Belsomra vs. Ambien: Which Is Best for You? (2024)

Belsomra (suvorexant) and Ambien (zolpidem) are both medications taken to treat insomnia or difficulty sleeping. These medications work differently, and one or the other may benefit certain people more or less.

A couple of key differences include how fast they work as well as their addiction or dependency risks. Ambien may be a better choice if falling asleep quickly is a priority. However, Belsomra may be better for helping you maintain sleep throughout the night.

Understanding Belsomra

Belsomra is an orexin receptor antagonist. Orexin is a neurotransmitter, a chemical in the brain that attaches to the orexin receptor 1 (OX1R) or orexin receptor 2 (OX2R). These receptors regulate sleep and wakefulness, stress responses, and appetite.

Drugs like Belsomra block the activity of these neurotransmitters by attaching to the receptors they would normally attach to in order to cause wakefulness effects.

Belsomra’s only approved use is for adults with insomnia or difficulty falling asleep or staying asleep.

Benefits of Belsomra

Some benefits of Belsomra include:

• It can help maintain sleep throughout the night.
• It has a lower risk of dependence compared to some other sleep medications.
• It utilizes a newer mechanism of action compared to most other agents that have historically worked to help with sleep and are more likely to cause abuse or dependency.
• It may be more suitable for longer-term use compared to other sleep medicines.

Side Effects of Belsomra

Common side effects of Belsomra include:

• Drowsiness
• Headaches
• Dizziness

Less common side effects of Belsomra include:

• Sleep paralysis
• Abnormal dreams
• Hallucinations
• Next-day impairment that includes difficulty driving or doing other activities that require alertness

Understanding Ambien

Ambien is a sedative-hypnotic medication generally taken in the short term to treat insomnia. It binds to the gamma-aminobutyric acid-A (GABA-A) receptor at the same site where benzodiazepine medications bind. This causes the receptor to attract more of the GABA neurotransmitter, which results in less neuron firing. The outward result is a sedative effect that helps induce and maintain sleep.

You may hear Ambien referred to as a “Z-drug.” This is a group of medications that includes Ambien (zolpidem), Lunesta (eszopiclone), Imovane (zopiclone), and Sonata (zaleplon). All of these have mechanisms of action that are similar to those of Ambien. These are also all U.S. Food and Drug Administration (FDA)-scheduled drugs, which means they have some extra restrictions and regulations that prescribers and pharmacies must follow when dispensing them.

Benefits of Ambien

Benefits of Ambien include:

• It works quickly to help people fall asleep.
• It can improve sleep duration because it can help people stay asleep longer, improving overall sleep quality.
• It comes with convenient dosing options, including immediate-release products and extended-release products.

Side Effects of Ambien

More common side effects include:

• Dizziness
• Headache
• Nausea/diarrhea

Some potentially more serious side effects include:

• Memory problems
• Behavioral changes
• Sleepwalking
• Dependence and withdrawal
• Hangover effects the morning after taking the drug

Preventing Side Effects

Avoid combining Belsomra and Ambien with other medications that can cause respiratory depression, or trouble breathing, such as narcotics or benzodiazepine medications. These medications can cause drowsiness or sedation and taking them together is more likely to cause side effects.

Though sleep medications can be effective, it’s always best to try to address the root cause of sleep problems whenever possible to avoid side effects or even dependence on unnecessary medications. Frequent contributors to sleep difficulties include anxiety and stress, conditions like chronic pain, sleep apnea, or hormonal issues, or lifestyle factors such as work schedule, alcohol or caffeine intake, and sleep environment.

Who Should Avoid Belsomra and/or Ambien?

Despite its effectiveness, some individuals should refrain from taking both Belsomra and Ambien. Some examples of these individuals or groups include:

• People with depression or mental health issues may worsen symptoms of depression or thoughts of suicide.
• Elderly individuals, such as those older than 65, may be more susceptible to certain side effects of Ambien and Belsomra, like confusion and dizziness, which may put them at a higher risk of falls.
• People who have complex sleep disorders like sleepwalking. Ambien or Belsomra may worsen this.
• Those who also take narcotics, like oxycodone or hydrocodone, or benzodiazepines, like Xanax (alprazolam) or Valium (diazepam). These medications may add side effects to those caused by Ambien or Belsomra, like confusion, excessive sleepiness, and respiratory depression.

Those who should avoid Belsomra include:

• People with narcolepsy because Belsomra works by blocking the neurotransmitter orexin. Orexin is involved in regulating sleeping and wakefulness, which means that Belsomra could worsen narcolepsy symptoms.

People for whom Ambien is not the best choice include:

• People with a history of substance abuse or dependence because Ambien can be a habit-forming medication.

Summary

Belsomra and Ambien can both contribute to better sleep, but they work differently and may have properties that are better suited for certain individuals and types of insomnia. Ambien works on the neurotransmitter GABA, which has an overall calming effect. This mechanism is similar to that of benzodiazepine medications but is more selective for sleep-specific receptors. Belsomra works on a different neurotransmitter, orexin, and prevents it from attaching to receptors that promote wakefulness.

If your main problem is that it takes you a long time to fall asleep, taking Ambien may be a better choice for you. If your sleep problem is frequently waking up throughout the night, Belsomra may be worth trying first. Ambien is a Schedule 4 controlled substance that comes with a higher risk of abuse potential and dependence, so if you have a history of either of these conditions, you may want to avoid Ambien altogether.

Trying to address the root cause of insomnia is always best, whether it's stress, a chronic condition, or an environmental factor. Treating what is making you have trouble falling asleep is a more sustainable solution than adding a sleep drug to your medication regimen.