Diazepam For Sleep
Diazepam, a type of benzodiazepine, is often used to treat a range of conditions, including anxiety disorders, muscle spasms, alcohol withdrawal symptoms, and seizures. However, it has also been found to affect sleep in certain circumstances.
Although diazepam is not FDA-approved for the treatment of insomnia, it does have sedative effects, reduces sleep latency, and can promote deep sleep. However, it changes the sleep architecture, which may make you feel less rested after the night [1].
Caution
Diazepam is not FDA-approved for sleep problems or reducing sleep latency in insomnia
What is sleep architecture?
Sleep architecture is the cycle of sleep one goes through. It includes Rapid Eye Movement (REM) and Non-REM sleep, split into four stages that oscillate in regular patterns. Each stage is characterized by distinct neural patterns and serves slightly different functions [2].
Diazepam in sleep: the scientific evidence
There have been a spectrum of studies looking at diazepam or Valium for sleep and sleep-related problems.
One study found that diazepam could reduce sleepwalking in healthy adults [3]. In another study, diazepam reduced anxiety and nightmares, helping individuals get a better night's sleep [4]. Diazepam has also been used in patients with breathing problems and sleep apnea, but it must be used only under medical supervision, as respiratory depression is a common side effect of taking diazepam [5, 6]. This side effect could lead to suffocation if it occurs at night.
However, not all studies agree that diazepam is good for sleep. One study, although carried out on cats, found that diazepam increased sleep latency [7].
Another study found that individuals became tolerant to the effects of diazepine even after a single dose, meaning that they no longer saw improvements in their sleep after a single dose [8]. This study echoes a widespread concern with benzodiazepine medication and how easy it is to develop a tolerance to it.
Developing tolerance may lead you to take higher and higher doses to achieve the same therapeutic effects but with increasing unwanted side effects.
How much diazepam should I take for sleep?
The recommended dose of diazepam is between 2-10mg, as it has a rapid onset and long half life. The dose may be lower in adolescents and older people if you are taking any drugs that could interact with diazepam or have specific variants of enzymes that metabolize diazepam.
Summary: Diazepam for sleep
To summarize, while diazepam has been found to have multiple features of sleep in specific populations with different sleep difficulties, it disrupts sleep architecture, resulting in feeling less rested after a night of diazepam-induced sleep. Therefore, it may not benefit many people with sleep difficulties. As diazepam is a prescription medication, its use must be consulted with a healthcare professional and you must only take the prescribed daily dose.
Amitriptyline for sleep
Amitriptyline, a tricyclic antidepressant, is often prescribed as a sleep aid. It contains the active ingredient amitriptyline hydrochloride, which works by increasing certain brain chemicals called neurotransmitters like serotonin and norepinephrine. These help improve mood, sleep, pain, and anxiety. Amitriptyline also blocks histamine activity, which is similar to anti-histamine allergy drugs, which can induce daytime drowsiness [9]. If you take amitriptyline in the evening, this drowsiness may be desirable.
In contrast to diazepam, amitriptyline is not addictive and is more difficult to develop a tolerance to it. It is also cheaper than novel sedative medication, as it is available as a generic un-branded oral tablet [10]. It can be helpful for individuals with co-morbid conditions that contribute to your sleep problems, especially if you have depression and/or anxiety, as this if the main approved use of amitriptyline.
The tolerability of a drug for improving sleep is an important consideration when deciding. One study found that 10-20 mg of amitriptyline before bedtime was well tolerated and improved sleep [11]. Furthermore, there is an ongoing prospective randomized clinical trial to compare the efficacy of amitriptyline compared to cognitive behavioral therapy for insomnia, the standard non-pharmacological treatment for insomnia. This study will help us to better understand the effects of amitriptyline on sleep [2]
However, it's important to note that while amitriptyline can be effective for sleep, it may not be suitable for everyone. For example, leg movements were increased in a sub-group of patients taking amitriptyline for sleep. This may disrupt your sleep and counteract the expected benefits of amitriptyline [12]. Therefore, discussing all your symptoms with your doctor is crucial to finding the best treatment option.
Side effect of amitriptyline
The common side effects of amitriptyline include dry mouth, daytime sleepiness, and constipation. More severe side effects can include increased suicidal thoughts or serotonin syndrome, a state in which you have too much serotonin in your brain. This is more likely to occur after a drug interaction.
Diazepam or Amytriptiline for sleep?
When it comes to choosing between Diazepam and Amitriptyline for sleep, it's important to consider their different effects and potential side effects.
Diazepam, a benzodiazepine, is often used to treat sleep disorders associated with medical illnesses. However, studies have shown that commonly available sleep medications, such as Lormetazepam, may have a greater hypnotic effect than diazepam, with fewer side effects, such as hangovers [13, 14, 15].
Amitriptyline, a tricyclic antidepressant, can also have a sedative effect and decrease sleep latency and total wake time. Specifically, it can increase total non-REM sleep. Similar to diazepam, however, this results in a different sleep architecture from natural sleep [16, 17, 18]. In contrast to diazepam, it is not habit-forming, which makes it safe to take over longer time periods [9].
In conclusion, both Diazepam and Amitriptyline can be effective for sleep, but their effectiveness and side effects can vary. Amitriptyline is preferable to the two medications. Before seeking prescription medicines for sleep problems, make sure to try herbal remedies and lifestyle adjustments of CBT-I. If these don't help, speak to your healthcare provider to determine the best treatment option for you.