Sedatives and hypnotics work on the central nervous system to aid sleep, relieve anxiety, or have a calming effect. Benzodiazepines are the main class of medications that fit into this category. Although there are more than twenty derivatives of benzodiazepine, only certain ones have been approved to treat anxiety (e.g., clonazepam, diazepam, alprazolam, and lorazepam), sleeplessness (insomnia) (e.g., flurazepam, quazepam, estazolam, temazepam, and triazolam), or panic disorder (e.g., alprazolam).
Barbiturates are an older class of medication that was also used for these indications. However, barbiturates have a narrow therapeutic index (i.e., the window of effectiveness before toxicity occurs). They are more likely to cause respiratory depression, coma, and death and are rarely used nowadays. The main issue with the use of benzodiazepines is dependence. Benzodiazepines vary in their propensity to cause sedation and the length of time they show effects. All benzodiazepines work by enhancing the inhibitory action of Î³-aminobutyric acid (or GABA).
Other drug classes that show a sedative effect include agonists of melatonin receptors, first-generation antihistamines, anesthetics, zolpidem, zopiclone, eszopiclone, zaleplon, and several others. Many Sedatives and hypnotic drugs also exhibit hypnotic properties. This blog discusses most facts about sedatives and hypnotics.
How do sedatives and hypnotics work?
Sedatives and hypnotics are groups of drugs that work by suppressing the CNS or central nervous system, primarily by targeting the GABA receptors. Benzodiazepines (or BZD), selective melatonin agonists, and benzodiazepine-receptor agonists are examples of drug classes that fall under hypnotics and sedatives, most commonly used for the treatment of anxiety and insomnia, among other indications. Common sedatives include gamma-hydroxybutyrate (GHB), barbiturates, benzodiazepines, opioids, and sleep-inducing medications such as eszopiclone (Lunesta) and zolpidem (Ambien). Sedatives are CNS depressants and vary widely in their potency. They are usually available in the form of a pill or liquid.
What is the difference between sedatives and hypnotics?
- Sedatives are medications that decrease activity and have a relaxing and calming effect. At higher doses, sedatives often cause sleep. In comparison, drugs used majorly to cause sleep are called hypnotics.
- A sedative drug decreases activity and moderates excitement. It relaxes the recipient, whereas a hypnotic drug produces drowsiness and facilitates the onset and maintenance of a state of sleep resembling natural sleep in its electroencephalographic characteristics and from which the user can be aroused easily.
Because the functions of sedatives and hypnotics frequently overlap, and because medications in this class usually produce dose-dependent effects (ranging from anxiolysis to loss of consciousness), they are referred to collectively as sedative-hypnotic medicines. Doctors regularly prescribe hypnotic drugs to treat insomnia and other sleep disorders, with over 90% of insomnia patients being recommended hypnotics in some countries.
Hypnotics are medications often used to induce, extend, or improve sleep quality and reduce wakefulness during sleep. The most commonly used hypnotics are benzodiazepine receptor agonists (or BzRAs), antipsychotics, antihistamines, antidepressants, and melatonin (or melatonin receptor agonists). Many agents can depress the function of the CNS and generate calming or drowsiness (or sedation).
Older Sedatives and hypnotic drugs depress the central nervous system in a dose-dependent fashion, producing a spectrum of responses from mild sedation to coma and death. Sedation is also a side effect of many medicines that are not general CNS depressants (like antihistamines and antipsychotic agents). Although such agents may intensify the effects of CNS depressants, they often produce more specific therapeutic effects at concentrations far lower than those causing substantial central nervous system depression. For example, they can't induce surgical anesthesia without other agents.
Benzodiazepine Sedatives and hypnotics resemble such agents. In simple terms, hypnotics are drugs that help people fall asleep. Many hypnotic medications are available, and doctors recommend and prescribe them depending on your sleep problem. Lifestyle and sleep habit changes are also effective for treating specific sleep problems. If you experience chronic insomnia or problems sleeping, contact the doctor or health care professional. Doctors specializing in sleep problems (sleep medication) can help you determine the cause of your insomnia and treat it. Hypnotic drugs are also called sleeping pills, sleep aids, or soporifics.
What are hypnotics used to treat?
Doctors prescribe hypnotics to help treat insomnia. Insomnia is a sleep problem involving difficulty falling or staying asleep. Inadequate sleep affects energy levels, health, mood, and work performance. Common causes of insomnia are depression, anxiety, stress, traumatic events, and medications. Knowing the cause of your insomnia and treating it can reduce the need for sleep medications to induce or aid sleep.
Side effects of sedative-hypnotic drugs
Research has shown that medication using sedatives and hypnotics, even in small doses, is not a safe long-term treatment for insomnia or anxiety, especially for people 65 and older. Side effects of sedative-hypnotic drugs depend on the type of drug used.
Some common side effects of Sedatives and hypnotics medicines include:
- Rebound insomnia
- Dry mouth
- Short-term forgetfulness
- Withdrawal symptoms (for example, anxiety or insomnia)
- Dizziness, drowsiness, and abnormal dreams
- Unpleasant taste
- Confusion and dizziness
- Diarrhea and stomach upset
- Upper respiratory infections
- Loss of coordination and sleepiness
- Hair loss and dry skin
- Loss of appetite and nausea
Possible severe side effects can include:
- Sleep paralysis
- Abnormal and suicidal thinking
- Behavioral changes
- Worsening of depression
- Exfoliate dermatitis
- Sleep driving and other complex behaviors
Are Sedatives and hypnotics addictive?
Benzodiazepines are addictive sedative-hypnotic drugs and are federally controlled substances. People can develop physical dependence after several days of using them, and the risk is higher during long-term usage. Doctors must take care when prescribing benzodiazepine medications to people with a history of alcoholism or drug abuse because they are more likely to become addicted to benzodiazepine drugs.
What should I avoid while taking sedative-hypnotic drugs?
- Don't drink alcohol before and after taking a sleep medication because consuming alcohol while using a sleep medicine or sedative can cause severe drowsiness and dizziness.
- You should not use these drugs if you are pregnant unless necessary. Pregnant women with sleep problems should improve their sleep hygiene, relax, and adopt ways to reduce stress. Benzodiazepine usage is harmful to the fetus when pregnant women take them during the first trimester. Therefore, you should avoid them if you are pregnant. If you are pregnant, discuss the use of sedative-hypnotic drugs with your doctor.
Which drug is hypnotic?
Diphenhydramine (for example, Benadryl) and doxylamine (for instance, Unisom) are over-the-counter (or OTC) medicines that help people fall asleep. These drugs are antihistamines that lead to drowsiness and sedation. Only take these medicines for a few days. Talk with the doctor or health care professional if you have insomnia for longer than a couple of weeks. You must read the instructions and warnings before using OTC sleep medicines or hypnotics because they can cause severe adverse effects if not used correctly. These may also interfere with the action of other medications. Following are examples of commonly used hypnotics.
Types of hypnotics (or hypnotic drugs)
The FDA has approved five types of hypnotic drugs for the treatment of sleep problems, including:
- Melatonin receptor agonists
- Nonbenzodiazepine receptor agonists
- Orexin receptor agonist
These hypnotic medications effectively treat sleep problems, but they work differently. Some sleep medications only last a few hours (short-acting pills), while others last longer in your body (long-acting medicines). Doctors and health care professionals choose hypnotics or sleep medications based on the type of your sleep problem. For example, people having trouble falling asleep will benefit from a short-acting sleep medication. People with difficulty staying asleep will benefit more from long-acting hypnotic drugs. There are several sedative-hypnotic drugs available. Talk to the doctor, pharmacist, or other health care professional for any additional information about the generic forms available.
- quazepam (Doral)
- temazepam (Restoril)
- estazolam (Prosom)
- flurazepam (Dalmane)
- triazolam (Halcion)
Melatonin receptor agonists
- prexin receptor antagonist
- ramelteon (Rozerem)
- suvorexant (Belsomra)
Non-benzodiazepine receptor agonists
- eszopiclone (Lunesta)
- zolpidem (Ambien CR, Ambien, Intermezzo, Zolpimist, Edluar)
- zaleplon (Sonata)
- mirtazapine (Remeron)
- trazodone (Oleptra)
The dosage of these hypnotic drugs differs. Talk to the doctor about the exact dose you require to fall asleep.
Natural and herbal hypnotics and hypnotic supplements
Synthetic melatonin pills, capsules, or tablets can help people fall asleep. Melatonin is commonly used for treating jet lag. Melatonin takes a few days, up to a few weeks to work, when you use it to treat sleep problems. Valerian is another supplement available to treat insomnia. Discuss with the doctor or pharmacist before using herbal, natural, or other supplemental hypnotic products for insomnia.
The sedative-hypnotic drugs that don't specifically target the benzodiazepine receptor belong to a group of agents that depress the central nervous system in a dose-dependent fashion, progressively generating calming or drowsiness (or sedation), sleep (or pharmacological hypnosis), unconsciousness, surgical anesthesia, and fatal depression of respiration and cardiovascular regulation. These drugs share their properties with many chemicals, including general anesthetics and aliphatic alcohols, most notably ethanol.
What drugs or supplements can interact with Sedatives and hypnotics?
Combining sleep medications or using other medicines that cause drowsiness will cause severe drowsiness. Stimulants like amphetamines or coffee can reduce the effect of sedatives or sleep medicines.
The takeaway from this blog
Sedatives and hypnotics are two classes of prescription medications commonly called sleeping pills, tranquilizers, or sedatives. These affect your central nervous system â€ "your spinal cord and your brainâ€ "and have a relaxing and calming effect. They are usually prescribed to older adults for anxiety, stress, and difficulty sleeping problems. There are two significant sedative-hypnotic drugs, i.e., benzodiazepines and Z-drugs. Common benzodiazepines include Librium (chlordiazepoxide), Valium (diazepam), Xanax (alprazolam), and Ativan (lorazepam). Common Z-drugs include Lunesta (eszopiclone), Ambien (zolpidem), and Sonata (zaleplon). These are often prescribed to patients with difficulty sleeping and anxiety.