We often encounter doubts about sleeping pills in our outpatient practice. What are sleeping pills? First of all, we need to understand what sleeping pills are. The sedative-hypnotic drugs prescribed by the “green prescription” in outpatient clinics are what we usually call “sleeping pills”. The most commonly used sedative-hypnotic drugs in clinical practice are still benzodiazepines and non-benzodiazepines, the former including clonazepam, alprazolam, eszopiclone, diazepam, oxazepam, etc.; the latter including zopiclone, dezopiclone, zolpidem, zaleplon, etc. How to choose sleeping pills? Question 1: Will taking sleeping pills become addictive, and will it not be as easy to quit as taking drugs in the long term? The main concern of this group of patients is the addictive adverse effects brought about by sedative-hypnotics. The clinical manifestations associated with addiction mainly include tolerance, withdrawal symptoms and psychiatric dependence. Withdrawal symptoms commonly include anxiety, restlessness, rebound insomnia, irritability and, in some cases, gastrointestinal symptoms and auditory hypersensitivity. The severity of withdrawal symptoms is related to the dose of benzodiazepines used, the mode of administration, and the combination of multiple benzodiazepines. It is also related to the user’s physiological status, mental status, and history of substance abuse. Coping strategies: For drugs with addictive properties, there is no need to be overly stressed; proper use of the drug under the guidance of a specialist is critical. Individualized principles should be followed when discontinuing use, and the patient’s length of treatment, drug half-life, likelihood of discontinuation symptoms, and total daily dosage should be considered. Overall, the drug should be discontinued slowly and progressively: 25% of the original dose every 2 weeks until it is completely reduced. The dose should be reduced at a moderate rate when the drug is used at high doses and in small increments at low doses to prevent severe withdrawal symptoms. Compared to benzodiazepines, non-benzodiazepines have relatively less addiction and adverse reactions and are relatively safer, so you can choose appropriately according to your situation. Warm tips: People with a history of other drug abuse, alcohol abuse, substance addiction or mental illness and other addiction susceptibility factors should be used with caution. Question 2: Why do you feel groggy, sleepy and have difficulty concentrating when you wake up in the morning after taking sleeping pills? This question is mainly about the “hangover” phenomenon of sedative-hypnotic drugs. The main reason is the half-life of the drug (that is, the time it takes for the drug to enter the body, be metabolized in the body, and for the concentration of the drug in the blood to drop to half of the maximum blood concentration.) The half-life of a drug varies, and the time it takes to be completely cleared in the body varies. Some drugs have a long half-life and excessive sedation caused by a long lasting residual appears, possibly like intoxication. Generally, sleeping drugs with short half-lives have no accumulation effect and no hangover effect when repeatedly administered, but withdrawal symptoms are obvious and more uncomfortable after stopping the drug, and rebound insomnia (drug insomnia) can easily occur; the opposite is true for hypnotics with long half-lives. Coping strategies: Individualized treatment should be used according to the patient’s specific situation, choosing sedative-hypnotic drugs with different half-lives. If the patient’s problem is difficulty in falling asleep, drugs with fast onset of action should be selected (e.g. zolpidem, zaleplon); if the patient’s problem is difficulty in maintaining sleep, drugs with long half-life should be selected (e.g. temazepam, eszopiclone, clonazepam); if the patient is combined with depression, antidepressants with certain help for insomnia should be considered (e.g. doxepin, mirtazapine, amitriptyline). Warm tip: Do not operate machinery or drive while taking sleeping pills for a long time! Question 3: Why is my whole body limp and weak after taking sleeping pills? This is an adverse reaction of muscle relaxation of sedative-hypnotic drugs. The muscle relaxation of the whole body produced by sleeping pills is not only that the brain is sleeping, but also that the muscles are asleep. This may not be a bad thing for a person with chronically over-tightened muscles, but for an elderly person, it may cause him to accidentally fall down when he gets up. For patients with chronic whistling disorders, sleeping pills produce whistling inhibition as the muscles relax throughout the body and cause the whistling muscles to relax. Coping strategies: If sedative-hypnotic drugs must be used, they should take into account the metabolic characteristics of patients of different ages, and must start with small doses and gradually increase them, so that they can be reduced once they have achieved their effect. Elderly patients should try to get up with the help of a chaperone. Warm tip: For some patients with lung disease and whistling apnea syndrome, muscle lesions, the medication should be taken with caution. Question 4: Will taking sleeping pills affect my memory? This is an adverse reaction to cognitive impairment caused by sedative-hypnotics. If you do not fall asleep immediately after taking sleeping pills and continue to do things or talk to people, you will forget everything you did last night when you wake up the next day, giving you a feeling of forgetfulness, especially if you take sleeping pills for a long time, which can bring serious consequences of memory loss and decreased response. Coping strategies: Generally speaking, short-term use of sleeping pills and temporary memory loss are more likely to occur with strong sleeping pills, but this is only temporary and will not affect memory as a result. Long-term use of sleeping pills should start at a low dose and maintain a minimum effective dose, try to avoid continuous nightly use and use for more than 2-4 weeks, and encourage patients to use them when really necessary. Warm tips: Do not take with alcohol or use sleeping drugs immediately after drinking alcohol, damage to the liver can occur or cause amnesia or even central oversuppression causing harm. The ideal sedative-hypnotic drug should be able to induce sleep quickly. There is no effect on sleep structure, no residual effect the next day, no effect on memory function, no whistling inhibition, and no dependence or withdrawal symptoms with long-term use, but it often does not work as intended. Therefore, when taking such drugs should pay attention to the following issues: 1, take the medication as prescribed by the doctor; 2, choose a suitable hypnotic drug; 3, master the time to take the drug; 4, apply the minimum effective amount; 5, avoid long-term fixed consumption of a hypnotic drug; 6, should not be too fast to stop the drug; 7, release psychological doubts and stress; 8, actively treat the primary symptoms; 9, pay attention to the combination of drug therapy and non-drug therapy.