Hypnotics and Sleep

Hypnotics are substances that increase sleepiness and may cause an individual to sleep or have a partial loss of consciousness. For this reason, hypnotics can be very useful to aid sleep in individuals that have difficulty sleeping, such as those that suffer from insomnia.

There are two broad groups of hypnotic medications: benzodiazepines and non-benzodiazepines. Melatonin has also been suggested as a type of hypnotic and appears to be effective for some patients with sleeping difficulties.

Benzodiazepine Hypnotics

Benzodiazepine hypnotics are a relatively safe and effective medical management option to aid sleep and treat insomnia. Examples include:

• Triazolam
• Lorazepam
• Alprazolam
• Temazepam
• Oxazepam
• Prazepam
• Estazolam
• Flunitrazepam
• Flurazepam (long-acting)
• Clonazepam (long-acting)
• Quazepam (long- acting)

When used over the long-term, however, some people may develop a tolerance for and dependence on the medications. They can also be dangerous when used in combination with alcohol or other sedating drugs.

Non-Benzodiazepine Hypnotics

Non-benzodiazepine hypnotics can be used to aid sleep and treat insomnia, and are generally associated with fewer adverse effects than benzodiazepine hypnotics. These include:

• Zaleplon
• Zolpidem
• Eszopiclone
• Ramelteon

These medications have been linked to strange behaviors, such as eating and driving while still asleep which can be dangerous. Similarly to benzodiazepine medications, they are recommended for short-term use to avoid the development of dependence.

Melatonin as a Hypnotic

Melatonin is a hormone that is present in the highest concentrations in the body close to the bedtime of individuals when feelings of sleepiness are most profound. As a result of this, some medical research has focused on the action of melatonin to induce sleep, as it could have the potential to be used as a natural hypnotic.

It has been proven to effectively improve sleep in some circadian rhythm sleep disorders (e.g. jet lag syndrome, shift worker disorder, delayed sleep phase syndrome) and in elderly patients with an identified reduction in melatonin concentration. However, the clinical recommendations following the melatonin research are not clearly defined, as there is a potential for interactions with other psychotropic drugs and worsening of sleep-breathing disorders.

For this reason, further research is required to investigate the therapeutic effects and patient tolerability of the medication when used to aid sleep for individuals with sleeping disorders.

Cautions

While hypnotic medication can be very useful to manage problems with sleeping, it is important to use them in the best way to avoid negative outcomes.

If there are any underlying health conditions that may be affecting sleep, such as depression or anxiety, these should be addressed before hypnotic medications are introduced. Behavioral or psychological interventions are sometimes able to sufficiently improve sleeping habits and treat sleeping disorders, without the need for hypnotics.

Side effects of hypnotics when taken to aid sleep may include:

• Increased risk of falls
• Memory loss (in elderly)
• Altered behaviors

Taking hypnotic medication regularly can lead to increased difficulty getting to sleep and reliance on the drug. For this reason, it is recommended to take pills on three days or less each week. Additionally, if hypnotic medications need to be ceased, it is important that the dose is slowly reduced to lower the risk of withdrawal symptoms and recurrence of sleep problems.

References

• https://www.nlm.nih.gov/medlineplus/ency/article/002376.htm
• http://emedicine.medscape.com/article/292498-medication#2
• http://www.australianprescriber.com/magazine/26/4/78/81
• http://www.ncbi.nlm.nih.gov/pubmed/9441514