Histamine H 1 receptor blockers: diphenhydramines ( diphenhydramine and its synonyms from different companies); promethazines ( pipolfen , diprazine ); doxylamine ( donormin ), which are mainly used to treat allergic diseases (urticaria, hay fever, allergic rhinitis, conjunctivitis, angioedema, serum sickness, etc.). These drugs also have a moderate hypnotic and a strong sedative effect. If they are taken, depression of the central nervous system, daytime sleepiness, confusion, dizziness, blurred vision in case of intolerance and overdose are possible .
By causing sedation and drowsiness, they encourage the person to fall asleep. Most of these products have a long lasting effect and therefore can cause morning drowsiness, headache, lethargy and dry mouth.
The bad thing is that after several days or weeks of administration, the effect of H 1 -blockers decreases, which requires an increase in the dose of sleeping pills and, accordingly, the risk of complications from taking them increases.
Unlike non-prescription drugs, histamine- 1 receptor blockers are used to treat sleep and insomnia disorders under strict medical supervision. In older people, the dose should be reduced by 2 times. Due to the sedative and long-lasting hypnotic effect, drugs of some groups (diphenhydramines, promethazines and doxylamines) cannot be prescribed while working for motor transport drivers and others whose profession requires a quick mental and physical reaction.
Benzodiazepines are more effective than previous products. Accelerating sleep, they shorten the first phase of sleep and increase the duration of the second phase. This is a large range of drugs that are widely used in the domestic market of hypnotics ( hlozepid , sibazon , phenazepam , nozepam , lorazepam , nitrazepam , mazapam ). When they receive sleep becomes more complete. The advantages of benzodiazepines are, first of all, that they are quickly absorbed and enter the brain; their action in time coincides with the duration of the night; the main substances and decomposition products are removed quickly and by the morning the head is bright. Means with a shorter duration of action are usually used to facilitate falling asleep, and agents with a longer duration are used to maintain sleep.
When properly administered, a short course (day or week) and at the minimum dose of complications, as a rule, does not occur. But if you violate the rules of admission to them there is a decrease in sensitivity, which causes the need to increase the dose, and as a result, dependence is formed. As observations have shown, such patients are generally prone to drug abuse, and sometimes to drug addiction. The instability of the gait with frequent falls, confusion, blurred vision, decreased sensitivity in the legs are not uncommon complications, especially in the elderly. A dangerous combination of benzodiazepines and alcohol, as their effect is enhanced. As a result, excessive sedation, frequent dizziness, movement coordination disorders with falls, bruises and injuries develop.
Sudden discontinuation of benzodiazepines causes withdrawal syndrome with relapse of insomnia. Sometimes such insomnia is much harder and more painful than before taking the drugs. This complication can be avoided by gradually reducing the dose – to reduce the number of tablets for a long time or from the very beginning of treatment to take small doses.
A benzodiazepine prescribing physician should take into account the activity of the drug’s metabolites, the mode and duration of administration, the age and associated diseases of the patient.
– Zolpidem ( Ivadal ) – a means of pyridine series. This is a new drug that, while not being a benzodiazepine, stimulates central benzodiazepine receptors. It is used for situational and prolonged sleep disorders, with difficulty falling asleep, night and early awakenings. It should be taken immediately before bedtime. It can also cause decreased sensitivity and addiction.
– Zopiclone ( somnol , imovan ) is a means of a new generation of pyrrolone series. Zopiclone is a fast-acting sleeping pill, with a short half-life. It does not reduce the duration of the fast phase of sleep and does not disturb the normal sequence of its stages. Sleep occurs within half an hour and lasts more than 6 hours. If the dream was interrupted, then the person falls asleep more easily. There is no sleepiness in the morning, the quality of life does not suffer, as the feeling of cheerfulness and the ability to concentrate is preserved.
– Other hypnotics. These include barbiturates ( phenobarbital , amobarbital , cyclobarbital ), meprobamate and hlorvinol . All of them in terms of effectiveness and safety are inferior to benzodiazepines. Often, for financial reasons, they are prescribed, although they try to avoid it, since there are more modern medicines. Sometimes, antidepressants with a sedative effect ( amitriptyline , trazodone ,trimipramine ) are prescribed as small doses of oral medication . They are useful for sleep depressions.
Summarizing the above information about the medicinal treatment of insomnia, it becomes clear that sleeping pills help a person to quickly fall asleep and sleep if they are used in adequate doses and a short course. The task of the doctor is to select the medicine in such a way as to determine the minimum effective dose without side effects. It is important to know that sleeping pills cannot be taken all the time. They are drunk only in emergency cases, if necessary, in combination with sleep hygiene and correction of the underlying disease.
In appointing sleeping pills, it is imperative to consider precautions and contraindications. Sleeping pills should not be taken by people who have breathing problems during sleep, pregnant women, nursing mothers, alcohol abusers and drug addicts. You can take sleeping pills only if they are prescribed by a doctor (in the case of short-term insomnia – no longer than 2-3 weeks, or for chronic – when you need to take the medicine once for 2 or once for 3 nights in the minimum dose).