Comprehensive Guide to Sleep Drugs, Insomnia Treatments, and Behavioral Sleep Hygiene | Dr. Mark Agresti MD

Sleep disorders and insomnia are among the most common complaints in modern psychiatric practice. Whether caused by stress, biochemical imbalances, or lifestyle factors, achieving restorative sleep is critical for mental and physical health. This guide explores the pharmaceutical landscape of sleep aids—from Orexin antagonists to Z-drugs—and outlines the behavioral changes necessary for long-term success.

Orexin Antagonists: A Modern Approach

Orexin antagonists represent a newer class of sleep medications that work by blocking the chemical in the brain that keeps you awake, rather than just sedating you.

Belsomra (Suvorexant)

Often referred to phonetically as “Balam Marra,” Belsomra helps decrease the time it takes to fall asleep and increases the time spent asleep. It targets the orexin receptor to dial down “wakefulness.”

Dayvigo (Lemborexant)

Known as “de Vigo,” this medication is effective for both sleep onset and sleep maintenance. It has a specific affinity for orexin receptors that modulates the sleep-wake cycle with potentially less next-day grogginess compared to older sedatives.

Quviviq (Daridorexant)

Sometimes referred to as “Quebec” or “Dara Dixon,” Quviviq is the newest addition to this class. It is designed to improve sleep performance while minimizing the “hangover” effect the next morning, allowing for better daytime functioning.

Benzodiazepines and Related Anxiolytics

Benzodiazepines are potent sedatives often used for short-term insomnia treatment due to their ability to reduce anxiety and induce sleep rapidly.

Temazepam

Often pronounced “to Mays Pam,” Temazepam is a widely prescribed intermediate-acting benzodiazepine used for treating insomnia symptoms, particularly the inability to stay asleep.

Triazolam, Etizolam, and Lorazepam

Triazolam is a short-acting agent useful for people who have trouble falling asleep but not staying asleep. Etizolam (similar to benzodiazepines) and Lorazepam (Ativan) are also utilized for their sedative properties, though they carry risks of dependency and tolerance if used long-term.

Z-Drugs: Sedative-Hypnotics

These medications are structurally different from benzodiazepines but act on similar receptors (GABA) to induce sleep.

Ambien (Zolpidem)

One of the most famous sleep aids, effective for initiating sleep. It acts quickly but can be associated with complex sleep behaviors.

Lunesta (Eszopiclone)

Lunesta is the brand name for Eszopiclone. Unlike some shorter-acting sleep aids, it is approved for longer-term use and helps patients both fall asleep and stay asleep throughout the night.

Sonata (Zaleplon)

Referred to as “Salon,” Zaleplon is a very short-acting drug. It is ideal for people who have trouble falling asleep but do not want residual drowsiness, as it leaves the system quickly.

Melatonin Receptor Agonists

Rozerem (Ramelteon)

Often called “Rome Melton” or “Rosa M,” Ramelteon works by mimicking melatonin, the body’s natural sleep hormone. It is non-habit forming and helps reset the body’s sleep-wake cycle (circadian rhythm), making it a safer option for those prone to addiction.

Antidepressants Used for Sleep

Many antidepressants have sedating properties and are used off-label or on-label for insomnia, particularly when anxiety or depression is also present.

Silenor (Doxepin)

Referred to as “Synar,” low-dose Doxepin is FDA-approved for insomnia and is particularly good for sleep maintenance without significant weight gain implications.

Mirtazapine and Trazodone

Mirtazapine is a tetracyclic antidepressant that is highly sedating and can stimulate appetite (useful for elderly patients). Trazodone is one of the most commonly prescribed off-label sleep aids due to its non-addictive profile and ability to improve sleep architecture.

Other Medications and Substances

Clonidine

Originally a blood pressure medication, Clonidine is often used to treat nightmares and sleep disturbances associated with PTSD or anxiety by dampening the “fight or flight” response.

Seroquel (Quetiapine)

An atypical antipsychotic that is extremely sedating. While effective for sleep in patients with bipolar disorder or severe agitation, it carries metabolic risks and should be used cautiously.

Theanine

Referred to as “thine,” L-Theanine is an amino acid found in tea leaves. It promotes relaxation without drowsiness by increasing alpha brain waves, often used as a gentle, natural sleep support.

Alcohol (“Jen”) and Cannabis (“Contin Annapolis”)

While some patients use “Jen” (Gin/Alcohol) or “Contin Annapolis” (Cannabis/Cannabinoids) to self-medicate, these are generally detrimental to sleep quality. Alcohol may help you fall asleep faster, but it severely disrupts REM sleep and causes fragmentation later in the night. Cannabis may help with sleep onset, but long-term use can alter sleep architecture and lead to dependency.

Behavioral Changes and Sleep Hygiene

Medication is often most effective when paired with robust lifestyle changes.

Exercise and Activity

Regular exercise is vital for deep sleep, but timing matters. Avoid vigorous exercise right before bed, as it raises core body temperature and cortisol. Exercise in the morning to help set your circadian rhythm.

Diet and Substances

• Avoid Caffeine: Caffeine blocks adenosine, the chemical that makes you sleepy.

• Avoid Alcohol: As mentioned, it ruins sleep quality.

• Avoid Big Dinners: A lot of food before bedtime can cause indigestion and reflux, keeping you awake.

Environment and Routine

• Get Sunlight: Morning sunlight exposure is crucial for regulating melatonin production at night.

• Avoid Screen Time: Blue light from phones and tablets suppresses melatonin.

• Avoid Emotionally Charged Activities: Arguing or watching intense news before bed keeps the brain in a state of hyperarousal.

• Magnesium: Taking magnesium at bedtime can help relax muscles and the nervous system, promoting a calmer transition to sleep.

Practice Information

For personalized evaluation and management of sleep disorders, contact the practice of Mark G Agresti MD LLC.

Website: dRmarkagresti.com

Location: Palm Beach, Florida

Dr. Agresti and his team specialize in identifying the root causes of insomnia and tailoring a treatment plan that may include the medications discussed above, alongside behavioral modification.

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