I. Antihistamines

II. Benzodiazepines

III. Non-Benzodiazepine hypnotics

  1. Zopiclone (Imovane)--Cognitive behavioral therapy was associated with better sleep outcomes than Zopiclone 7.5mg QHS at 6mos in a 6wk study in 46 adults with chronic primary insomnia (JAMA 295:2851, 2006--abst)

IV. Melatonin-related compounds

  1. Melatonin
  2. Ramelton (Rozerem) 8mg at HS
    1. A melatonin agonist
    2. May increase serum prolactin though clinical significance uncertain; theoretically could cause amenorrhea and galactorrhea in women or decreased libido in men
    3. May have less abuse potential than benzodiazepines (Arch. Gen. Psychiat. 63:1149, 2006--JW)
  3. Tasimelteon