be taken with proper medical supervision.

Lunesta (eszopiclone)

Lunesta (eszopiclone) is a sedative-hypnotic medication used to help people both fall asleep and stay asleep.

A common side effect is an unpleasant or bitter taste in the mouth. Similar to Ambien, Lunesta also carries a black box warning due to the potential risk of complex sleep behaviors while not fully awake. It should be used only as directed by a healthcare provider.

Remeron (mirtazapine)

Remeron (mirtazapine) is a tetracyclic antidepressant that can have sedating effects and may help improve sleep in some people.

However, it may also cause side effects such as weight gain and carries a black box warning regarding the potential risk of suicidal thoughts and behaviors. It should be used under the guidance of a healthcare provider who can monitor its effects and determine if it is the right option.

Restoril (temazepam), Valium (diazepam), and Xanax (alprazolam)

Restoril (temazepam), Valium (diazepam), and Xanax (alprazolam) are benzodiazepines commonly used for short-term management of anxiety and sleep problems.

Because these medications are controlled substances, they carry a risk of misuse, dependence, and withdrawal symptoms. They also include black box warnings and should only be used under close medical supervision.

Other benzodiazepines, such as Ativan (lorazepam), Klonopin (clonazepam), and Halcion (triazolam), may also be prescribed in certain cases to help manage anxiety or insomnia.

Rozerem (ramelteon)

Rozerem (ramelteon) is a melatonin receptor agonist that works by mimicking the body’s natural sleep hormone, melatonin, to help regulate sleep patterns.

Unlike some sleep medications, Rozerem is not considered habit-forming and may be an option for people who prefer to avoid controlled substances. It should still be used according to a healthcare provider’s guidance.

Silenor (doxepin)

Silenor (doxepin) is a tricyclic antidepressant that is used at lower doses to help people who have difficulty staying asleep or wake up frequently during the night.

Possible side effects may include sleepiness and nausea. As with any medication, it should be used under the guidance of a healthcare provider.

Sonata (zaleplon)

Sonata (zaleplon) is a sedative-hypnotic medication that helps people fall asleep, but it is not typically used to help maintain sleep throughout the night.

Similar to Ambien and Lunesta, Sonata carries a black box warning due to the potential risk of complex sleep behaviors while not fully awake. It should only be used as directed by a healthcare provider.

Trazodone

Trazodone is an antidepressant that is sometimes prescribed off-label to help with sleep due to its sedating effects.

Possible side effects may include dizziness, dry mouth, and low blood pressure. Like other antidepressants, trazodone carries a black box warning regarding the potential risk of suicidal thoughts and behaviors and should be used with proper medical guidance.

STOPPING MEDICATION

Always talk with your healthcare provider before stopping any medication. Many anxiety and sleep medications need to be gradually reduced through a tapering schedule rather than stopped suddenly.

Stopping medication “cold turkey” may lead to withdrawal symptoms and can be dangerous in some cases. Your healthcare provider can guide you through a safe tapering plan and help monitor any changes.

After stopping medication, anxiety or insomnia symptoms may return, so it’s important to stay in contact with your provider about next steps. Continuing supportive approaches such as cognitive behavioral therapy, relaxation techniques, and meditation may also help manage symptoms.

OTHER TREATMENT OPTIONS FOR ANXIETY AND INSOMNIA

There are many nonprescription approaches that may help manage symptoms of anxiety and insomnia. You can discuss these options with your healthcare provider and consider using one or more of these methods alongside prescription treatment, if medication is needed.

Therapy (the type of therapy will depend on the exact condition being treated)

Meditation, relaxation, breathing techniques, acupuncture, massage therapy, yoga

Improving sleep hygiene habits

Lifestyle changes, such as eating a healthy diet, exercising regularly, stopping smoking, and limiting caffeine and alcohol

Dietary supplements such as melatonin, which helps control the sleep cycle (check with your healthcare provider before using a supplement)

WHEN TO SPEAK WITH A DOCTOR

If you are experiencing anxiety and insomnia, or are unsure whether your symptoms are temporary stress or a more serious condition, it’s important to consult a healthcare provider for proper evaluation and guidance. While an occasional sleepless night is usually not a concern, ongoing symptoms that interfere with daily life may require support.

If medication is prescribed, always follow your prescription instructions carefully. Read the medication guide, ask questions if anything is unclear, and never take more than the recommended dose or use medication longer than advised. Many sleep medications are intended for short-term use only.

When taking sleep medication, make sure you have enough time for a full night’s rest before activities that require alertness, such as driving or operating equipment. Avoid alcohol unless your healthcare provider says it is safe.

Report any concerning side effects to your provider, and never stop anxiety or sleep medication suddenly. A healthcare professional can help you create a safe plan to reduce or stop medication when appropriate.

Source: SingleCare

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