We found that patients with insomnia, in the choice of applying sedative-hypnotic drugs, also reflect the current personality changes and the special psychology of taking medication. Without medication, it is difficult to survive the painful ordeal of insomnia; with medication, there is a whole lot of worry. I do not know how to use sedative-hypnotic drugs, in fact, if you take the medication according to medical advice, you will avoid these worries to the maximum extent.
I. What is a sedative-hypnotic drug?
Drugs that can relieve agitation and restore quiet mood are called sedative drugs. Drugs that can promote and maintain near-physiological sleep are called hypnotics. The same drug, in smaller doses to play a sedative effect, in larger doses to play a hypnotic effect. Collectively known as sedative-hypnotic drugs.
Second, the current clinical application of sedative-hypnotic drugs.
At present, the sedative-hypnotic drugs commonly used in clinical treatment can be divided into benzodiazepine sedative-hypnotic drugs, non-benzodiazepine sedative-hypnotic drugs, other drugs with sedative-hypnotic effects (antidepressants, antipsychotics).
1.Benzodiazepine sedative-hypnotic drugs.
Traditional sedative-hypnotic drugs (such as barbiturates, etc.) are universal central depressants, with a gradual increase in dose to produce sedation, hypnosis, goo-shit anesthesia, the amount of poisoning can cause respiratory paralysis and death. Benzodiazepines have better anxiolytic and sedative-hypnotic effects, with a large safety range, and have completely replaced traditional sedative-hypnotics such as barbiturates. There are more than 20 types of them in common clinical use. Although their structures are similar, the anxiolytic, sedative-hypnotic, anticonvulsant, muscle relaxant and tranquilizing effects of different derivatives are focused on each other. Benzodiazepines are safe, fast-acting and well-tolerated. Currently, they are still the most widely used hypnotic drugs. Benzodiazepines can shorten the time to fall asleep, reduce the time and number of awakenings, and increase the total sleep time. They are divided into short-acting, intermediate-acting, and long-acting categories according to the half-life of the drugs.
Short-acting class (half-life <12 hours): such as triazolam, midazolam (quick sleep), norethindrone, brotizolam, etc.. It is mainly used for difficulty in falling asleep and waking up easily.
Medium-acting class (half-life 12-20 hours): commonly used are hydroxyzolam, chlordiazepoxide, solazepam, alprazolam (Gagludine), oxazepam (5-15), clorazepam (Librium), etc., mainly used for difficulty in falling asleep.
Long-acting classes (half-life 20-50 hours): such as Valium, Nitro Valium, Clonidine, Flunitrazepam, Flunitrazepam, etc., are more effective for early awakening and difficulty in falling back to sleep after waking up.
The main side effects of benzodiazepines are
(1) Residual effects
It means that the hypnotic effect of the drug at night is prolonged to the next daytime and produces adverse reactions, such as hangover effect, dizziness, drowsiness and so on. Therefore, do not take such drugs after 10:00 p.m.
(2) Forgetting effect
It refers to the effect on memory after taking the drug. The degree of amnesia is related to the plasma concentration of the drug, i.e. the higher the dose of the drug, the higher the concentration in the blood, and the more serious the amnesia. Therefore, be sure not to increase the dose at your own discretion.
(3) Discontinuation reaction
The most common discontinuation reaction is rebound insomnia. Rebound insomnia is a kind of sleep disorder, which means that insomnia symptoms are more serious than before treatment 1-2 nights after starting to discontinue the drug. It is recommended to start with the smallest dose that produces efficacy and gradually reduce the dose at the time of discontinuation.
(4) Tendency to addiction
Drug dependence, including psychological dependence and somatic dependence. Benzodiazepines can produce drug dependence mainly due to: insomnia, benzodiazepine treatment, rebound insomnia, the need to continue drug treatment, the development of tolerance, the need to increase the dose of drug treatment, the development of drug dependence, and the inability to terminate treatment. These side effects are most likely to occur with short-acting benzodiazepines, while long-acting benzodiazepines are slow to develop and have stronger respiratory depression and daytime residual effects. In order to avoid these adverse effects, it is currently advocated to achieve satisfactory sleep with minimal effective doses and short-term intermittent use. Benzodiazepines should not be used as hypnotic drugs for more than 4 weeks.
Drug dependence is rarely caused if the medication is taken correctly as prescribed.
Note: Do not use with alcohol, painkillers, and other central depressants, as this can have serious consequences in terms of excessive depression of the heartbeat and respiration. Pay attention to the side effects caused by the drug to the patient’s nervous system, i.e. drowsiness, dizziness and other problems. It is best to add rails to the patient’s bed so that the patient does not fall. If the patient has to get up to go to the toilet, etc., it is better to have help and not to move on their own. Do not drive or climb higher during the day.
2.Non-benzodiazepine sedative-hypnotics.
Currently, the following are commonly used in clinical practice: zopiclone (Amnesia), zolpidem (Synthroid) and zaleplon. Their chemical structure is different, and barbiturates and benzodiazepines are also different, but they all have obvious hypnotic effect, the characteristics of this class of drugs addiction and withdrawal reaction is very small, does not inhibit breathing, the half-life is short, so the next day will not produce the “hangover” phenomenon, suitable for application in people with difficulty sleeping and pathological basis of insomnia It is suitable for those who have difficulty sleeping and those who have pathological insomnia and should suffer from acute insomnia before examinations. Because of the minimal side effects, addiction and withdrawal reactions are rare, they have become the first-line drugs for the treatment of insomnia in Europe and the United States, and have a tendency to replace benzodiazepines, but the disadvantage is that they are expensive.
3, with sedative-hypnotic effect of other drugs.
Certain antidepressants.
Some antidepressants also have significant sedative-hypnotic effects, such as tricyclic amitriptyline, doxepin. The new antidepressants trazodone, mianserin, mirtazapine, not only effective sedative-hypnotic effect, but also very significant reduction of excessive dreaming, thus greatly improving the sleep quality of patients suffering from excessive dreaming.
Certain antipsychotics.
Clozapine, olanzapine, etc., are also effective when applied in small doses, especially in the early stages of application. It must be noted that the medication must be administered under the guidance of a medical professional! The use of medication should be accompanied by appropriate self-regulation.