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Hypnotics

Definition

Hypnotics are medications that cause sleep or partial loss of consciousness.

Information

Hypnotics are prescribed for insomnia (difficulty sleeping). These drugs include benzodiazepines and non-benzodiazepines.

Hypnotics should only be taken under a doctor's direction. They may be unsafe when mixed with alcohol or with each other. Taking hypnotics with alcohol or with each other can lead to excessive drowsiness (sedation) and even death.

Before taking a hypnotic for sleep problems, you and your doctor should consider the following:

• Address any mental health problems, such as anxiety or depression, first.
• As a general rule, do not take sleeping pills more than 3 days per week.
• Behavioral or psychologic techniques can sometimes cure insomnia. Sleeping pills only help as long as you take them.
• Hypnotics may increase the risk of falls and memory loss in the elderly.
• Some hypnotics are addictive. Non-benzodiazepine hypnotics may be less addictive than benzodiazepine hypnotics. However, non-benzodiazepine hypnotics may cause dangerous or strange behaviors, such as driving, making phone calls, or eating while asleep.
• When taking a hypnotic drug, start with the lowest dose possible, especially if you are elderly.
• Stop taking hypnotics gradually, to reduce the risk of withdrawal or further sleep problems.

Benzodiazepine hypnotics

• Long-acting benzodiazepines include flurazepam (Dalmane), clonazepam (Klonopin), and quazepam (Doral).
• Medium- and short-acting benzodiazepines include triazolam (Halcion), lorazepam (Ativan), alprazolam (Xanax), temazepam (Restoril), oxazepam (Serax), prazepam (Centrax), estazolam (ProSom), and flunitrazepam (Rohypnol). Short-acting benzodiazepines may be useful for air travelers who want to reduce the effects of jet lag.
• Benzodiazepines are, in general, safe and effective medications for insomnia and some anxiety disorders. However, their long-term, daily use can lead to addiction in some people. Antidepressants, which are not addictive, are often used for the long-term treatment of many anxiety disorders.
• Benzodiazepines can have many side effects. The most common are daytime drowsiness and a hung-over feeling, which can increase the risk of automobile accidents. Benzodiazepines may also worsen certain breathing problems and can lead to falls in the elderly. Benzodiazepines taken during pregnancy may be associated with birth defects (such as cleft palate).
• Benzodiazepines can be dangerous when used in combination with alcohol or with each other. Overdoses can be serious, although they are very rarely fatal.
• Over time, these drugs can lose their effectiveness. People may want to increase their dose, which can eventually lead to addiction in some people.
• Withdrawal symptoms can be very serious if you suddenly stop taking benzodiazepines. Symptoms can include insomnia, anxiety, and, in extreme cases, death. If you want to stop taking benzodiazepines, talk to your doctor about a safe way to do this.

Non-benzodiazepine hypnotics

Newer medications called non-benzodiazepines can improve insomnia with fewer side effects than benzodiazepines. As noted above, however, they sometimes cause dangerous or strange behaviors, such as driving, making phone calls, or eating while asleep. In general, these drugs are recommended for short-term use (1 - 4 weeks).

• Zaleplon (Sonata) lasts for a short time, so it is best for people who have trouble falling asleep.
• Zolpidem (Ambien, Ambien CR) is one of the most commonly prescribed drugs for insomnia. It lasts longer than zaleplon. You should not take it unless you plan on getting at least 7 - 8 hours of sleep.
• Eszopiclone (Lunesta) improves insomnia and can be taken on a long-term basis.
• Ramelteon (Rozerem) is the newest type of hypnotic. One advantage of this medication is that it is not habit-forming.

References

Mahowald MW. Disorders of sleep. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 429.