Evie Summers
Sleeping pills are medications that can help people fall asleep, relieve stress, and reduce anxiety. They are typically used for a short time and in combination with good sleep practices and behavioural treatments. Sleeping pills are of various kinds, including Benzodiazepines, Z-drugs, melatonin receptor stimulators, antidepressants, antianxiety medications, orexin receptor antagonists, and antihistamines. While these medications can be effective in promoting sleep, they may also have side effects such as constipation, muscle weakness, dizziness, and fatigue. Prolonged use of sleeping pills can lead to drug tolerance, dependency, and adverse effects on health. Therefore, it is essential to exercise caution and consult a healthcare provider before taking any sleep medication.
| Characteristics | Values |
|---|---|
| Drug class | Benzodiazepines, Z-drugs, melatonin receptor stimulators, antidepressants, antianxiety medications, orexin receptor antagonists, antihistamines, anticonvulsants, antinarcoleptics, antipsychotics |
| Mechanism of action | Benzodiazepines stimulate GABA, causing sedation, muscle relaxation, and reduced anxiety. Z-drugs slow brain activity. Antidepressants and antianxiety medications induce sleep as a side effect. Orexin receptor antagonists alter orexin's action in the brain. |
| Examples | Benzodiazepines: alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), lorazepam, temazepam (Restoril). Z-drugs: Zolpidem, Ambien, Zopiclone, eszopiclone (Lunesta), zaleplon (Sonata). Melatonin receptor stimulator: ramelteon (Rozerem). Antidepressants: mirtazepine (Remeron), trazodone. Antianxiety medications: quetiapine (Seroquel). Orexin receptor antagonists: suvorexant (Belsomra), lemborexant (Dayvigo), daridorexant (Quviviq). Antihistamines: diphenhydramine (ZzzQuil), doxylamine (Unisom). Anticonvulsants: carbamazepine (Epitol, Tegretol), gabapentin enacarbil (Horizant), pregabalin (Lyrica), valproate (Depakene). Antinarcoleptics: methylphenidate (Ritalin), modafinil (Provigil), pitolisant (Wakix), sodium oxybate (Xyrem, Xywav). Antipsychotics: quetiapine (Seroquel), olanzapine (Zyprexa), risperidone (Risperdal) |
| Side effects | Constipation, diarrhea, muscle weakness, drowsiness, dizziness, balance issues, fatigue, irritability, depression, tolerance, addiction, dependence, rebound insomnia, overdose |
| Usage recommendations | Short-term use, avoid long-term due to potential side effects and health risks. Combine with good sleep practices and behavioral treatments. |
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Benzodiazepines
Doctors may prescribe a short course of benzodiazepines or Z-drugs when necessary to address sleeping difficulties or insomnia. Z-drugs, such as zolpidem and zopiclone, are a separate class of medications that act similarly to benzodiazepines but are not technically benzodiazepines. They are the most frequently prescribed class of sleep medications due to their minimal side effects, low potential for drug tolerance, and addiction.
In summary, benzodiazepines are a powerful class of sleeping pills that can effectively treat insomnia, anxiety, and other disorders. They work by stimulating GABA in the brain, leading to sedation and reduced anxiety. While they are commonly prescribed and can be beneficial for short-term use, they should be used cautiously due to their potential for addiction and side effects. It is important for individuals to consult with their healthcare providers to determine if benzodiazepines are a suitable treatment option for their specific needs.
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Z-drugs
Sleeping pills are typically recommended for short-term use only, as they can cause dependency, drug tolerance, and other side effects. They are not a cure for insomnia. Some of the drugs used in sleeping pills include antidepressants, barbiturates, benzodiazepines, and Z-drugs.
Some common Z-drugs include zolpidem, zopiclone, eszopiclone, and zaleplon, which vary in terms of efficacy and side effects. Zolpidem is available in oral tablets, oral spray, and sublingual formulations for initial insomnia, while an extended-release version is approved for initial and middle insomnia. Eszopiclone has the longest half-life of 6 hours at its maximum dose and is used for sleep maintenance and initiation. Zaleplon is the shortest-acting Z-drug and is indicated for sleep initiation following middle-of-the-night awakenings.
Despite their benefits, Z-drugs are not without risks. At higher doses or when combined with other CNS depressants, Z-drugs have been associated with sleep-eating, sleepwalking, and driving while asleep. They can also impair physical and cognitive performance, with detrimental effects on motor function, balance, attention, processing speed, and memory. Additionally, Z-drugs can accumulate in the body over time if the elimination half-life is long and with frequent use, leading to increased side effects and potential tolerance and dependence issues.
While Z-drugs have been touted as an improvement over older generations of sleep medications, recent reports have surfaced of adverse side effects and negative impacts on patients' lives. This has sparked discussions about the true effectiveness of Z-drugs in treating insomnia and the potential risks associated with their use.
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Antidepressants
Sleeping pills are typically recommended for short-term use due to their potential side effects, which can include constipation, muscle weakness, and a hangover effect the following day. They can also cause dependency, drug tolerance, and changes in brain function with long-term use.
Doxepin is the only FDA-approved antidepressant for the treatment of insomnia. It has been shown to improve sleep for up to three months, and it is not associated with dependence or withdrawal symptoms. Other antidepressants with sedating effects, such as trazodone, may also improve sleep, but the evidence for their efficacy is limited, and they are generally used off-label as sleep aids. Selective serotonin reuptake inhibitors (SSRIs) have also shown some promise in improving sleep measures.
While antidepressants can be beneficial in treating insomnia, they are not licensed for this use, and their effectiveness is not well established. They are often prescribed due to concerns over the long-term use of hypnotics and the limited availability of psychological treatments, such as cognitive behavioural therapy (CBT). It is important to note that antidepressants should be used with caution and under medical supervision due to their potential side effects.
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Antipsychotics
Atypical antipsychotics, such as risperidone, olanzapine, quetiapine, and ziprasidone, generally cause less sedation than conventional antipsychotics while effectively controlling psychosis and agitation. Quetiapine, a second-generation antipsychotic, has been used to treat insomnia, but its efficacy is poorly documented, and it may have substantial side effects, even at low doses. Norwegian national recommendations advise against the increased use of antipsychotics for insomnia due to these concerns.
The use of antipsychotics to treat insomnia may be appropriate in certain cases, such as when an individual has a serious mental illness that interferes with their sleep. The American Psychiatric Association recommends considering antipsychotics for insomnia only if there is a serious mental illness present, such as bipolar disorder with mania. It is important to consult with a doctor and explore other treatment options before resorting to antipsychotic drugs for insomnia.
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Orexin receptor antagonists
There are currently three orexin receptor antagonists that have been approved by the FDA for the treatment of insomnia: suvorexant, lemborexant, and daridorexant. Suvorexant, also known by the brand name Belsomra, was approved in 2014 and is available in 5-, 10-, 15-, and 20-mg tablets. The starting dosage of suvorexant is 10 mg, taken within 30 minutes before bedtime, with at least 7 hours remaining before planned awakening. If the 10-mg dosage is ineffective, it can be increased to a maximum of 20 mg once daily. However, dosing cannot be repeated if sleep induction or maintenance fails.
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Frequently asked questions
There are several classes of drugs used in sleeping pills, including Benzodiazepines, Non-Benzodiazepines (or Z-drugs), Antidepressants, Antihistamines, Melatonin Receptor Agonists, Orexin Receptor Antagonists, and Antipsychotics.
Long-term use of sleeping pills can lead to several side effects, including poor memory, brain degeneration, Alzheimer's disease, risk of accidental falls, respiratory depression, and drug tolerance. Sleeping pills can also cause drowsiness, dizziness, fatigue, irritability, and depression.
Yes, there are some natural alternatives to sleeping pills that may help improve sleep. These include melatonin, L-tryptophan, valerian, and cognitive behavioral therapy (CBT). However, it is always recommended to consult with a healthcare professional before starting any new treatment or supplement.
