A brief discussion on medication for insomnia

As the saying goes, "One night without sleep is not enough for ten nights. One night without sleep is not enough for ten nights." About one-third of a person's life is spent sleeping. Sleep has a great impact on people's physical, psychological, and behavioral aspects. Insomnia will cause people to feel dizzy, have headaches, have decreased attention, and have low immunity. Long-term insomnia causes memory loss in the brain, reduces work efficiency, and can even lead to a series of problems such as personality changes and mental abnormalities, leading to many psychological disorders and inducing high blood pressure, diabetes, and coronary heart disease.

Why do people suffer from insomnia?

Insomnia can be caused by many reasons, such as stress, anxiety, irregular sleep, poor sleeping environment, etc. It can also be caused by some mental or organic diseases, such as depression, anxiety, hyperthyroidism, etc.

What are the symptoms of insomnia?

Insomnia can be an independent syndrome or a symptom of multiple diseases. The symptoms of insomnia vary from patient to patient, and may manifest as difficulty falling asleep, waking up easily, waking up early, poor sleep quality, etc. The main manifestation is difficulty falling asleep or maintaining sleep, such as waking up early [1].

Classification and characteristics of sedatives and hypnotics

The most common sedative hypnotic is benzodiazepine. Long-acting ones include diazepam (Valium), flurazepam, etc.; medium-acting ones include nitrazepam, estazolam, etc.; short-acting ones include triazolam, oxazepam, etc. Its characteristics are high therapeutic index, low visceral toxicity and safe use. It is currently the most commonly used drug for the treatment of insomnia. Benzodiazepines can significantly shorten the time to fall asleep, significantly prolong the duration of sleep, reduce the number of awakenings, reduce the occurrence of nightmares, do not affect the metabolism of other drugs, and have mild dependence and withdrawal symptoms. Benzodiazepines are the most commonly used sedative hypnotic in clinical practice.

The second is non-benzodiazepine drugs, including zopiclone, zaleplon, zolpidem, etc. This type of drug can significantly shorten the time to fall asleep, reduce the number of awakenings at night, increase the total sleep time, and improve the quality of sleep. There are fewer adverse reactions. The mechanism of action of this type of drug is similar to that of barbiturates, but its half-life is short and it is easily cleared from the body, thereby reducing the accumulation of drugs in the body, reducing the production of the "hangover" effect, and rarely aggregates after repeated use, which improves the safety of drug use. Therefore, it has been widely recognized after listing and has become an ideal drug for the treatment of insomnia. At present, it is the first choice for the treatment of sleep disorders together with benzodiazepines. However, due to its high price, its use is limited to a certain extent.

The third category is barbiturates, including phenobarbital and amobarbital. This type of drug has a low therapeutic index. Low doses can produce sedation, and medium doses can slightly inhibit the respiratory center. After taking it, there are sequelae such as drowsiness, dizziness, and somnolence. Long-term use can produce tolerance and dependence. Sudden discontinuation of the drug is prone to "rebound" phenomenon (after dependence is formed, discontinuation of the drug is prone to agitation, insomnia, anxiety, convulsions, etc.). Currently, barbiturates are rarely used to treat sleep disorders [2].

References:

[1] Wang Jijun, Zhang Mingdao. Sleep disorders[J]. Foreign Medicine: Psychiatry, 1996, 23(1): 26-30.

[2] Fan Xicheng. Research and analysis on sleep disorders and medication status[J]. China Medical Guide, 2012, 10(17): 89-90.