Types and How to Choose Sleeping Pills/Sleep Inducers | Choose by Insomnia Type, Not Strength
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When you have several sleepless nights, you may be tempted to think that being prescribed strong sleeping pills would solve the problem. However, the actual criteria for choosing a sleeping pill are not its strength, but rather what type of insomnia you have and how much impact on the next morning you can tolerate.
This page categorizes currently used sleeping pills by their mechanism of action, explaining how to choose based on the type of insomnia, how long it takes for them to take effect, their side effects, and how to choose if you are concerned about dependence. All medications are listed by their generic names.
What are sleep aids?
Sleep aids are a general term for medications prescribed to alleviate insomnia symptoms (difficulty falling asleep, waking up during the night, light sleep, etc.). They are broadly classified into three main types based on their mechanism of action: GABA receptor agonists, melatonin receptor agonists, and orexin receptor antagonists.
Sleep aids (sleeping pills) support sleep by promoting natural drowsiness or calming the brain's awakened state, depending on the insomnia symptoms. Broadly, they are categorized into "GABA receptor agonists" (benzodiazepine and non-benzodiazepine types), which induce sleep by calming overall brain activity, and "melatonin receptor agonists" and "orexin receptor antagonists," which act on the body's inherent sleep-wake mechanisms.
Sleeping pills are broadly divided into 3 categories
Although often grouped together as "sleeping pills," there are three categories with completely different mechanisms of action and vastly different tendencies for dependence and side effects.
In recent years, the latter two categories, which have lower dependence potential, are increasingly considered first. The basic idea is that a "highly effective drug" is not necessarily a "good drug," and that you should choose with the discontinuation in mind.
| Category | Representative Generic Names | Characteristics | Tendency for Dependence |
|---|---|---|---|
| GABA receptor agonists (benzodiazepine and non-benzodiazepine) | Zolpidem, Zopiclone, Eszopiclone (Lunesta), Triazolam, Brotizolam, Flunitrazepam | Induces sleep forcibly. Rapid onset of effect. | Relatively high. Tolerance and dependence can develop with long-term use. |
| Melatonin receptor agonists | Ramelteon (Rozerem) | Acts on the biological clock to promote natural sleepiness. Gradual effect. | Low |
| Orexin receptor antagonists | Suvorexant, Lemborexant (Dayvigo) | Suppresses the action of substances that maintain wakefulness. Also used for middle-of-the-night awakenings. | Low |
What is Dayvigo (Lemborexant)?
Dayvigo is a sleep aid classified as an orexin receptor antagonist. It promotes natural sleep by blocking the action of "orexin," a substance that awakens the brain. Approved in Japan in 2020, it is a relatively new medication used for both difficulty falling asleep and middle-of-the-night awakenings.
Characteristics of Dayvigo
- Considered to have low dependence, offering high reassurance for long-term use.
- Effects can be felt from the first day of administration.
- Can be expected to be effective for insomnia characterized by waking up in the middle of the night.
- Morning grogginess can be managed by adjusting the dosage.
What is Lunesta (Eszopiclone)?
Lunesta is a sleep aid classified as a non-benzodiazepine (Z-drug) that acts on GABA-A receptors to calm brain activity, providing a strong hypnotic effect. While highly effective for sleep initiation and fast-acting, it is designated as a psychotropic drug, and long-term or high-dose use carries risks of dependence and tolerance.
Characteristics of Lunesta
- Highly effective for inducing sleep, with a rapid onset of action.
- A characteristic side effect is a "bitter taste."
- Generally used for the shortest necessary duration.
- Our clinic supports prescription of the generic drug (eszopiclone).
Why you shouldn't choose based on a "sleeping pill strength ranking"
While stronger drugs may seem to guarantee sleep, drugs with stronger or longer-lasting effects carry greater disadvantages, such as:
- Residual drowsiness the next morning (hangover effect)
- Dizziness, falls, and fractures when getting up to use the restroom at night
- Amnesia, where one doesn't remember events after taking the medication
- Rebound insomnia when discontinued (difficulty sleeping worsens)
Especially for elderly individuals, gentler medications are considered first, taking into account the risk of falls and delirium.
Consideration by type of insomnia
Even if it's "can't sleep," the appropriate medication changes depending on whether you can't fall asleep or wake up in the middle of the night.
| Type of Insomnia | Condition | Selection Approach |
|---|---|---|
| Sleep-onset insomnia | Takes 30 minutes to 1 hour or more to fall asleep after getting into bed | Uses a short-acting drug. Less likely to have hangover effects. |
| Sleep maintenance insomnia | Wakes up multiple times during the night and has difficulty falling back asleep | A drug with a relatively longer duration of action or a category that suppresses arousal is considered. |
| Early morning awakening | Wakes up more than 2 hours earlier than planned | May be due to underlying depressive symptoms; insomnia alone may not be the sole target of treatment. |
| Non-restorative sleep | Gets enough sleep but doesn't feel rested | May prioritize confirming other causes, such as sleep apnea. |
If early morning awakening persists, or if it is accompanied by low mood or loss of interest, it is important to evaluate the underlying condition rather than treating insomnia with medication alone.
Time to onset of effect
For medications acting on GABA receptors, drowsiness typically appears within 15 to 30 minutes after administration. Take the medication right before bedtime and lie down immediately afterward. If you continue to be active after taking the medication, the risk of amnesia and parasomnias (performing actions while not fully conscious) increases.
On the other hand, melatonin receptor agonists are not intended for immediate effect; it takes 1 to 2 weeks, or sometimes even longer, to assess their effectiveness. Do not discontinue them if you don't sleep well on the first night, but continue taking them and then evaluate.
Main Side Effects
- Hangover effect: Drowsiness and grogginess the next morning. More likely with longer-acting medications.
- Dizziness/Falls: Caution is needed when getting up during the night.
- Amnesia: Memory from the time of taking the medication until falling asleep may be impaired.
- Parasomnia: May involve performing actions like eating or walking while asleep, with no memory of it the next morning.
- Delirium: May manifest as confusion at night, particularly in elderly individuals.
- Nightmares/Daytime fatigue: May be observed with orexin receptor antagonists.
Do not take with alcohol. This increases the risk of excessive effects, amnesia, and respiratory depression.
For those concerned about dependence
Here's how to think about avoiding dependence:
- Consider orexin receptor antagonists (Dayvigo), which have a lower risk of dependence.
- There is also the option of choosing a non-benzodiazepine drug (Lunesta) that is said to have less impact on the next morning.
- Consult with your doctor about using it only on days when it's needed, rather than every night.
- Do not continue indefinitely; reassess the need every few months.
- If you have been sleeping well for a while, gradually reduce the dosage under your doctor's guidance.
If you have been taking the medication for a long time, sudden self-discontinuation can lead to rebound insomnia and withdrawal symptoms. Always reduce gradually.
Online Prescription of Dayvigo and Lunesta
Our clinic offers online prescriptions for Dayvigo, an orexin receptor antagonist known for low dependence, and generic Lunesta (eszopiclone) for those seeking a strong sleep-inducing effect.
View online sleep aid consultation
Things to review before medication
- Maintain a consistent wake-up time (fixing your wake-up time is more effective than fixing your bedtime).
- Get sunlight in the morning.
- Avoid caffeine, alcohol, and smoking before bed (a nightcap can lighten sleep).
- Only go to bed when you feel sleepy. Lying in bed for a long time when you can't sleep can associate your bed with wakefulness.
- Refrain from using smartphones before bed.
Frequently Asked Questions
Orexin receptor antagonists (Dayvigo) are considered to have lower dependence than traditional benzodiazepine or non-benzodiazepine types. If you wish to avoid dependence, consider this option first, and consult your doctor about using it only when necessary, rather than every night.
Currently, due to inventory conditions, handling is temporarily suspended. Other options, such as orexin receptor antagonists (Dayvigo), which are also considered to have low dependence, are available. Please consult with your doctor during your appointment.
