Prescription medication should be taken only when authorized by a licensed physician and preferably when under his or her care. The authorities have designated these medicines as prescription-only because the can be dangerous, prone to abuse, or easy to make mistakes with. Over-the-counter medicines should be treated with respect, too. They are real drugs and can sometimes be powerful and cause unforeseen side effects. Pay close attention to your body when you use a drug, particularly when starting a new one.
Keep drugs in a specific area (that's why they invented medicine cabinets) and away from pets, children, and mentally incompetent people who might be in the house. In the case of an overdose, call your local poison control center. In the US, you can call 1-800-222-1222.
Medicines are an aid. You still have to do your part by maintaining good sleep hygiene and habits. Use the medicine only while you need it (following any specific instructions given by your doctor, of course.) Medicines for insomnia, and other sleep disorders, generally treat the symptoms, not the underlying cause. They are not a cure.
You should also monitor your health and reaction to any medicines you take.
Many sleep drugs have a risk of becoming habit-forming. Your doctor and/or pharmacist can talk to you about this. Even with the risk of dependency, it is sometimes worth using a medicine if the potential benefits outweigh the risk. Also be aware that suddenly halting a medicine can result in uncomfortable withdrawal; you may wish to look into tapering off the medicine – this goes even for OTC medicines. General tips.
The common advice has been to take a sleeping pill 30 munutes before you go to bed. Research where patients experimented wuth differebt tumes suggests patient satisfaction is higher when the pills are taken later. The authors suggest targeting the desired wake-up time and taking the pill 7 hours before that time.
Drugs can react with each other, and if you take more than one they can amplify or suppress each other or produce undesired or unforeseen consequences. The word “polypharmacy” was coined to refer to the issues and concerns involved when a person takes two or more drugs at the same time. An estimated 6 to 10 percent of Americans take hypnotics at some point during the year.
Discuss all medicines you take with your doctor, even over-the-counter ones. That means telling every doctor about prescriptions other doctors have you on. There should be no shame admitting you go to more than one doctor, if you do. Good doctors can handle that reality.
And good doctors are particularly cognizant of the dangers of drug interactions. All the guidance from the pharmaceutical companies, from the FDA, and from professional societies warns against interactions for certain drug combinations.
Pregnant or breast-feeding women should be particularly careful and reluctant to take medicine. Do so ONLY with the advice of your doctor. That includes over-the-counter pills.
Sleep medicine requires special care as much of it makes you sleepy (duh!) and that can be dangerous when “operating heavy machinery” as the chestnut goes. The most common heavy machinery most people operate is their cars, and drowsy driving (under the influence of drugs or not) is a major problem.
Caffeine and nicotine can contribute to insomnia beyond their stimulant properties. It worsens anxiety, manic thinking and behavior in people prone to that. When it wears off it can leave the person with lower energy and mood. Too much caffeine can result in insomnia, and so can reducing the consumption of caffeine! Many drugs have similar paradoxical properties.
In a flexible dosing schedule, patients are instructed to take pills “as needed” They employ their judgement on any given night. Patients have medication, usually a benzodiazepine receptor agonist (a z-drug) or ramelteon, but they don’t take it every night. Some patients may be able to manage the regimen themselves and take medication only when really needed. Others may need a fixed dosing schedule which allows them to take medication only certain nights of the week. If patients use medication judiciously and do not take sedatives every night, they are more effective. In addition to medication, patients learn relaxation techniques and good sleep practices.
This is not always easy, especially if there are any addictive properties of the drug. Talk to your doctor about challenges and concerns when stopping a medicine. Tapering is often a good strategy for getting off a drug, especially one that can be habit-forming as some sleep aids are.
Agonists: drug compounds that bind to and cause a functional effect identical in quality and quantity to the endogenous ligand
Antagonist: drug compounds that bind but cause no functional effect;
Partial Agonist: causes functional effect that, at a maximum, is only a fraction of that of the endogenous ligand
Many medicines work because the body’s cells have receptors that interact with the drug molecules. An agonist is a drug that mimics the affect of a natural chemical in the body by binding to the receptor that the natural chemical occupies. An antagonist is a drug that blocks the natural chemical. You hear many drugs described as such-and-such agonists or antagonists. For instance, the headache medicine Imitrex is a serotonin agonist.
More on ADME of insomnia medicines.