No new prescription sleep drugs hit the market in 2008, but research in several fields is under way. "I'm excited about a lot of these new drugs," says Lisa Shives, MD, president and medical director of Northshore Sleep Medicine in Evanston, Ill., and spokesperson for the American Academy of Sleep Medicine. "The brain is a complicated setup with approximately 17 different neurotransmitters involved in the sleep-wake cycle and, as soon as we fully understand all of them, drugs will present better solutions for sleep disorders."
Here, some potential treatments that could soon help you rest easier—and suggestions for what to do in the meantime.
For jet lag or shift work
In the pipeline: Two clinical trials have found that a new medication called tasimelteon helped subjects whose sleep pattern had been shifted forward by five hours fall asleep faster and sleep for longer. The drug, called a melatonin analogue, works by targeting melatonin receptors in the brain. Melatonin is the naturally occurring hormone that helps regulate the body's sleep-wake patterns. Unlike existing benzodiazepine-hypnotic sleep medications, melatonin analogues have shown no tendency toward addiction or dependence. The manufacturer of tasimelteon hopes the product will be available to patients within the next few years.
For now: While there's no drug specifically approved for helping jet lag sufferers sleep, Dr. Shives explains that taking over-the-counter melatonin "one or two hours before your new adjusted bedtime" for two to four days before an east-bound flight can help your body transition. (East-bound flights are typically tougher on sleep schedules than west-bound flights.) Upon arrival at your destination, you would take melatonin at your desired bedtime, and then upon your return home, you'd take it again at your regular bedtime to help readjust. Read more about melatonin.
For age-related sleep issues
In the pipeline: Circadin, a new drug developed in Israel, may help people 55 and older get much-needed sleep, as melatonin levels in their brains decrease as a consequence of aging. By slowly releasing small amounts of melatonin over timerather than one immediate dose, as is typically the case with over-the-counter melatoninthe drug has been shown to help people sleep thorough the night without sacrificing next-day alertness. Already available in several European countries, Circadin is expected to be offered stateside sometime in 2009.
For now: The first thing Dr. Shives recommends is a thorough examination to determine the cause of the sleeplessness, whether it's insomnia or an underlying problem like sleep apnea. For insomnia, she recommends patients try cognitive behavioral therapy along with low doses of prescription nonbenzodiazepines, such as Ambien, Lunesta, or Sonata, which have been shown to cause relatively low incidences of grogginess and next-day alertness problems. Although she does not recommend it, she notes that it was common in the past for people to take over-the-counter antihistamines for their sedating properties. "If an antihistamine doesn't say it's non-drowsy, it will make you drowsy," she explains. "But we should always be careful when using antihistamines because they may have the opposite affect and make older patients feel wide awake." Read more about sleep and aging.