AsleepA reader wrote to Ask The Savvy Insomniac about sleeping pills for people who have trouble with insomnia in the middle of the night.

“I don’t have a problem getting to sleep,” he explained. “I go jogging with my dog after work and that really tires me out.  So I’m out by 10 or 10:30. But I have to go to the bathroom at least once a night, and then I can’t get back to sleep. Sometimes I wake up at 1:30 and I’m awake for the rest of the night! I’m about ready to give up and ask for a sleeping pill. Any thoughts?”

Intermezzo

If you decide to go the chemical route, Intermezzo, manufactured by Purdue Pharma, is an option for people with sleep maintenance insomnia (whose problem is awakening for stretches in the middle of the night). It’s a sublingual form of zolpidem (a.k.a. Ambien), and it comes in such low doses (1.75 and 3.25 mg) that it’s been approved by the FDA for use in the middle of the night. Dissolving a pill in the mouth is supposed to be a faster mode of delivery than swallowing the pill whole. Provided you still have four hours of shut-eye left, it’s not supposed to leave you feeling groggy in the morning.

But I’m put off by drug companies that repackage an old drug like zolpidem and then slap a brand name price on it. According to goodrx.com, 30 sublinguals of Intermezzo (3.5 mg) cost upwards of $225. That’s about $7.50 a pill! Fine and dandy for those who have good prescription drug coverage. But what about insomniacs who don’t?

Why not go with generic zolpidem, 5 mg, instead, and split each pill in half? (Pill splitters are free—just ask your pharmacist.) If you do it this way, the cost of getting back to sleep will be a mere 15 cents a night.

Zaleplon

Another option worth exploring with your doctor is zaleplon, the generic for the drug Sonata. This drug was never intended for use in the middle of the night, yet I hear talk about it from time to time. Zaleplon has a very short half-life (1 hour). An hour after you take this drug, the amount in your blood plasma is reduced by half. A drug that moves in and out of the system so quickly just might be safe for use in the middle of the night. Thirty capsules of zaleplon, 5 or 10 mg, cost about $20, or 66 cents a pill.

Doxepin, or Silenor

A third option for middle-of-the-night awakeners is Silenor. This drug, approved for sleep maintenance insomnia, operates on a different neurotransmitter system and is taken at the beginning of the night.

But once again, a pharmaceutical company (Somaxon) has taken an inexpensive generic drug (doxepin), reduced the dosage slightly, and is charging megabucks for the repackaging. According to goodrx.com, 30 Silenor tablets (which contain 6 mg of doxepin apiece) cost about $190—or $6.30 a pill. Contrast this with the cost of generic doxepin—just 23 cents per 10-mg capsule. When you consider that doxepin used as an antidepressant is sold in 150-mg capsules, the difference between a dosage of 6 and 10 mg of doxepin sounds rather slight. And the difference in price between the brand name drug and the generic is huge!

If your problem is waking up in the middle of the night, what have you found that helps you get back to sleep?

Posted by Lois Maharg, The Savvy Insomniac

Lois Maharg has worked with language for many years. She taught ESL, coauthored two textbooks, and then became a reporter, writing about health, education, government, Latino affairs, and food. Her lifelong struggle with insomnia and interest in investigative reporting motivated her to write a book, The Savvy Insomniac: A Personal Journey through Science to Better Sleep. She now freelances as an editor and copy writer at On the Mark Editing.

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