Hypnotics

Medications that cause sleep or partial loss of consciousness.

Commonly known as sleeping pills, are a class of psychoactive drugs whose primary function is to induce sleep and to be used in the treatment of insomnia, or surgical anesthesia.

Hypnotic group is related to sedatives.

Whereas the term sedative describes drugs that serve to calm or relieve anxiety, the term hypnotic generally describes drugs whose main purpose is to initiate, sustain, or lengthen sleep.

Ref2241ed to collectively as sedative-hypnotic drugs.

These drugs are regularly prescribed for insomnia and other sleep disorders, with over 95% of insomnia patients being prescribed hypnotics.

Many hypnotic drugs are habit-forming.

It is recommended changes in the environment before and during sleep, better sleep hygiene, and the avoidance of caffeine or other stimulating substances before prescribing medication for sleep.

Hypnotic medications should be used for the shortest period of time necessary.

Most hypnotics prescribed today are either benzodiazepines or nonbenzodiazepines.

Among individuals with sleep disorders, approximately 14% are taking or prescribed nonbenzodiazepines, while 11% are taking benzodiazepines.

Barbiturates, have fallen out of use.

Such drugs are not prescribed for children unless used to treat night t2241ors or somnambulism.

Elderly people are more sensitive to side effects of fatigue and cognitive impairments.

Risks generally outweigh any marginal benefits of hypnotics in the elderly.

Adverse effects, such as dependence and accidents, require the use of the lowest effective dose for the shortest therapeutic time period, with gradual discontinuation in order to improve health without worsening of sleep.

The neuro-hormone melatonin has a hypnotic function.

Substance dependence is possible, and deaths from overdoses sometimes occur, especially in combination with alcohol and/or other depressants.

Questions have been raised as to whether they disturb sleep architecture.

Nonbenzodiazepines are less toxic than their predecessors, barbiturates.

Other sleep remedies that may be considered sedative-hypnotics exist including: mirtazapine, clonidine, quetiapine and the over-the-counter sleep aid diphenhydramine.

Quinazolinones are also a class of drugs which function as hypnotic/sedatives that contain a 4-quinazolinone core, and include cloroqualone, diproqualone, etaqualone (Aolan, mebroqualone, mecloqualone and methaqualone (Quaalude).

Benzodiazepines can be useful for short-term treatment of insomnia, as use beyond 2 to 4 weeks is not recommended due to the risk of dependence.

Benzodiazepines improve sleep-related problems by shortening the time spent in bed before falling asleep, prolonging the sleep time, and, in general, reducing wakefulness.

Like alcohol, benzodiazepines are commonly worsen sleep in the long-term.

Benzodiazepines can disrupt sleep architecture: decreasing sleep time, delaying time to REM sleep, and decreasing deep slow-wave sleep.

Deep slow wave sleep is the most restorative part of sleep for both energy and mood.

Hypnotic problems, including benzodiazepines, are possible tolerance, rebound insomnia, and reduced slow-wave sleep and a withdrawal rebound insomnia and a prolonged period of anxiety and agitation.

Longer-acting benzodiazepines such as nitrazepam and diazepam have residual effects that may persist into the next day and are, in general, not recommended.

Older adults should not use benzodiazepines to treat insomnia unless other treatments have failed to be effective.

Benzodiazepine mechanism of action is primarily at GABAA receptors.

Nonbenzodiazepines are a class of psychoactive drugs that are very much like benzodiazepines.

Nonbenzodiazepines pharmacodynamics are very similar to benzodiazepines, with similar benefits, side-effects, and risks, but are unrelated on a molecular level.

Examples include zopiclone, eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien).

Melatonin hormone is produced in the pineal gland and secreted in dim light and darkness.

It promotes sleep in diurnal mammals.

Melatonin receptor agonists that bind to and activate melatonin receptors, prescribed for several sleep disorders, include ramelteon, and tasimelteon.

Ramelteon (Rozerem®) is approved for treatment of insomnia, and tasimelteon (Hetlioz®) is approved for the circadian rhythm sleep disorder non-24-hour sleep–wake disorder in totally blind individuals.

Clinically, H1 antagonists are used to treat allergies, and sedation is a common side-effect.

Some H1 antagonists, such as diphenhydramine (Benadryl) and doxylamine, are also used to treat insomnia.

Second-generation antihistamines cross the blood–brain barrier to a much lower degree than the first ones, and therefore having a much lower sedative effect.

High doses of second generation anti-histamine can still induce the central nervous system effect of drowsiness.

Some antidepressants have sedating effects and include:

Serotonin antagonists and reuptake inhibitors

Trazodone

Tricyclic antidepressants

Amitriptyline

Doxepin

Trimipramine

Tetracyclic antidepressants

Mirtazapine

Selective serotonin reuptake inhibitors

Serotonin–norepinephrine reuptake inhibitors

Norepinephrine reuptake inhibitors

Antipsychotics

Melatonin

Nonbenzodiazepines zaleplon and zolpidem have a half life of 1 and 2 hours, respectively.

The benzodiazepine clonazepam has a half life of about 30 hours, and makes the drug suitable for sleep-onset difficulty.

Prescribed for insomnia and include benzodiazepines and non-benzodiazepines.

Some hypnotics may be addictive.

Non-benzodiazepine hypnotics may be less addictive than benzodiazepines.

Non-benzodiazepine hypnotics may have dangerous or strange behaviors associated.

Treatment is initiated with the lowest dose possible, especially in the elderly.

Stoping hypnotics should be done gradually, to reduce the risk of withdrawal or further sleep problems.

Benzodiazepines are divided into short, medium and long-acting agents.

Long-acting benzodiazepines include flurazepam (Dalmane), clonazepam (Klonopin), and quazepam (Doral).

Medium- and short-acting 2242

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