Sleeping pills: tips to use them correctly

Sleeping pills are effective and safe drugs against insomnia, but to reap all the benefits should always be taken under medical supervision.

Hypnotic and anxiolytic drugs are frequently prescribed by doctors around the world to promote sleep in case of occasional or recurrent insomnia and to counteract acute anxiety, both in patients suffering from generalized anxiety disorder and in those suffering from panic attacks or major depression associated with anxious symptoms and / or insomnia.

The tranquilizing and sedative effects of some of these drugs have also been exploited to reduce individual tension and responsiveness prior to invasive diagnostic procedures (e.g., gastroscopy or colonoscopy) and dental or surgical interventions (basal anesthesia), as well as to manage alcohol withdrawal symptoms in chronic alcoholics.

In recent years, the additional muscle relaxant properties of some sleeping pills have proved beneficial in the context of pain therapy, particularly to alleviate the symptoms of painful musculoskeletal disorders associated with muscle contracture, while the anticonvulsant action has been found useful for the treatment of some forms of epilepsy and febrile seizures in children.

Given the wide range of use of sleeping pills, it is immediately evident that they are useful drugs for the health and well-being of people of all ages.

However, like all medicines, to obtain the maximum therapeutic benefit without incurring side effects it is necessary to identify the most suitable drug with the help of the doctor and take it in the correct doses and times, as prescribed, to allow the active ingredient to act optimally.

Knowing the mechanism of action and characteristics of these compounds can help to better understand the rationale behind their administration and to increase the clinical appropriateness of their use.

What they are and how they work

Given the efficacy demonstrated by some sleeping pills against anxiety disorders and insomnia therapy, we have tried to optimize their therapeutic activity and reduce possible side effects by modifying the molecular structure in various ways, without interfering with the fundamental mechanism of action.

Many insomnia drugs act at the level of the central nervous system, modulating the activity of a key neurotransmitter for mood and sleep control called gamma-aminobutyric acid, or GABA.

This neurotransmitter has a natural inhibitory effect on the neurons with which it interacts. Some sleeping pills, binding to the same receptors of the nerve cells to which GABA binds, mimic its action, enhancing it and determining anxiolytic, hypnotic, sedative, muscle relaxant, anesthetic and anticonvulsant effects, more or less marked and prolonged.

The duration of action

Some categories of sleeping pills are classified mainly on the basis of their half-life (corresponding to the period of time necessary for their maximum concentration in the blood to halve after taking a predefined dose), on which the duration of their pharmacological action also depends.

In particular, over the years, long-term (half-life > 48 hours), intermediate (half-life 24-48 hours), short (half-life <24 hours) and very short duration of action (half-life 1-7 hours) have been developed and entered clinical practice.

In addition to the half-life, the duration of action of some insomnia drugs is also affected by the type of degradation that the substance takes after exerting the desired effects undergoes.

Some sleeping pills, in fact, are eliminated without leaving a trace, while others are broken down into intermediate degradation compounds still endowed with hypnotic and / or anxiolytic activity that prolongs the effects of the drug taken.

How to choose a sleeping pill

The duration of action of a sleeping pill does not only affect the frequency of administration necessary to obtain the desired therapeutic effects, but also the specific use that is intended or can be made.

For example, when the intake is aimed at counteracting an anxiety disorder with significant and persistent symptoms, it is preferable to use a long- or intermediate-acting drug, able to offer effective and constant coverage from anxious symptoms.

On the contrary, when the goal is to counteract insomnia, it is preferable to choose one with a short duration of action and free of active metabolites, able to quickly induce sleep and increase its duration in a way comparable to the physiological sleep-wake cycle. In this way, the typical side effects of sleeping pills with a longer half-life are greatly reduced, such as the feeling of physical fatigue and residual drowsiness the next day, attention / concentration and memory difficulties that can interfere with study and intellectual performance in general.

Studies conducted on sleeping pills with a short half-life have shown that, if you take the dose prescribed by your doctor in the evening before bedtime, sleep improves significantly in terms of ease of falling asleep, overall sleep duration and fewer nocturnal awakenings, allowing you to get up the next day rested and able to face all common daily activities, including driving the car.

Tips and warnings for correct use

In clinical practice, sleeping pills characterized by a very favorable risk/benefit profile have been remarkably successful.

This does not mean that even the best drug against insomnia can cause some modest side effects, which it is good to know and take into account to get the maximum benefits from its intake. The two main drawbacks associated with the use of sleeping pills are habituation (or tolerance) and dependence.

Habituation causes that, with the prolongation of the period of intake, the therapeutic action is progressively reduced until it becomes almost irrelevant in the long term, unless the doses of the drug are progressively increased; Addiction can create some problems when you decide to stop treatment after a few weeks or months of continuous use, resulting in a rebound phenomenon characterized by an abrupt, but transient, increase in anxiety, agitation and insomnia and the appearance of tremors, tachycardia and gastric disorders.

The extent of both habituation and withdrawal after withdrawal are related to the length of the intake period, the intrinsic potency of the specific sleeping pill and the doses taken, as well as the individual sensitivity to the drug. With regard to habituation, however, it should be noted that the most recent data obtained on some sleeping pills seem to dispel a little fears about it.

In general, to avoid addiction and dependence it is advisable to take sleeping pills for short periods (ie no more than 2-4 weeks) or even as needed. However, this strategy allows you to effectively control occasional or recurrent insomnia, short-term anxiety episodes and pain syndromes associated with muscle spasms. In addition, a 3-4 week treatment with some sleeping pills allows to offer immediate and safe relief to patients suffering from anxiety disorders and / or depression, waiting for the antidepressant drugs to start to take effect, which will then have to be taken long-term.

To avoid rebound and abstinence, pharmacological treatment against insomnia should always be suspended gradually, with progressive reduction of doses. Both the treatment and its interruption should always be carried out under medical supervision, taking every day, with precision, the amount of drug prescribed at the indicated time. Increasing doses does not improve therapeutic effects and exposes you to the risk of overdose toxicity.

In general, sleeping pills interact little with other drugs, thus being useful even in patients who are taking different medicines for the treatment of concomitant diseases.

When more caution is needed

When used correctly, under medical supervision, by adults without other significant medical conditions and who are not taking potentially interfering drug therapies, most sleeping pills are effective, safe and well-tolerated drugs. However, some categories of people should avoid taking them or take them only if the doctor deems it absolutely necessary.

In particular, sleeping pills should not be taken during pregnancy because several studies have indicated a possible adverse action on the developing fetus (1st trimester) and on the last stages of its growth (2nd-3rd trimester). Even after childbirth, if you opt for breastfeeding, caution is needed since sleeping pills taken by the mother can pass into milk.

Drugs against insomnia must also be used with caution, only in cases of actual need and at specific medical suggestion, in children, who can benefit in case of febrile seizures or in the presence of sleep disorders that cannot be managed with non-pharmacological measures or natural remedies of proven efficacy and safety in pediatric age (for example, extracts of chamomilevalerian or melatonin).

The third category of patients who should take sleeping pills sparingly is that of the elderly, who are however the most frequent users, especially due to sleep disorders, particularly frequent with advancing age, and symptoms such as irritability, agitation and nervousness that often accompany conditions of cognitive decline and dementia.

In this regard, it should be remembered that, especially when the goal is to improve sleep, in the elderly the use of drugs against insomnia with short duration of action and free of active metabolites that can prolong the sedative effect on the nervous system should be privileged. This decreases the extent of side effects such as residual sleepiness during the day, mental confusion and attention/concentration and memory deficits, resulting in a reduction in the risk of falls and even serious trauma (in particular, fractures of the femur).

Always in order to prevent or contain possible side effects in the elderly and in patients already on another drug that can interact or modify the metabolism of a specific sleeping pill, the doctor should always provide for the administration of the minimum effective doses and prescribe their intake for short periods of time (15-20 days maximum) or intermittently.

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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