Belsomra vs. Ambien for Insomnia: 4 Key Differences To Consider
Key takeaways:
Belsomra (suvorexant) and Ambien (zolpidem) are both prescription sleep medications. But they work differently to help with insomnia.
Ambien is available in more dosage forms than Belsomra. These include immediate-release (IR) tablets and capsules, extended-release tablets (Ambien CR), and sublingual tablets (Edluar). Belsomra only comes in one dosage form.
Both Belsomra and Ambien are controlled substances with a risk of dependence and misuse. But Ambien may be more likely to cause withdrawal symptoms if you stop taking it abruptly.
Your healthcare team should consider factors such as your age, sleep patterns, and potential side effects when determining which option may be best for you.
Table of contents
Belsomra (suvorexant) and Ambien (zolpidem) are prescription medications that treat insomnia (trouble sleeping) in adults. Both are effective sleep aids, but they work in different ways and have distinct risks and side effects to consider.
If you and your healthcare team are deciding between Belsomra and Ambien, understanding their key differences can help you make an informed choice. Here’s what you should know.
1. Belsomra and Ambien work differently for insomnia
Both Belsomra and Ambien are used to treat insomnia. But they affect different pathways in the brain to help you sleep.
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Ambien is a sedative-hypnotic (“Z-drug”), also known as a non-benzodiazepine. It enhances the activity of gamma-aminobutyric acid (GABA), a chemical messenger that slows brain activity and promotes sleep. Ambien can help if you have difficulty falling asleep and staying asleep, depending on which form you take (more on this later).
Belsomra is an orexin receptor antagonist (ORA). It works by temporarily blocking the effects of orexin, a chemical messenger that promotes wakefulness. This reduces wakefulness signals, which can help you fall asleep and stay asleep longer.
ORAs such as Belsomra were developed to provide an alternative to Z-drugs by targeting wakefulness rather than sedation. And because of how they work, ORAs also don’t seem to be associated with some of the same risks. We’ll discuss that later.
2. Ambien is available in more dosage forms than Belsomra
Belsomra is only available as an oral tablet. Ambien has multiple formulations, which provide options depending on your treatment needs.
Ambien comes in immediate-release (IR), extended-release (Ambien CR), and sublingual (Edluar) forms.
Ambien IR works quickly and can be ideal for people who struggle to fall asleep.
Edluar is dissolved under the tongue, helping the medication to kick in even faster. It can also be a good option if you have difficulty swallowing pills.
Ambien CR has longer-lasting effects, helping with both falling and staying asleep.
Beating insomnia: Real people share their experiences with insomnia and how they were able to get the sleep they needed.
Comparing options: There are many sleep medications to choose from. Here’s a guide to prescription and over-the-counter sleep aids to help you find the right fit.
Ambien side effects: Review these common side effects of Ambien so you can be prepared to manage them or seek medical care.
Belsomra is approved to help you get to sleep and stay asleep. It should be taken 30 minutes before bedtime, while all Ambien forms should be taken right before you go to bed. In both cases, you should only take a dose if you have at least 7 hours before you plan on getting up. Food can slow the absorption of both medications, so take your dose on an empty stomach.
3. Belsomra and Ambien have different side effects and risks
Since they help you sleep, both Belsomra and Ambien can make you drowsy. They’re also both controlled substances, meaning that they have a risk of dependence and misuse. But there are also important differences in their potential side effects and risks to consider.
| Belsomra side effects and risks | Ambien side effects and risks |
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With both medications, you may experience impairment the following day. This can impact your ability to drive or perform other tasks that require you to be alert. Make sure you can dedicate at least 7 to 8 hours to sleep before taking a dose, and don’t take more than the prescribed amount. Be sure to follow your prescriber’s instructions for how to manage your risk.
If you or someone you know is having thoughts of suicide, you’re not alone, and help is available. Call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
Good to know: Side effects for both Belsomra and Ambien seem to be linked to the dosage. With higher doses, side effects may be more likely. So if you’re experiencing side effects while taking a higher dosage, your prescriber may suggest lowering it.
4. Belsomra may be less likely to cause withdrawal symptoms
Ambien can lead to physical dependence — especially with higher doses and longer use. If you suddenly stop taking it, you may experience withdrawal symptoms such as anxiety, sweating, and difficulty sleeping. In severe cases, confusion and hallucinations are possible. Withdrawal symptoms haven’t been reported with Belsomra.
To minimize the risk of withdrawal after stopping Ambien:
Don’t exceed your prescribed Ambien dosage.
Take the lowest effective dose for the shortest time possible.
Don’t abruptly stop taking Ambien on your own. Follow your prescriber’s instructions for how to safely stop taking it.
Belsomra wasn’t found to lead to physical dependence or withdrawal symptoms during clinical trials. But it’s still best to take the lowest effective dose and talk to your prescriber before you stop taking Belsomra.
Can you take Belsomra and Ambien together for insomnia?
No. Typically, sleep medications shouldn’t be combined. This can result in excessive side effects, especially drowsiness, which can be dangerous.
If you feel like the medication you’re taking for insomnia isn’t working, talk with your prescriber. They may suggest increasing your dose (if possible) or switching to a different medication that may work better.
How do healthcare professionals decide which medication to prescribe for insomnia?
Before turning to medications such as Belsomra or Ambien, healthcare professionals usually recommend behavioral strategies and lifestyle changes first. These non-drug approaches are often more effective in the long term and come without the risks of side effects or dependence.
If non-drug treatments aren’t enough, both Belsomra and Ambien are recommended by the American Academy of Sleep Medicine as potential options for treating insomnia. But it’s important to note that they typically offer modest benefits. Results can also vary from person to person. The best choice for you may depend on factors such as:
Insomnia type: If you have trouble falling asleep, Ambien may be preferred. If you have trouble staying asleep, Belsomra may be an option to consider.
Your age and fall risk: In general, experts recommend that older adults should avoid medications such as Ambien. This is because of an increased risk of sudden confusion (delirium) and falls. While falls are still possible, your prescriber may consider a medication such as Belsomra.
History of substance use: Ambien has a higher potential for dependence and misuse. If you have a history of substance use, Belsomra may be a better choice for you.
Cost: Belsomra is available only as a brand-name medication. Ambien comes in both brand-name products and lower-cost generics.
Ultimately, the best medication for you will depend on your specific health situation. You and your prescriber can work together to determine the right treatment.
The bottom line
Belsomra (suvorexant) and Ambien (zolpidem) are two prescription medications for insomnia. They’re both controlled substances with a risk of misuse and dependence. But Ambien may be more likely to cause withdrawal symptoms if you suddenly stop taking it.
Other key differences between Belsomra and Ambien include how they work, potential side effects, and available dosage forms. Ambien may work better to help you fall asleep, while Belsomra might be preferred for helping you stay asleep. Your prescriber can help determine which medication might be best for you.
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References
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Awasthi, H., et al. (2023). Abrupt withdrawal from chronic high-dose zolpidem use: A case report of resulting delirium. Cureus.
Merck Sharp & Dohme. (2025). Belsomra- suvorexant tablet, film coated [package insert].
Muehlan, C., et al. (2023). The orexin story and orexin receptor antagonists for the treatment of insomnia. Journal of Sleep Research.
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