The Psychiatrist’s Guide to Sleep Medications: What to Use (and What to Avoid) for Insomnia

Discover a comprehensive guide to sleep medications, including trazodone, gabapentin, hydroxyzine, and melatonin, with insights on how each targets unique sleep pathways. This video offers practical tips for treating insomnia, depression, trauma, and bipolar-related sleep disturbances.

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Struggling with insomnia, nightmares, or difficulty staying asleep? This video breaks down the most effective sleep medications available, including trazodone, gabapentin, and hydroxyzine, each targeting different pathways like GABA, melatonin, histamine, and the cholinergic system. Learn which medications work best for bipolar disorder, depression, and trauma-related sleep issues, and how to use them safely and effectively.

We explore the role of GABA-based sleep aids, such as benzos and Z-drugs, but highlight why gabapentin is a safer, less habit-forming option. Although technically a sodium channel agent, gabapentin still plays a key role in sleep, especially for those with bipolar disorder or cannabis-related sleep issues. We discuss practical dosing strategies, starting at 300 mg and adjusting as needed for optimal sleep.

Next, we focus on histamine-based sleep aids, including hydroxyzine. While effective, it has potential anticholinergic effects at higher doses. We highlight when and how to use hydroxyzine and why it’s better for nighttime use than for anxiety. We also discuss the pros and cons of Benadryl (diphenhydramine), which many turn to but has stronger anticholinergic effects, making it a less favorable choice.

For those seeking natural sleep solutions, we discuss melatonin supplements and how U.S. regulation issues impact product consistency. We offer tips on when to use melatonin and what to watch for when selecting a supplement.

Trazodone is often a first-line sleep medication, especially for depression-related sleep issues. It addresses both sleep onset and maintenance, making it a versatile option. We cover how to start trazodone at 25 mg and titrate up to 200 mg if needed. Its role in reducing nightmares in trauma-related sleep issues is highlighted, along with how it compares to mirtazapine and Seroquel. While mirtazapine and Seroquel work on serotonin, histamine, and alpha receptors, they carry higher risks of weight gain, which trazodone does not.

For bipolar disorder, stable sleep can prevent cycling. While lithium is essential for mood stabilization, it takes 2 weeks to work, so adjunctive options like gabapentin are often used. For severe cases, short-term use of benzodiazepines may be warranted. This video guides you on how to balance sleep medications with mood stabilizers to avoid sleep-related mood destabilization.

If you’re dealing with trauma-related nightmares, you’ll learn about key medications like prazosin, which is often used for PTSD nightmares. We also discuss clonidine, which has stronger blood pressure effects, and how gabapentin may be a surprising but effective option for trauma-related sleep disturbances. Trazodone is another solid choice, as it supports sleep onset, maintenance, and nightmare suppression.

This video serves as a practical guide to selecting the right sleep aid for your condition. From insomnia treatment to managing depression, bipolar, and trauma-related sleep disturbances, you’ll learn which sleep medications work, how to use them, and how to avoid side effects like weight gain and daytime sedation. We explore the roles of GABA, histamine, serotonin, and cholinergic systems, giving you the knowledge to make more informed decisions about your sleep health.

If you’re looking for a comprehensive resource on sleep aids like trazodone, gabapentin, hydroxyzine, and melatonin, this video has everything you need to understand their benefits, risks, and best use cases. Whether you’re managing bipolar disorder, depression, or trauma-related nightmares, you’ll leave with practical, evidence-based solutions.

[Robis]

Love the extensive use of cats in the teaching material

[axelbmarley]

Tbh this is the first time I've heard of Trazodone helping against nightmares. I've always learned that Trazodone makes dreams more vivid, which made me understand that it would actually be bad for nightmares. Thanks for the insight!

[kenhaze]

This stuff is great to listen to as a research PhD b/c literature consistently states hydroxyzine has barely any affinity for mAChr, and this is actually a pretty consistent pattern for a lot of agents w/ observed putative anticholinergicity. Whether the observed anticholinergic effects are the result of an indirect mechanism or just that the assays used aren't so good, what actually matters is the observed effects, for certain purposes.

[papayafigure]

Amazing video! One thing I don't like in the Hydroxyzine is that it builds up a tolerance really quickly

[ProximoSepultura]

The VA put me on mirtazapine for PTSD. I gained weight but sleep like a baby and get quality sleep. I’d rather sleep like a baby than have a beach bid thanks

[Robert_Presto]

I found Olanzapine great for great nights sleep. You have to take it around 5:00PM same time everyday.

[MrSticks]

Thank you for the video! What is primary role of benzos and Z-drugs in your vision of sleep disorders treatment?

[IgnacyStefanczyk]

Is the stuff you say about gabapentin also applicable for pregabalin? Or are there aby important differences?

[lessnightlights]

Avatar cuteness escalation results are in: 🥰

[ArborZen]

I respect your approach to other psych topics but you truly neglect the DORA class even if it’s the most efficacious way of treating insomnia. It seems like money is the primary barrier but this is an outdated view. Daridorexant is $135/month on GoodRX now. $135 is nothing in 2024 with inflated salaries