Sleeping pills: their advantages, principle of action and possible risks

Sleeping pills are currently represented by preparations of different chemical groups. Barbiturates, which used to be the main sleeping pills for a long time, began to lose their leading importance. At the same time, compounds of the benzodiazepine series are increasingly used.

Barbiturates have a number of disadvantages. The sleep they cause is different from the natural one: they facilitate the onset of sleep (falling asleep), but its structure changes the ratio of the fast (paradoxical, desynchronized) and slow (orthodox, synchronized) sleep phases. Often the dream becomes intermittent, with an abundance of nightmares. After it, there is a long drowsiness, weakness, disruption of coordination of movements, nystagmus and other undesirable phenomena. With repeated use, tolerance develops (habituation), and it is necessary to increase the dose to obtain a hypnotic effect.

The hypnotics of the benzodiazepine group have a certain degree of advantage over barbiturates – they are better tolerated. However, neither by the nature of the caused sleep, nor by side effects they meet the “physiological” requirements. All tranquilizers of the benzodiazepine group have a sedative effect to a certain extent and contribute to the onset of sleep. By the intensity of individual aspects of the action (sedative, anxiolytic, myorelaxing, etc.), different preparations of this group differ among themselves. All of them are connected in the brain tissues with specific benzodiazepine receptors, which are subdivided into subtypes. The main significance for the hypnotic effect is the inhibition of the activity of the cells of the reticular activating system of the brain stem.

The reticular formation, which is a branched network of neurons and nerve fibers, located in the brain stem and responsible for activating the electrical activity of the brain, controls the cycle of sleep and wakefulness. Barbiturates and some other medicines suppress the activity of certain areas of the brain, in low doses having a hypnotic effect, and in high doses – a general anesthetic effect.

Alcohol, opiates, antihistamines and other drugs that depress the central nervous system (CNS) have a similar effect. The hypnotic benzodiazepine series and some other sleeping pills do not lead to anesthesia, even at very high doses.

Ambien is one of the most well known remedies for insomnia. The market of sleeping pills radically changed in 1993, when the French company released a new drug Ambien. Ambien acted just like benzodiazepines, but it had fewer side effects. These pills proved to be so safe that many doctors violated the long-term rule not to prescribe to patients medications to treat ordinary insomnia.

Complications and side effects

Since taking barbiturates is accompanied by an abstinence syndrome, a violation of coordination of movements and suppression of reflex activity, certain activities, for example, driving a car should be avoided until the intake completely stops.

Is joint use of sleeping pills and alcohol dangerous before bedtime?

It’s dangerous. Alcohol enhances the effect of hypnotics, deepening their sedative effect, which is fraught with serious complications. A small amount of alcohol taken before bedtime has a strong hypnotic effect but the abuse of alcohol is harmful.

Is it dangerous for children to take sleeping pills?

All medicines, without exception, must be stored in a place inaccessible to children. Due to low body weight, the child’s intake of hypnotics in amounts that are even slightly higher than the therapeutic dose for an adult is deadly. If necessary, hypnotics are still prescribed for children, but only for a short time and with strict adherence to the dosage.

Is the long-term use of sleeping pills harmful?

It is harmful. In connection with the too careless use of hypnotics in the past, many patients acquired dependence on barbiturates. After some time after the start of the drug, the effectiveness of the prescribed dose decreases and the patient needs more and more of it. In addition, sleep caused by sedatives is not as refreshing as natural, so hypnotics are recommended for intake only for a short time: until a doctor identifies the causes of insomnia and eliminates them.

Studies have shown that medications such as Ambien may not improve the quality of sleep and do not increase its duration too much. One study showed that patients taking a real sleeping pill fell asleep only twelve minutes faster than those who drank a placebo and generally slept only eleven minutes longer at night.

So why do so many people take sleeping pills if it does not improve their sleep too much? Part of the answer lies in the widely known placebo effect. Any tablet, even if it contains only sugar, soothes the patient.

However, the sleeping pill has one more effect. Such drugs as Ambien can cause so-called anterograde amnesia. Because of these pills, short-term memory works for a while. For this reason, during treatment with Ambien, it is necessary to go to bed immediately: if you continue to stay awake, you can behave like a sleepwalker, and this is dangerous for life.

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