HYPNOTICS AND ANXIOLYTICS

INSOMNIA

Insomnia is trouble falling asleep, staying asleep through the night, or waking up too early in the morning. Episodes of insomnia may come and go or be long-lasting.

The quality of your sleep is as important as how much sleep you get.

Causes

Sleep habits we learned as children may affect our sleep behaviors as adults. Poor sleep or lifestyle habits that may cause insomnia or make it worse include:

-Going to bed at different times each night

-Daytime napping

-Poor sleeping environment, such as too much noise or light

-Spending too much time in bed while awake

-Working evenings or night shifts

-Not getting enough exercise

-Using the television, computer, or a mobile device in bed

The use of some medications and drugs may also affect sleep, including:

-Alcohol or other drugs

-Heavy smoking

-Too much caffeine throughout the day or drinking caffeine late in the day

-Getting used to certain types of sleep medicines

-Some cold medicines and diet pills

-Other over-the-counter or prescription medicines, herbs, or supplements

Physical, social, and mental health issues can affect sleep patterns, including:

-Bipolar disorder.

-Overactive thyroid gland.

-Waking up at night to use the bathroom.

-Feeling sad or depressed. (Often, insomnia is the symptom that causes people with depression to seek medical help.)

-Physical pain or discomfort.

-Stress and anxiety, whether it is short-term or long-term. For some people, the stress caused by insomnia makes it even harder to fall asleep.

With age, sleep patterns tend to change. Many people find that aging causes them to have a harder time falling asleep, and that they wake up more often.

Symptoms

The most common complaints or symptoms in people with insomnia are:

-Trouble falling asleep on most nights

-Feeling tired during the day or falling asleep during the day

-Not feeling refreshed when you wake up

-Waking up several times during sleep.

People who have insomnia are sometimes consumed by the thought of getting enough sleep. But the more they try to sleep, the more frustrated and upset they get, and the harder sleep becomes.

Lack of restful sleep can:

-Make you tired and unfocused, so it is hard to do daily activities.

-Put you at risk for auto accidents. If you are driving and feel sleepy, pull over and take a break.

ANXIETY

Fear and anxiety are part of life. You may feel anxious before you take a test or walk down a dark street. This kind of anxiety is useful - it can make you more alert or careful. It usually ends soon after you are out of the situation that caused it. In some people. the anxiety does not go away, and gets worse over time. They may have chest pains or nightmares. They may even be afraid to leave home. These people have anxiety disorders. Types include:

-Panic disorder.

-Obsessive-compulsive disorder.

-Post-traumatic stress disorder.

-Phobias.

-Generalized anxiety disorder.

Treatment can involve medicines, therapy or both.

HYPNOTICS AND ANXIOLYTICS

1. HYPNOTICS:

-Benzodiazepines: Nitrazepam, Flurazepam (Dalmane), Loprazolam, Lormetazepam and Temazepam.

-Zaleplon (Sonata), Zolpidem Tartrate (Stilnoct) and Zoplicone (Zimovane) are non-benzodiazepine hypnotics, but they act at the benzodiazepine receptor.

-Chloral and derivatives: Cholral Hydrate (Chloral mixture/elixir, Welldorm) and Triclofos sodium.

-Clomethiazole (Heminevrin).

-Antihistamines (on sale to the public for occasional insomnia): Promethazine hydrochloride, Sodium oxybate (Xyrem) and Melatonin (Circadin).

2. ANXIOLYTICS:

-Benzodiazepines: Diazepam, Alprazolam, Chlordiazepoxide Hydrochloride, Lorazepam and Oxazepam.

-Buspirone hydrochloride (Buspar).

-Meprobamate.

3. BARBITURATES:

-Barbiturates (Sodium Amytal, Soneryl, Seconal sodium, Tuinal).

Sources:

-http://www.nlm.nih.gov/medlineplus/

-BNF 57 March 2009