Ashwin Lewis
Sleep medicine has evolved significantly over the centuries, with various substances being used to aid sleep since ancient times. Early sleep medicine involved the use of alcohol and opiates, which were later replaced by more modern drugs. The development of sleep medicine as a specialty emerged with advancements in neurophysiology and sleep research, particularly in the second half of the 20th century. The first benzodiazepine marketed specifically for sleep was flurazepam in 1970, which quickly became the most widely prescribed sleeping pill. However, concerns arose about its side effects, including dependence and daytime sedation. Today, sleep disorders are commonly treated with prescription medications like Z-drugs and benzodiazepines, although these come with their own risks and are generally recommended for short-term use.
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What You'll Learn
Alcohol and opiates were used in ancient times
Alcohol and opiates have been used as sleep aids since ancient times. Alcohol is the most widely used sleep aid globally and has been used as such for at least 9,000 years. Alcohol does help one fall asleep faster, as it works on the same brain receptors as some sleeping tablets. However, it is quickly broken down by the body, leading to a 'mini-withdrawal' process in the second half of the night, resulting in disturbed sleep. Long-term alcohol abuse leads to poor sleep, and the nervous system continues to be affected by alcohol for up to two years after stopping consumption, further disturbing sleep.
Opiates, derived from the opium poppy, have been used as a medicine and recreationally for centuries. Opium use was prevalent in ancient Mesopotamia, where it was used to help people sleep, relieve pain, calm crying children, and even as an anaesthetic during surgery. Opium was introduced to China and East Asia in the 6th or 7th century AD through trade along the Silk Road. In the 1800s, opium derivatives like morphine became widely used as pain relievers. Heroin was also first synthesized for medical use before its addictive properties were discovered.
While alcohol and opiates have been used since ancient times to aid sleep, they have ultimately proven to be detrimental to sleep quality.
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The first sleeping pill was flurazepam in 1970
Sleep aids have been used since the earliest days of recorded human history, with substances like alcohol and opiates being used as sedatives as early as ancient times. However, these substances were later found to negatively impact sleep quality, with alcohol causing interrupted sleep and opiates being linked to dangerous medicines and poisoning.
The development of sleep medicine as a specialty emerged in the second half of the 20th century with advancements in sleep monitoring techniques. The first sleeping pill, flurazepam, was introduced in 1970 and it quickly became the most widely prescribed sleeping pill within two years. Flurazepam is a "classical" benzodiazepine and was perceived to have advantages over previously dominant barbiturates and other drugs like glutethimide and methaqualone. These advantages included reduced toxicity in overdose and less interference with REM sleep, which was believed to potentially cause psychiatric difficulties.
Flurazepam has anxiolytic, anticonvulsant, hypnotic, sedative, and skeletal muscle relaxant properties. While it was effective in treating mild to moderate insomnia, it also presented challenges. The drug has abuse potential and can cause next-day drowsiness, dizziness, light-headedness, and ataxia. Long-term use can lead to drug tolerance, dependence, rebound insomnia, and central nervous system-related adverse effects.
The history of sleeping pills continued to evolve with the discovery of chloral hydrate in the mid-19th century and the development of barbiturates as sedatives in the early 20th century. However, these drugs also exhibited drawbacks, including reduced effectiveness over time and the development of dependence.
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Sleep disorders were limited to self-perceived insomnia or sleepwalking
Sleep disorders have been recognised and treated since ancient times, with alcohol and opiates being used as sleep aids. However, the scope of sleep disorders was limited to self-perceived insomnia or sleep disturbances observed by others, such as sleepwalking and sleep terrors. The recognition of other sleep disorders emerged with the development of sleep monitoring techniques in the 20th century.
For centuries, the understanding of sleep disorders was largely restricted to self-reported insomnia and sleepwalking or sleep terrors observed by others. This limited scope persisted until the second half of the 20th century when advancements in sleep monitoring techniques revealed a broader range of sleep disorders.
Early modern sleep medicine in England involved the use of dangerous substances, with a fine line between medicines and poisons. The application of alchemical processes to traditional ingredients, rather than the presence of opium, was the key characteristic of laudanum, a powerful internal medicine for treating fever and pain. However, its use challenged the belief that potent medicines should only be ingested for 'desperate diseases'.
Shakespeare's plays, such as "Romeo and Juliet" and "Antony and Cleopatra", explored the relationship between sleeping draughts and poisons, reflecting the uncertainties surrounding sleep medicine at the time. The fear of poisoning led to the preference for external applications, such as compresses and aromatics, over internal medicine to induce sleep.
The development of actimetric devices by the Viennese biologist Szymanski in the pre-EEG era enabled the differentiation between mono and polyphasic sleep-wake patterns in different species. This innovation contributed to the study of sleep in infants and adults, particularly in distinguishing day-active and night-active animals.
It wasn't until the late 20th century, with the interaction of chronobiology and sleep research, that circadian sleep-wake disorders were recognised as a distinct group of disturbances. This advancement paved the way for the establishment of sleep medicine as a specialised field with its own diagnostic and therapeutic approaches.
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Sleep medicine innovations included actimetric devices to study sleep patterns
Sleep medicine has evolved significantly over the centuries, with a range of substances and techniques being used to aid sleep and understand sleep patterns. In ancient times, people used alcohol and opiates to help them sleep, but these were not effective in the long term and often led to disturbed sleep and dependence.
The search for effective sleep aids and treatments continued into the early modern period, with external applications such as compresses and aromatics being favoured to avoid the risks of ingesting dangerous substances. The drug laudanum, for example, was a powerful internal medicine for dealing with pain and fever, but it challenged the belief that potent medicines should only be used in desperate cases.
In the 19th century, the potential negative impact of unusual working hours on sleep was recognised, and the concept of 'sleep-wake cycles' began to emerge. This early understanding of circadian rhythms laid the groundwork for more advanced sleep research in the 20th century.
Innovations in sleep medicine truly began to take off in the second half of the 20th century, with the development of key neurophysiological findings and sleep research. This era saw the emergence of actimetric devices, pioneered by the Viennese biologist Szymanski, who sought to measure activity continuously across 24 hours in various animals and human babies. This technology helped differentiate between mono and polyphasic sleep-wake patterns in different species, as well as between day-active and night-active animals.
Actimetric devices, also known as actigraphy, are now widely used in sleep medicine. These devices are typically worn on the wrist or ankle and resemble a wristwatch. They track movements to help identify sleep patterns and detect sleep disorders. Actigraphy is particularly useful for long-term monitoring of sleep-wake patterns and can be used to evaluate various sleep disorders, including insomnia, hypersomnia, circadian rhythm disorders, and excessive sleepiness. This technology is non-invasive, cost-effective, and can be used in the home environment, making it a valuable tool for both research and clinical evaluation of sleep disorders.
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Hypnotic drugs are prescribed for insomnia
Sleep aids have been used since ancient times, with substances like alcohol and opiates being used to help with sleep. However, these substances were found to provide only temporary relief and could lead to long-term disturbances in sleep patterns.
Today, there are various medications available to treat insomnia, a sleep disorder characterised by repeated difficulty with sleep initiation, maintenance, consolidation, or quality. Hypnotic drugs, also known as sedative-hypnotics, are one such class of medications that are commonly prescribed to treat insomnia. These drugs affect the central nervous system, specifically the brain and spinal cord, resulting in a calming and relaxing effect.
There are two main types of sedative-hypnotics: benzodiazepines and Z-drugs. Benzodiazepines were the first widely prescribed sleeping pills, with flurazepam, introduced in 1970, becoming the most popular within two years. Other common benzodiazepines include Xanax (alprazolam), Librium (chlordiazepoxide), Valium (diazepam), Klonopin (clonazepam), Prosom (estazolam), Ativan (lorazepam/orazepam), and Restoril (temazepam). While effective in treating insomnia, benzodiazepines have been associated with dependence and daytime sedation. They are also known to cause memory issues, drowsiness, and increased risk of falls and fractures in older adults.
Z-drugs, on the other hand, are non-benzodiazepine hypnotics that include medications like eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien). These drugs are used to treat short-term insomnia. However, like benzodiazepines, Z-drugs carry risks of memory problems, daytime drowsiness, and increased risk of accidents in older adults. Additionally, both types of drugs are highly addictive, and their effectiveness may decrease over time as the body becomes accustomed to them.
While hypnotic drugs can be effective in treating insomnia, they are not recommended for long-term use, especially in older adults. Non-drug alternatives, such as avoiding caffeine, exercising regularly, and maintaining a healthy bedtime routine, are often suggested as safer and more sustainable options for improving sleep.
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Frequently asked questions
In the past, people used various substances to help them sleep, including alcohol and opiates. However, these were not effective in the long term and often caused more harm than good. Early modern sleep medicines included dangerous substances such as poisons and opium. The first benzodiazepine marketed specifically for sleep was flurazepam, which became available in 1970.
Benzodiazepines are a class of drugs that act as sedatives, helping to calm or relieve anxiety and initiate, sustain, or lengthen sleep. They are often referred to as sedative-hypnotic drugs.
As of 2010, 10.8% of individuals with sleep disorders in the USA were taking benzodiazepines. However, due to concerns about side effects, dependence, and withdrawal, they are generally only prescribed for short-term use.
Alternative sleep aids include "Z-drugs" such as nonbenzodiazepines, which are less likely to cause dependence but may have similar side effects. Other off-label sleep remedies include mirtazapine, clonidine, and quetiapine. However, these are generally not recommended unless first-line treatments are unsuccessful or unsafe. Behavioral changes, such as improving sleep hygiene and avoiding caffeine and alcohol, are often the best way to improve sleep without the need for medication.
No, currently, there are no prescription sleep medicines specifically for children. Changing a child's sleep behaviors and improving sleep hygiene are usually the recommended approaches to addressing sleep issues in children.
