HYPNOTICS - SEDATIVES - SLEEPING TABLETS

What are the types of Hypnotics ?

Benzodiazepines are the most commonly used. temazepam, nitrazepam, flurazepam, loprazolam and lormetazepam. Some of this group may also be used to treat anxiety, such as diazepam. Barbiturates are rarely used now. Other sleeping tablets include chloral hydrate and chlormethiazole. Newer ones are zolpidem and zopiclone. Certain antihistamine product that cause drowsiness can be used to aid sleep. Diphenhydrtamine (Nytol), promethazine (Phenergan, Nightime, Sominex) are such examples.

What are Hypnotics for ?

Most people have difficulty getting to sleep, or staying asleep (insomnia) from time to time. This is usually because they are worried or have temporary pain or discomfort. This is natural, and normal sleep patterns often return without treatment. Persistent sleeplessness can be caused by problems such as anxiety or depression, or by pain from a physical illness. Sleeping tablets are used when simple measures are not enough, and lack of sleep is affecting your health. They should be used to get back to a normal sleeping pattern. You may be given other medication to treat the particular problem that is disturbing your sleep.

How do Hypnotics work ?

They work on your brain by reducing the level of mental activity, allowing you to fall asleep more easily. Unfortunately, the nature of your sleep is affected. The amount of dream sleep and deep sleep is reduced. Light sleep is increased. Therefore, even if you sleep for longer, you might not feel as well rested as you do after a night of natural sleep. Zopiclone and zolpidem are designed to help your sleep follow a more natural pattern.

How should Hypnotics be used ?

Normally, sleeping tablets are taken about 15 to 30 minutes before you go to bed. They are all slightly different, but will start to have an effect in 15 to 60 minutes. You should only take the dose that your doctor tells you to take. Higher doses may be dangerous. If you are over 60 years old you may be asked to take half a tablet because older people mostly need smaller doses to get the same effect. You should only take them for as long as your doctor tells you to. Taking any sleeping tablets regularly for a long time may result in you becoming dependent on them. If your doctor decides to stop treatment, return any left-over tablets to your pharmacist. Only keep them if your doctor tells you to do so. They are not normally used for children.

During Treatment with Hypnotics

Some people feel drowsy and less alert next day. This is especially so if they delay going to bed after taking their tablets. You might feel dizzy, light-headed, unsteady on your feet, confused, forgetful and weak. These effects may go with continued use, but are best discussed with your doctor. If drowsiness and reduced alertness are obvious, do not drive or operate machinery while you are taking them. You might get headaches, stomach upsets, blurred vision or vivid dreams and nightmares, but these are less common. If you get a rash which you didn't have before, stop taking your sleeping tablets and see your doctor. If you take sleeping tablets for a long time they will not be as effective as they were at the start. It is tempting to take higher and higher doses, but do not take more tablets unless your doctor has advised it. It is easy to become dependent on any sleeping tablets: barbiturates are the worst in this regard, and are now little used.

Drug Interference

Any other drug that can make you drowsy will clearly make you even more drowsy when you are taking sleeping tablets. This includes alcohol! Blood thinners (anticoagulants) are affected by chloral hydrate: you may need to take a lower dose of blood thinners to avoid a risk of bleeding. On the other hand, with barbiturates, blood thinners may need to be increased to prevent a tendency to clotting. Contraceptive pills are made less effective if you have barbiturates: additional protection will be needed. Anti-epileptics are made less effective by barbiturates: the dose may need to be higher. This is not a full list. You should check with your doctor about your particular drugs or medications. Antivirals. Ritonavir can increase the effects of some benzodiazepines such as diazepam, flurazepam and zolpidem. This can produce extreme sedation and depress breathing. They should not be used together.

What if Hypnotics are not taken ?

If you are taking barbiturates you should not stop taking them without consulting your doctor first because you may get withdrawal symptoms: restlessness, trembling and insomnia. For all other sleeping tablets, if you go to bed and forget to take your tablet but remember straight away, take your tablet as usual. If you fall asleep without taking your tablet and wake up a few hours later, do not take the missed dose. Start taking it again the next night. If you have been taking them for less than 2 weeks, you can safely stop as soon as you no longer need them. If you have been taking them for more than a few weeks you should not stop taking them suddenly as you might suffer "withdrawal": feeling anxious, having nightmares or being unable to sleep. Speak to your doctor who will advise you how to stop them gradually.

General advice on Hypnotics

If you have serious lung disease, some sleeping tablets can depress your breathing. This makes sleep-related breathing problems worse. If you have an alcohol or drug dependency problem, you may also become dependent on sleeping tablets. You should avoid sleeping tablets if you are pregnant or breast-feeding.