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Hypnotic drugs

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For the state of mind see Hypnosis.

Hypnotic drugs induce sleep[1], used in the treatment of insomnia and in surgical anesthesia. Because drugs in this class generally produce dose-dependent effects, ranging from anxiolysis to production of unconsciousness, they are often referred to collectively as sedative-hypnotic drugs.[2] Often the treatment of insomnia will not begin with drugs at all. Since many hypnotic drugs are habit-forming, a physician will usually recommend alternative sleeping patterns, sleep hygiene, and exercise before prescribing medication for sleep, due to a large number of factors known to disturb the human sleep pattern. Hypnotic medication when prescribed should be used for the shortest period of time.[3] The benzodiazepine and nonbenzodiazepine hypnotic medications also have a number of side effects such as daytime fatigue, motor vehicle crashes, cognitive impairments and falls and fractures. Elderly people are more sensitive to these side effects and a meta analysis found that the risks generally outweigh any marginal benefits of hypnotics in the elderly.[4] A review of the literature regarding benzodiazepine hypnotic as well as Z drugs concluded that these drugs caused an unjustifiable risk to the individual and to public health and lack evidence of long term effectiveness due to tolerance. The risks include dependence, accidents and other adverse effects. Gradual discontinuation of hypnotics leads to improved health without worsening of sleep. Preferably they should be prescribed for only a few days at the lowest effective dose and avoided altogether wherever possible in the elderly.[5]

BenzodiazepinesEdit

Benzodiazepines are the most well known and most frequently prescribed hypnotic medication presently. However, their use in recent years is being increasingly replaced by newer nonbenzodiazepine hypnotic drugs and the supplement melatonin. They are effective in the short term but with long term use beyond 1 - 2 weeks tolerance to their hypnotic effects develops thus making them ineffective for long term use. They are also a cause of hospital admissions especially in the elderly who are more sensitive to their effects. Additionally, benzodiazepine withdrawal syndrome can develop upon their discontinuation. This is characterized by rebound insomnia, anxiety, confusion, disorientation, insomnia, and perceptual disturbances. Prescription hypnotics are therefore best limited to short term use to avoid tolerance, drug dependence and the adverse effects of long term use.[6]

Benzodiazepines tend to exert their hypnotic effects at high dosage compared to the more moderate dosage needed for anxiolytic effects to be felt.[7] The downside of the hypnotic properties of benzodiazepines is that they actually worsen the sleep architecture and thus the quality of sleep.[8] They are also associated with an increased risk of road traffic accidents.[9]

NonbenzodiazepinesEdit

Nonbenzodiazepines have demonstrated efficacy in treating sleep disorders. There is some limited evidence that suggests that tolerance to nonbenzodiazepines is slower to develop than with benzodiazepines. However, data is limited so no conclusions can be drawn. Data is also limited into the long term effects of nonbenzodiazepines. Further research into the safety of nonbenzodiazepines and long term effectiveness of nonbenzodiazepines has been recommended in a review of the literature.[10]

ExamplesEdit

These drugs include:

  • Alcohol is also used as a hypnotic drug, though not medically. To quote the British National Formulary: "Alcohol is a poor hypnotic because its diuretic action interferes with sleep during the latter part of the night. Alcohol also disturbs sleep patterns, and so can worsen sleep disorders"

AbuseEdit

Effects in the elderlyEdit

See alsoEdit

ReferencesEdit

  1. Dorlands Medical Dictionary:hypnotic.
  2. Brunton, Laurence L; Lazo, John S; Lazo Parker, Keith L (2006), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 11th Edition (11 ed.), The McGraw-Hill Companies, Inc., ISBN 0-07-146804-8, http://www.accessmedicine.com/resourceTOC.aspx?resourceID=28 
  3. Mendels J (September 1991). Criteria for selection of appropriate benzodiazepine hypnotic therapy. J Clin Psychiatry 52 Suppl: 42–6.
  4. Glass J, Lanctôt KL, Herrmann N, Sproule BA, Busto UE (November 2005). Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ 331 (7526): 1169.
  5. (December 2004)What's wrong with prescribing hypnotics?. Drug Ther Bull 42 (12): 89–93.
  6. Frighetto L, Marra C, Bandali S, Wilbur K, Naumann T, Jewesson P (March 2004). An assessment of quality of sleep and the use of drugs with sedating properties in hospitalized adult patients. Health Qual Life Outcomes 2: 17.
  7. Montenegro M, Veiga H, Deslandes A, et al (June 2005). [Neuromodulatory effects of caffeine and bromazepam on visual event-related potential (P300): a comparative study.]. Arq Neuropsiquiatr 63 (2B): 410–5.
  8. Barbera J, Shapiro C (2005). Benefit-risk assessment of zaleplon in the treatment of insomnia. Drug Saf 28 (4): 301–18.
  9. Gustavsen I, Bramness JG, Skurtveit S, Engeland A, Neutel I, Mørland J (December 2008). Road traffic accident risk related to prescriptions of the hypnotics zopiclone, zolpidem, flunitrazepam and nitrazepam. Sleep Med. 9 (8): 818–22.
  10. Benca RM (March 2005). Diagnosis and treatment of chronic insomnia: a review. Psychiatr Serv 56 (3): 332–43.

Key textsEdit

BooksEdit

  • Bisaga, A. (2008). Benzodiazepines and other sedatives and hypnotics. Arlington, VA: American Psychiatric Publishing, Inc.
  • Dupont, R. L., & Dupont, C. M. (2005). Sedatives/Hypnotics and Benzodiazepines. New York, NY: Guilford Publications.
  • Lader, M. (1995). Sedative and hypnotic drugs: Dependence and abuse. Ashland, OH: Hogrefe & Huber Publishers.
  • Mendelson, W. (2003). Long-term use of hypnotic medications. New York, NY: Cambridge University Press.
  • Mendelson, W. B. (1990). Do studies of sedative/hypnotics suggest the nature of chronic insomnia? New York, NY: Oxford University Press.
  • Mendelson, W. B. (1990). Insomnia: The patient and the pill. Washington, DC: American Psychological Association.
  • Miller, N. S., Klamen, D. L., & Costa, E. (1998). Medications of abuse and addiction: Benzodiazepines and other sedatives/hypnotics. New York, NY: Plenum Press.
  • Morin, C. M., Baillargeon, L., & Bastien, C. (2000). Discontinuation of sleep medications. Thousand Oaks, CA: Sage Publications, Inc.
  • Nishino, S., Mishima, K., Mignot, E., & Dement, W. C. (2004). Sedative-Hypnotics. New York, NY: American Psychoanalytic Association.
  • Sloan, J. W., & Wala, E. P. (1998). Pharmacology of sedatives, hypnotics, and anxiolytics. New York, NY: Plenum Press.
  • Sowers, W. (1998). Psychological and psychiatric consequences of sedatives, hypnotics, and anxiolytics. New York, NY: Plenum Press.

PapersEdit

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  • Aden, G. C., & Thatcher, C. (1983). Quazepam in the short-term treatment of insomnia in outpatients: Journal of Clinical Psychiatry Vol 44(12) Dec 1983, 454-456.
  • Akanmu, M. A., Honda, K., & Inoue, S. (2002). Hypnotic effects of total aqueous extracts of Vervain hastata (Verbenaceae) in rats: Psychiatry and Clinical Neurosciences Vol 56(3) Jun 2002, 309-310.
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  • Allain, H., Bentue-Ferrer, D., Le Breton, S., Polard, E., & Gandon, J.-M. (2003). Preference of insomniac patients between a single dose of zolpidem 10 mg versus zaleplon 10 mg: Human Psychopharmacology: Clinical and Experimental Vol 18(5) Jul 2003, 369-374.
  • Allain, H., Bentue-Ferrer, D., Polard, E., Akwa, Y., & Patat, A. (2005). Postural Instability and Consequent Falls and Hip Fractures Associated with Use of Hypnotics in the Elderly: A Comparative Review: Drugs and Aging Vol 22(9) 2005, 749-765.
  • Allain, H., Le Coz, F., Borderies, P., Schuck, S., de La Giclais, B., Patat, A., et al. (1998). Use of zolpidem 10 mg as a benzodiazepine substitute in 84 patients with insomnia: Human Psychopharmacology: Clinical and Experimental Vol 13(8) Dec 1998, 551-559.
  • Allain, H., & Monti, J. (1997). General safety profile of zolpidem: Safety in elderly, overdose and rebound effects: European Psychiatry Vol 12(1) 1997, 21s-29s.
  • Allain, H., Patat, A., Lieury, A., le Coz, F., & et al. (1995). Comparison study of the effects of zopiclone (7.5 mg), zolpidem, flunitrazepam and a placebo on nocturnal cognitive performance in healthy subjects, in relation to pharmacokinetics: European Psychiatry Vol 10(Suppl 3) 1995, 129s-135s.
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Additional materialEdit

BooksEdit

  • Caldwell, J. A., Jr., & Caldwell, J. L. (2000). Studying pharmacological performance enhancement with behavioral, subjective, and electroencephalographic measures. Mahwah, NJ: Lawrence Erlbaum Associates Publishers.
  • O'Hanlon, J. F. (1988). Are actual driving tests necessary for evaluating drug safety? London, England: CNS (Clinical Neuroscience) Publishers.


PapersEdit

DissertationsEdit

  • Brady, K. T., Myrick, H., & Malcolm, R. (1999). Sedative-hypnotic and anxiolytic agents. New York, NY: Oxford University Press.
  • Barron-Quinn, J. L. (1982). The relationship of sedative-hypnotic response to self-injurious behavior and stereotypy: Dissertation Abstracts International.
  • Freeman, R. F. (1995). EEG topographic differences between dissociation and distraction during cold pressor pain. Dissertation Abstracts International: Section B: The Sciences and Engineering.
  • Gordon, L. B. (1978). Sedative-hypnotic abusers, polydrug abusers: A personality assessment: Dissertation Abstracts International.
  • Nelson, R. A. (2008). Effects of a non-pharmacological intervention on the sleep behavior and sedative/hypnotic drug use of nursing home residents. Dissertation Abstracts International: Section B: The Sciences and Engineering.
  • Sauerbrey, K. J. (1990). Sleep disorders and the elderly: The effect of progressive relaxation training versus sedative-hypnotic treatment on insomnia: Dissertation Abstracts International.


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