Sleep medicines such as zolpidem (Ambien), eszopiclone (Lunesta) and trazodone are widely used, and many people take them for years. Before relying on them long term, it is worth asking a question many people skip: could undiagnosed sleep apnea be part of the problem?
Why sleep apnea matters here
Obstructive sleep apnea causes repeated pauses in breathing during sleep. It leaves people tired no matter how long they sleep, and it is common and often missed. Sedating medicines can relax the airway further, and treating insomnia without addressing apnea leaves the real problem in place. Loud snoring, gasping or pauses noticed by a partner, morning headaches, high blood pressure and daytime sleepiness are all clues.
How we check
We do the initial workup in the office: a sleep history, a short screening questionnaire, and a look at blood pressure, weight, neck size and medicines. When apnea is likely, we refer you for a sleep study, often a home test, and coordinate the results and next steps.
The medicines themselves
Zolpidem and eszopiclone carry a warning about complex sleep behaviors such as sleepwalking or driving while not fully awake, and they can leave you groggy the next morning, especially older adults. Trazodone is commonly used for sleep, though it is officially approved for depression. All of these can add to the effects of alcohol and other sedating medicines.
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Primary care, mental health, and addiction medicine in one practice. New patients are often able to be scheduled within a week of requesting an appointment.
The first-line treatment for chronic insomnia
Cognitive behavioral therapy for insomnia, called CBT-I, is the recommended first treatment for long-term insomnia. It works as well as medicine in the short term and better over time, and it is often combined with a gradual taper of sleep medicines.
Get help from Hope Integrative Medicine
If you are relying on a sleep medicine or still waking up tired, we can do the initial workup, refer you for a sleep study when needed, and build a plan for better sleep. Our mental health team sees patients in person in West Ashley and by telehealth across South Carolina, alongside our primary care providers, and new patients are often able to be scheduled within a week of requesting an appointment. Request an appointment.
This article is general health information and does not replace advice from your own provider. Never start, stop or change a medication without talking with your prescriber. If you are having thoughts of harming yourself, call or text 988 or call 911.
Frequently Asked Questions
Long-term nightly use of zolpidem (Ambien) carries risks, including next-morning grogginess, falls in older adults and complex sleep behaviors such as sleepwalking. It is worth ruling out sleep apnea and trying CBT-I before relying on it for years.
Sedating medicines can relax the muscles of the airway and may worsen untreated obstructive sleep apnea. Loud snoring, gasping, morning headaches and daytime sleepiness are reasons to be checked first.
They work differently. Trazodone is approved for depression and commonly used at low doses for sleep, while Ambien is approved for insomnia. Neither is the first-line long-term treatment; CBT-I is.