Sleeping pills
Synonyms
Hypnotic, sedative
definition
The group of drugs popularly known as sleeping pills includes a wide range of active ingredients that are used to treat problems falling asleep or staying asleep. On the one hand, this includes herbal remedies, which are said to have a calming effect, on the other hand, drugs are also referred to as sleeping pills that are used, for example, before the induction of anesthesia as a premedication for so-called sedation (dampening).
In the course of this, the very different classes of active ingredients and their effects and side effects will be discussed.
Substance groups / classification
Herbal substances
These include substances, the extracts of valerian, hop, Lemon balm and Passion flower contain.
effect
The effect of herbal substances in the treatment of sleep disorders has largely not been scientifically proven and is probably based to a not inconsiderable extent on the placebo-effect. The placebo effect means that the mere fact that a “medication” is being taken gives the feeling that an improvement in sleep must occur and that this is more or less pronounced. However, this does not mean that herbal remedies are generally ineffective and nonsensical. For some - and quite a few - people, they can be very helpful at times. Therefore, in the case of sleep disorders - if other, non-drug therapy options relating to sleep hygiene were not helpful - can definitely be first try a herbal remedy can be done to treat the sleep disorder before any medicine is used.
Side effects
Since herbal sleeping pills are not actually medicinal products, their great advantage is that hardly any side effects occur when taking. It can rarely lead to rather unspecific complaints such as a headache, lighter Drowsiness and Gastrointestinal complaints come.
Interactions
In general, it applies to means that are used to promote sleep that their effect is in combination with alcohol can amplify. This is less of a problem with herbal remedies, but should still be in the eye be kept. In patients suffering from insomnia under a depression suffer, sometimes comes - often as self-medication - Johannis herbs for use. This should always be communicated to the attending physician, as St. John's wort has numerous interactions with other drugs - especially psychotropic drugs. The patients are often not aware of this, as they consider herbal remedies available without a prescription to be completely harmless and not worth mentioning.
Contraindications
When taking herbal remedies there are no specific Contraindications. Nevertheless, the attending physician should always be informed about the consumption of herbal substances so that he can get an idea of possible interactions and contraindications.
costs
Herbal sleep aids are without prescription and only partly pharmacy-only, so some are also available in the drugstore. As a price example, tablets are mentioned here that valerian- Extract included. The cheapest price for 60 tablets is around 7 euros. 120 pieces of passion flower capsules can be purchased for around 17 euros.
Antihistamines
effect
Some of the drugs from the group of antihistamines - like the herbal sleeping pills - are available in pharmacies without a prescription, but - in contrast to these - they are considered drugs in the conventional sense and have a scientifically proven effect. Antihistamines work by blocking certain histamine receptors and thus induce sedation (dampening), among other things. They were originally developed to curb allergic reactions - for example in the context of hay fever. Sedation was an undesirable side effect here. However, it is precisely the first generation antihistamines, i.e. the older ones, that are primarily used today in the treatment of sleep disorders.
The active ingredients available without a prescription include Diphenhydramine and Doxylamine. Both active ingredients are sometimes used to treat nausea. They are only rarely used in the treatment of allergic reactions, as newer active ingredients such as cetirizine or loratadine are available for this purpose nowadays.
Read more on the topic: Sedatives
Side effects
Since first generation antihistamines not only work on the histamine receptor, so-called anticholinergic side effects are not uncommon during treatment. These include dry mouth, difficulty urinating (micturition disorders), constipation (constipation) and difficulties with the close-up reaction of the eyes (accommodation). Headache, dizziness and drowsiness may also occur. The ability to react is reduced, so it is urgently advisable not to actively participate in road traffic (driving a car) after taking it and for the next few hours. It is therefore advisable to take it in the evening hours before going to bed. As a rule, this applies to all sleeping pills, regardless of which group they belong to.
Interactions
Due to the risk of an intensification of the sedative effect, antihistamines should not be taken together with alcohol, and a combination of several depressant drugs should be avoided or only after consultation with the attending physician. A combination with drugs that can also cause anticholinergic side effects should also be critically examined, as this can lead to a significant increase in these side effects.
Contraindications
Due to the anticholinergic side effect profile, patients with an enlarged prostate (Prostatic hyperplasia) and patients with glaucoma (glaucoma) avoid taking antihistamines as much as possible or only do one after consulting their doctor. Otherwise there is a risk of an increase in symptoms, including acute urinary retention or glaucoma attacks.
costs
There are numerous preparations that contain the above-mentioned active ingredients, only a few are mentioned here as examples. Vivinox sleep contains the active ingredient Diphenhydramine. 20 dragees cost around 6.50 euros. The preparation Betadorm also contains diphenhydramine. Here, 20 dragees cost around 7.50. The preparations that contain the active ingredient doxylamine include SchlafTabs, here 20 dragees cost around 4 euros.
For more information on this topic, see: Antihistamines
Benzodiazepines
Benzodiazepines are now among the most common drugs prescribed as sleeping pills or sedatives. However, this is not necessarily a good thing, since - in contrast to other sleeping pills - they have a strong potential for dependence. Benzodiazepines always require a prescription, in higher doses they are subject to the Narcotics Act (BtM).
effect
A distinction is made between short, medium and long-acting benzodiazepines. All of them work on the so-called GABA receptor and thus increase the activity of a damping ion current. They have a dampening (sedating), sleep-promoting (hypnotic), anxiety-relieving (anxiolytic) effect and, in higher doses, muscle-relaxing (muscle tone decreases). This explains their use in numerous areas, including the short-term treatment of sleep disorders, anxiety disorders, states of restlessness and as premedication before anesthesia. Due to their anti-convulsive (anticonvulsive or anti-epileptic) effect, they are also used in the acute treatment of seizures. Short-acting benzodiazepines such as triazolam or nitrazepam are used in particular for people who have difficulty falling asleep.
Side effects
Depending on the half-life of the respective substance, it can lead to the so-called hangover, so come to daytime sleepiness the day after ingestion. This happens especially when using longer-acting substances such as diazepam or lorazepam. With every active ingredient from the group of benzodiazepines, after ingestion there is a temporary incapacity to drive (active participation in road traffic) due to an extension of the reaction time. In high doses, respiratory depression can occur. Nevertheless, intoxication with benzodiazepines alone is very rare and difficult. However, combinations of benzodiazepines and other sedating substances are dangerous (see interactions). Benzodiazepines have a high potential for dependency, so their use should generally not be longer than 3-6 weeks.
Read more about: Tavor Expedit
Interactions
A combination of benzodiazepines with other sedating or hypnotic substances such as some antidepressants (especially tricyclic), other sleeping pills, some neuroleptics and, above all, alcohol can lead to serious side effects including respiratory failure.
Contraindications
The contraindications for taking benzodiazepines include current or known history of benzodiazepine dependence and other addiction disorders, acute alcohol intoxication, myasthenia gravis (a muscle disorder) and sleep apnea syndrome.
costs
Short-acting benzodiazepines that are used in the treatment of sleep disorders include triazolam. This is available under the trade name Halcion ®. With a cash prescription, there is a prescription fee of 5 euros for 10 tablets with 25 mg of active ingredient each. 10 tablets on a private prescription cost 12.82 euros. The active ingredient nitrazepam is available in the form of various preparations. For example, as Nitrazepam 5 mg, here 10 pieces cost 5 euros on a prescription, a private prescription costs 11.80 euros.
Z-Drugs / non-benzodiazepine agonists / benzodiazepine-like substances
This group of active ingredients is similar in its profile of action to those of the benzodiazepines, but they have a different structure. They bear the name Z-Drugs (in German roughly: Z-Medicines) because of their names: Zolpidem, zopiclone, and zaleplon. It is still controversial whether the Z-Drugs are as addictive as the benzodiazepines. In any case, however, there is a clear potential for dependency, although probably not as pronounced.
effect
Z-Drugs work on the same receptor as benzodiazepines, the GABA receptor, and thus increase an inhibitory ion current, the one sedating and sleep-inducing Has an effect.
Side effects
The side effects include a hangover (increased drowsiness) the day after ingestion metallic or bitter taste in the mouth, Gastrointestinal problems like nausea and Vomit and other. There is a significantly increased potential for dependency, so the application should no longer than 3-6 weeks respectively.
Interactions
A combination of Z-Drugs with other sedating / hypnotic substances like some Antidepressants, some Neuroleptics, other sleeping pills and alcohol should avoided otherwise the sedative effect can be significantly intensified to a life-threatening extent.
Contraindications
Non-benzodiazepine agonists are also considered strong addictive and should therefore not be used in people with a current or known history of dependency disorder, as these carry an increased risk of developing addiction again. Other contraindications are a Sleep apnea syndrome and severely impaired liver function.
costs
10 tablets with the active ingredient zopiclone each á 7.5 mg from Hexal cost 5 euros prescription fee for a prescription and 13.23 euros for a private prescription. 10 tablets containing the active ingredient zolpidem in an amount of 10 mg per tablet cost 5 euros prescription fee for a prescription and 13.23 euros for a private prescription. The listed preparations are examples; there are numerous others that are equivalent.
Melatonin
Melatonin is an endogenous hormone that is produced in the central nervous system. The synthetically produced variant of the hormone can be used as a treatment option for sleep disorders.
Read more in the following article: Melatonin
effect
The formation of melatonin is inhibited by light. This is why the melatonin level in the central nervous system rises in the dark. Melatonin serves as an important regulator of the day-night and thus sleep-wake rhythm.
Side effects
Melatonin rarely causes side effects. One of these rare side effects may include chest pain (angina pectoris), agitation, irritability, and others.
Interactions
A combination of melatonin with other drugs that have a sedative / hypnotic effect can increase the depressant effect of the drug. A combination with certain antidepressants and neuroleptics as well as with other sleeping pills and alcohol should therefore be checked critically.
Contraindications
Treatment with melatonin is not recommended here due to the lack of clinical data in patients under the age of 18, patients with significantly impaired liver and kidney function and patients with autoimmune diseases.
costs
20 tablets of Circadin ® 2 mg cost 5 euros for a prescription, and 26.16 euros for a private prescription.
Other sleeping pills
In addition to the above, there are other drugs that are used as sleeping pills, but usually only if the sleep disorder occurs in combination with an additional illness. So can some Antidepressants (for example Amitriptyline, trimipramine and mirtazapine) in patients with insomnia within a depression can be used.
Neuroleptics like Quetiapine or Clozapine can lead to a in patients suffering from psychosis with associated restless states Sedation to lead.
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