Background

Insomnia means that you have a hard time falling asleep, staying asleep, or both. Short-term insomnia can last up to 14 days, but it often goes away after a few nights. Stress and jet lag are common causes. Long-term, chronic insomnia can interfere with your life. If you have trouble sleeping three or more nights a week for a month or longer, talk to your doctor. There may be a medical cause for your insomnia.

This information is produced by Consumer Reports and Consumer Reports Best Buy Drugs, a public information project supported by grants from the States Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin.

Do You Need a Sleeping Pill?

If insomnia is a problem, these treatments may help:

  • Avoiding alcohol or caffeine.
  • Learning good sleep habits.
  • Taking an over-the-counter sleep aid, such as diphenhydramine (in Benadryl, Nytol, and Sominex) or doxylamine (Unisom and generic). Do not use for more than a few nights in a row.
  • Taking a benzodiazepine, a kind of prescription drug. These drugs are usually effective, but side effects include sleepiness the next day. There is also a risk of addiction. And they can make insomnia worse.

There is also a newer group of prescription sleeping pills. This report tells you about them.

Effectiveness of Newer Sedative Drugs

The newer sleeping pills include:

  • eszopiclone (Lunesta)
  • ramelteon (Rozerem)
  • zaleplon (Sonata and generic)
  • zolpidem (Ambien and generic) also available as an:
    • extended-release tablet (Ambien CR and generic)
    • dissolvable tablet (Edluar)
    • oral spray (Zolpimist)

All of the newer sleeping pills help people fall asleep faster. Zolpidem appears to help people fall asleep faster than the others, and may result in better quality sleep. It is not clear how well these pills help you stay asleep. Some people sleep longer. Others still wake up at night.

Drug and Year It Went on Market

Helps You Fall Asleep?

Average Time to Fall Asleep1

How much faster than placebo, on average?

Helps You Stay Asleep?

How much longer than placebo, on average?

Percent With Next-Day Drowsiness1

Risk of Rebound Insomnia?2

Risk of Dependency?

Zolpidem (Ambien) (1992)

Yes

33–46 minutes

20 minutes

Maybe

34 minutes

2%–3%

Maybe

Yes

Ambien CR (2005)

Yes

33–46 minutes

About 10 minutes

Yes

About 30 minutes

15%

Yes

Yes

Lunesta (2004)

Yes

50 minutes

19 minutes

Yes

46 minutes

8%–10%

Yes

Yes

Rozerem (2005)

Yes

75 minutes

8 minutes

No information

3 minutes

5%

No

No

Sonata (1999)

Yes

36–55 minutes

14 minutes

Evidence weaker than for zolpidem and Lunesta

19 minutes

5%–6%

No

Yes

Zolpidem sublingual tablet (Edluar) (2009)

Yes

20 minutes

6 to 10 minutes vs regular zolpidem tablets (no comparison to placebo)

Maybe

Not assessed

4%

Maybe

Yes

Zolpidem oral spray mist (Zolpimist)3 (2008)

Yes

33–46 minutes

Same as regular zolpidem tablets

Maybe

Same as regular zolpidem tablets

2%–3%

Maybe

Yes

1. As assessed in one major study or, if range given, several studies. Figures are not meant to imply that drugs were necessarily compared to each other in a study with consistent design.

2. Rebound insomnia occurs when you stop taking a sleeping pill and the insomnia gets worse. The risk of rebound insomnia is generally small, though some people are vulnerable. When experienced, it usually goes away in a few days.

3. Based on studies showing bioequivalence to zolpidem.

Our Recommendations

Four drugs used to treat insomnia—eszopiclone (Lunesta), ramelteon (Rozerem), zaleplon (Sonata and generic), and zolpidem (Ambien, Ambien CR, Edluar, Zolpimist, and generic)—are effective but not necessarily better than behavioral therapy or older, less expensive drugs for many people who need a sleep aid for a night or two.

Nonprescription drugs containing an antihistamine—for example, diphenhydramine (the active ingredient in Benadryl, but also sold as a sleep aid under the brand names Nytol and Sominex and as a generic) or doxylamine (Unisom and generic)—and older prescription sedatives called benzodiazepines, such as estazolam (generic only), flurazepam (Dalmane and generic), and temazepam (Restoril and generic), might work just as well as the newer sleeping pills.

But we recommend that both prescription and nonprescription sleeping pills be used judiciously because research has found that people with mild insomnia sometimes unnecessarily take these medications when they might be able to resolve their sleep issues with nondrug measures.

In addition, all insomnia medicines can cause side effects and dependency, and even worsen your sleeping problems when abused, misused, or taken too often. Possible side effects include daytime sleepiness, dizziness, unsteadiness, and rebound insomnia. Sleep-walking, sleep-driving, sleep-eating, memory lapses, and hallucinations have also been reported.

That said, people with persistent, chronic insomnia—three or more nights a week for months—should seek treatment. We advise cognitive behavioral therapy—a form of psychotherapy—that can improve sleep habits, possibly combined with a cautious use of sleeping pills. Research has found this can help relieve chronic insomnia.

For the average person seeking short-term help—for a few nights—we suggest trying an over-the-counter sleep aid first. If that doesn’t work, our comparison of the newer drugs led us to choose zolpidem as a Best Buy. This is the less expensive, generic version of the drug Ambien. Fifteen pills cost $27 to $31, depending on the dose and where you buy it.

This report was updated in January 2012.

Cost Comparison

Generic Name1,2

Brand Name

Is a Generic Drug?

Average Time to Fall Asleep

Average Cost for 7 Doses3

Average Cost for 15 Doses3

Newer Sedatives

Zolpidem 5 mg

Generic

Yes

33–46 minutes

$14

$31

Zolpidem 10 mg

Generic

Yes

33–46 minutes

$12

$27

Zolpidem 5 mg

Ambien

No

33–46 minutes

$54

$118

Zolpidem 10 mg

Ambien

No

33–46 minutes

$53

$115

Zolpidem 6.25 mg sustained-release

Generic

Yes

33–46 minutes

$41

$89

Zolpidem 12.5 mg sustained-release

Generic

Yes

33–46 minutes

$40

$87

Zolpidem 6.25 mg sustained-release

Ambien CR

No

33–46 minutes

$56

$122

Zolpidem 12.5 mg sustained-release

Ambien CR

No

33–46 minutes

$56

$121

Zolpidem 5 mg dissolvable tablet

Edluar

No

20 minutes

$47

$102

Zolpidem 10 mg dissolvable tablet

Edluar

No

20 minutes

$53

$116

Eszopiclone 1 mg

Lunesta

No

50 minutes

$56

$121

Eszopiclone 2 mg

Lunesta

No

50 minutes

$57

$123

Eszopiclone 3 mg

Lunesta

No

50 minutes

$58

$125

Ramelteon 8 mg

Rozerem

No

75 minutes

$47

$103

Zaleplon 10 mg

Sonata

No

36–55 minutes

$38

$83

Zaleplon 5 mg

Generic

Yes

36–55 minutes

$18

$39

Zaleplon 10 mg

Generic

Yes

36–55 minutes

$17

$36

1. Not all doses are listed due to space limitations. For a comprehensive list, see our full report for free at CRBestBuyDrugs.org.

2. All the medicines listed are tablets or capsules. Recommended use is typically one pill at bedtime.

3. Prices reflect nationwide retail average for October 2011, rounded to the nearest dollar. Prices are derived by Consumer Reports Best Buy Drugs from data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations.

NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health care professional. Consumer Reports is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, non-commercial use and may not be used in advertising, promotion, or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

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