Drugs against insomnia, let’s get to know them

In some cases, to sleep well you need to resort to specific medications. Here’s what they are and how to best use them.

There are those who suffer from it only occasionally and for very specific reasons and those who have to deal with it quite often or even constantly, for more or less prolonged periods.

In the first case, insomnia is an unwelcome companion, but without significant sequelae for health and general psychophysical well-being, except for the inevitable drowsiness, subdued performance, irritability and nervousness characteristic of the day following the troubled night.

The discourse changes, and substantially, when sleep disturbances persist for several weeks or months, making it difficult to fall asleep, causing frequent awakenings during the night or too early, even before dawn. In this second case, insufficient rest, in addition to reducing overall performance and mood, destabilizes the hormonal and metabolic balance, increasing the risk of developing (or seeing worsen) various organic and psychiatric diseases.

Adopting good lifestyle habits, following some precious rules of “sleep hygiene” and, when necessary, resorting to remedies of natural origin or drugs that can promote it are the keys to recover a good quality sleep and adequate duration. Here are some tips about it.

The causes and consequences of insomnia

Insomnia is an extremely common condition: epidemiological data indicate that 30-50% of people in adulthood occasionally suffer from this problem, while 6-13% (that is, about one in 8-15 people) meet the criteria for the diagnosis of real “sleep disorder”, according to the updated definition of the Statistical Diagnostic Manual of Mental Illnesses (DSM-5).

In particular, the DSM-5 defines insomnia as “a condition of dissatisfaction with the quantity or quality of sleep, characterized both by difficulties in initiating sleep and maintaining it, which determines a clinically significant condition of stress or net reduction of functionality in different areas (social, occupational, behavioral)” of life during the waking period.

At the origin of one or more sleepless nights there may be the most diverse causes, sometimes easily identifiable. Among the most frequent, we can remember a too abundant dinner, excessive intake of stimulants such as caffeine or guarana, a party ended at dawn, an impromptu physical malaise, tension for an exam, a period of difficulty in the family or at work, the change of home, excitement or stress for important event (such as a wedding or the arrival of a child), A long journey with relative jet-lag from time zone, night work or, trivially, the fact of not sleeping in your own bed.

Well known is, then, the insomnia that can accompany physical diseases, due to the symptoms of the disease itself (pain, need to maintain forced / uncomfortable positions, sweating, coughing and other breathing difficulties, etc.), the drugs taken to treat it (which can lead to sleep disorders among the side effects) or the concern for the treatment to be faced and its outcomes (surgery, chemotherapy etc.).

Two diseases typically associated with difficulty sleeping, so much so that they are part of the category of sleep disorders, are restless legs syndrome and sleep apnea syndrome.

Even more often than physical diseases, to cause more or less persistent forms of insomnia are disorders of psychic origin, such as depression, anxiety and bipolar disorder in the “manic” phase (so defined as characterized by an excessive level of psychophysical excitement / activation). In these cases, a more or less important destabilization of the sleep-wake cycle is an integral part of psychiatric pathology, to the point that, not infrequently, it represents one of the earliest symptoms, as well as one of the key signs for diagnosis.

The link between depression, anxiety, bipolar disorder and sleep alterations is two-way: if on the one hand, in fact, the presence of these psychiatric disorders can cause insomnia, on the other, insufficient sleep for several nights can facilitate the triggering of depressive or anxious episodes or “manic” phases of bipolar disorder, due to its destabilizing effects on the nervous system.

The correlation between sleep and psyche is so marked and proven that for some years now treatment approaches have been developed for these disorders based precisely on the modulation of sleep.

A weaker, but equally verified, two-way link exists between insomnia and neurocognitive disorders. It is, in fact, well known that elderly people suffering from cognitive decline and dementia often suffer from sleep disorders and alterations in the sleep-wake rhythm and that, even in this case, sleep difficulties can represent one of the initial symptoms of neurodegenerative disease.

On the other hand, numerous studies have indicated that patients suffering from chronic insomnia tend to present more often than those who sleep regularly and sufficiently cognitive disorders, especially in the areas of attention, operating memory (necessary to organize and perform complex tasks), episodic memory and “problem solving” (rational thinking oriented to solve a problem).

Other known long-term negative effects of chronic insomnia on health concern the metabolic and cardiovascular sphere and derive mainly from the impact of insufficient rest on hormonal structure, appetite and the regulation of vascular and cardiac function. In particular, insomnia has been shown to promote the development of overweight and obesity in adults and children, impaired glucose tolerance and type 2 diabetes (especially after the age of 40) and hypertension (one of the main risk factors for cardiovascular disease).

Practical tips to promote sleep

Regardless of the type of insomnia, the first approach recommended by all sleep medicine specialists to improve the quality and duration of night rest is non-pharmacological and involves the analysis of one’s lifestyle habits and sleep-related behaviors in order to correct any “mistakes” made in a more or less conscious way.

In general, to be in the ideal conditions for sleeping well, it is recommended to follow the following rules of “sleep hygiene”:

– try to eliminate environmental factors that can potentially interfere with quality sleep (noise, light, annoying odors, etc.)

– check that the temperature and humidity of the bedroom are adequate (ideally, about 15-18 ° C and 60% relative humidity)

– try to go to bed and always get up at the same time, even if the previous night you slept badly

– avoid sleeping during the day

– follow a healthy diet and provide light dinners, consisting of foods that are not too seasoned or spicy and easy to digest

– consume in moderation or completely eliminate exciting drinks (coffee, tea, energy drinks, cola drinks, guarana etc.)

– Do not drink alcohol and avoid smoking after dinner

– perform regular physical activity during the day, without excesses and preferably before 20.00

– go to bed only when you intend to sleep; do not read, watch television, use your smartphone or surf the Internet while in bed

– avoid engaging in demanding physical or intellectual activities, in the evening and especially before going to bed

– take a warm and relaxing shower or bath before bedtime

– during the evening or before going to bed, drink a chamomile or a natural relaxing herbal tea based on valerian, linden, passionflower, calendula, escolzia etc.

– try to take advantage of relaxation and meditation techniques (yoga, guided breathing, tai-chi, massage, acupontura etc.).

When to use insomnia medications

If, after following all the advice of “sleep hygiene”, sleep difficulties persist, it is necessary to contact the family doctor who, after a visit, will consider therapy with targeted drugs or will deem it necessary to deepen an in-depth study at a Sleep Medicine Center.

In this regard, it should be noted that the use of a pharmacological treatment with sleeping pills is almost always necessary when suffering from:

– “primary” insomnia, i.e. without recognizable external or organic causes

– restless legs syndrome, a sleep disorder characterized by a feeling of discomfort in the legs and the need to move them continuously, which sometimes also affects the arms.

Even in the presence of physical or psychiatric illnesses that prevent you from sleeping well for a sufficient number of hours, the use of hypnotic drugs becomes very often necessary if, after optimizing the treatment of the underlying pathology, symptoms that disturb sleep continue to be present (for example, incomplete pain control in patients suffering from osteoarthritis severe chronic or neuropathic pain) or a substantial alteration of the sleep-wake rhythm (for example, in anxious depression).

Depending on their molecular structure and the specific effects they exert on the nervous system, drugs generally referred to as “sleeping pills” can help you sleep well in several ways:

• promoting falling asleep
• allowing you to maintain the continuity of sleep (avoiding nocturnal awakenings)
• reducing the tendency to wake up at dawn.

All drugs in this category have an effective effect and are well tolerated, but only if they are used wisely, i.e. only when really necessary, on the prescription of the family doctor or a sleep medicine specialist, at the dosage and in the manner indicated and for the time necessary.

All these aspects can vary greatly from person to person. So, “do-it-yourself” is absolutely forbidden.

Drugs against insomnia: what they are and how to use them

The class of reference drugs to improve the duration and quality of sleep is that of “hypnotics”, which includes a large group of molecules characterized by the ability to shorten the time needed to fall asleep and reduce the likelihood of awakening during the night. In addition, they also exert sedative, anxiolytic, muscle relaxant and anticonvulsant activities more or less marked depending on the specific active ingredient considered.

On the market there are sleeping pills with different half-lives and, therefore, with a more or less prolonged duration of hypnotic action.

In general, to obtain the maximum benefit on sleep without having to pay for residual drowsiness and the drop in intellectual performance the next day, it is preferable to take drugs with a short or intermediate half-life, ie characterized by a duration of action comparable to the duration of a good sleep and no longer active to a significant extent upon waking.

Sleeping pills with a short half-life should be preferred in elderly patients, who with more powerful hypnotic drugs may experience mental confusion, daytime sleepiness and increased risk of falls.

Other hypnotic drugs and tranquilizers contain active ingredients indicated especially when sleep is of poor quality, rather than insufficient duration.

When sleep disorders are associated with depression, some older generation antidepressants can also be exploited. These drugs are characterized by a particularly marked sedative action and must be administered in calibrated dosage to obtain simultaneously the hypnoinducing effect and the antidepressant one.

However, the doctor can also prescribe these same drugs to non-depressed people who suffer from insomnia for the sole purpose of improving falling asleep and sleep duration.

Even older generation antihistamines, usually used to control seasonal allergies, can sometimes be proposed by the doctor to patients suffering from insomnia. Also in this case, these active ingredients are exploited not so much the primary therapeutic action as the “side effects” on sleep, little appreciated by allergic people, but favorable for those who struggle to fall asleep, regardless of the presence of other disorders.

When insomnia is linked to an alteration of the biological clock, due for example to jet-lag or a job that involves night shifts, melatonin can be effective to reset the sleep-wake rhythm. This natural substance, produced by the body when external light decreases (that is, after sunset and until the early hours of the night), has the task of inducing falling asleep and helping to maintain a deep sleep until dawn.

Taking melatonin from the outside, in the form of capsules or tablets, helps to improve the ability to adapt and to start sleeping well again. Melatonin can also be used in children and is useful in the elderly (whose body produces less), but to be safe and effective in rebalancing sleep it must always be prescribed by the doctor, just like hypnotic drugs (even when a dosage of less than 2 mg is expected, considered non-pharmacological).

Type of drug	When to take it
Hypnotic drugs with short or intermediate half-lives	Indicated in particular in elderly patients, as they promote falling asleep and avoid nocturnal awakenings without inducing drowsiness upon waking
Hypnotic drugs and tranquilizers	Indicated in case of poor quality sleep, rather than insufficient duration
Older generation antidepressants	Indicated when sleep disorders are associated with depression
Older generation antihistamines	They promote falling asleep as their side effect is exploited (ie the induction of drowsiness)
Melatonin	Indicated when insomnia is linked to an alteration of the biological clock

As an alternative or together with hypnotic drugs, psychology can also help insomnia sufferers through different cognitive-behavioral therapy approaches. Beyond the specific technique used, all interventions of this type are aimed at removing unfavorable attitudes towards night rest, with a view to eliminating psychological and behavioral obstacles that prevent you from falling asleep easily and sleeping well.