Sleeping pills

from Wikipedia, the free encyclopedia

A sleeping pill or hypnotic (from the Greek ὕπνος hypnos , 'sleep'; from Hypnos , the Greek god of sleep) is a substance that promotes sleep (by reducing the activity of the waking system in the brain ). There are smooth transitions to tranquilizers ( sedatives ) on the one hand and to narcotics on the other. Sleep pills are based on synthetically produced or naturally occurring ( herbal ) active ingredients . All of these substances change the natural sleep profile with their sleep-promoting effect .

Sleep pills are often given orally as tablets, capsules, or juice. Depending on whether the sleeplessness ( insomnia ) occurs more falling asleep or staying asleep in the phase, either agents having short or those with longer duration of action are used.

In higher doses and intravenously , short-acting sleeping pills are also used to calm a patient during an unpleasant examination (for example gastroscopy or colonoscopy ) (sedation); in anesthesia they are used to induce anesthesia .

Before the introduction of neuroleptics in the 1950s, sleeping pills were also widely used in the treatment of schizophrenia .

Herbal sleeping pills

There are some plants that have soothing and sleep-inducing ingredients. They are primarily used to calm down and induce sleep and to a lesser extent serve as a means of staying asleep. For example, extracts from valerian root , hop cones , lemon balm leaves and passion flower are used to induce and promote sleep . Cannabis tincture was also used as a sleep aid until the early 20th century .

Synthetic sleeping pills

In addition to the herbal sleeping pills, there are numerous chemical-synthetic sleeping pills. They can be divided into several groups. More effective synthetic sleep aids require a prescription .

Benzodiazepines

Benzodiazepines are a group of substances with calming, anxiolytic, antispasmodic and sleep-inducing effects, with the individual substances differing in terms of duration and strength. Common representatives are z. B. nitrazepam , triazolam , flurazepam or temazepam . They mainly affect stages II, III (lengthening) and IV (shortening) of synchronized (“orthodox”) sleep, the REM phase is almost unaffected. Benzodiazepines are not suitable for long-term use as sleeping pills and should generally not be used for more than four weeks. The risk of developing a dependency syndrome is considered to be increased. Deaths from misuse or attempted suicide are extremely rare.

Non-benzodiazepine agonists

Non-benzodiazepine agonists represent a group of substances whose representatives zopiclone , zaleplon and zolpidem differ structurally from the benzodiazepines, but bind to the same receptors ( GABA receptors ) and have a similar action profile. They will also Z-drugs (or z-hypnotics ) because their names with the letter Z begin. The muscle-relaxing and antispasmodic effect is lower than that of the benzodiazepines, and the potential for dependence is said to be lower. Z-drugs do not significantly affect sleep architecture. Non-benzodiazepine agonists, in particular zolpidem and zopiclone, have ousted the benzodiazepines as first-line sleeping pills in recent years.

Barbiturates

Barbiturates (chemical-structural descendants of barbituric acid ) are potent sleep aids with a high risk, as they have a dose-dependent effect on sleep. They have a relatively long half-life and therefore have an undesirable side effect and after-effect fatigue on the following day ("hangover"). They also suppress REM sleep , which is important for recovery , which can lead to a REM rebound . Fatal overdoses are possible, especially in connection with simultaneous consumption of alcohol, as the result is potentiation. Barbiturates are therefore hardly used any more as sleeping pills. In Germany, a step-by-step plan process concluded in 1994 officially prohibited its use as a sleeping pill.

Rare exceptions are sleep disorders that cannot be adequately alleviated by other means. Nowadays, otherwise common and effective sleeping pills must have failed several times. In such cases, an individual treatment attempt by the doctor in the context of the so-called off- license use in close consultation with the patient can be medically indicated and thus legally justified. This presupposes special information and documentation obligations of the doctor as well as the complete instruction of the patient about the possible risks and chances of the individual procedure.

Piperidinediones and Ureide

Structurally, the barbituric acid are related parties are not commonly used as a sleep aid piperidinedione - derivatives methyprylon , pyrithyldione , glutethimide and thalidomide (thalidomide) and the brominated urea derivatives ( ureides ) bromisoval and carbromal .

Antihistamines

Many antihistamines of the first generation of the ethanolamine or ethylenediamine type have a sedating effect in addition to their antiallergic effect. Diphenhydramine , doxylamine , meclozin and promethazine are therefore also used as sleep aids. They change the normal sleep pattern by extending the deep sleep phase and suppressing the REM sleep , which is important for recovery , which can lead to a REM rebound . Short-acting substances such as doxylamine and diphenhydramine have no, longer-acting antihistamines such as promethazine can show a pronounced hang-over effect. The potential for dependence is low. After a few days to weeks, a habituation effect occurs . The flooding speed is around 1–3 hours, which is why it is necessary to take it earlier. Adverse effects are predominantly anticholinergic effects, dizziness and headaches as well as gastrointestinal disorders. Intoxications are difficult to treat. Diphenhydramine and doxylamine are available without a prescription.

Other substances

Chloral hydrate , the first synthetic sleep aid, is hardly used any more because of the accumulation (accumulation) of its metabolite with a half-life of 3-4 days and the resulting hangover. Also ethinamate and methylpentynol are obsolete today. The thiazole derivative clomethiazole is now only used for the treatment of severe sleep disorders in old age when other treatment measures cannot be used due to ineffectiveness or side effects. The quinazolone derivative methaqualone ( Doriden ) is obsolete because of its addiction potential as a sleep aid.

As substances of biogenic origin, the amino acid tryptophan and the hormone melatonin are used as a sleep aid, as is the melatonin derivative Ramelteon . Tasimelteon is used to treat sleep disorders when there are deviations from the 24-hour rhythm.

Orexin receptor antagonists

Orexin receptor antagonists are a younger class of substances whose first therapeutically used representative suvorexant was approved in the USA in 2014. Another representative is lemborexant . The substances act at the orexin receptors of the two subtypes of OX 1 and OX 2 ( d ualer O Rexin r ezeptor- A ntagonist, DORA ). It is believed that this neutralizes the awakening effect of the neuropeptides orexin A and B in the brain. In humans, orexinergic neurons are located in the lateral hypothalamus and from there also influence other areas of the brain that regulate the metabolism and sleep-wake rhythm .

Sedation and anesthesia

For intravenous use hypnotics (possibly together with painkillers and muscle relaxants ) are used in diagnostic measures as well as in anesthesia, intensive care and emergency medicine for sedation , to induce or maintain anesthesia . Benzodiazepines ( midazolam , diazepam ), propofol , etomidates , barbiturates (such as thiopental ), 4-hydroxybutanoic acid or ketamine are used.

Side effects

Many hypnotics are broken down very slowly, so that the next morning you may feel tired and exhausted, the so-called "hangover". Depending on the type or mode of action, sleeping pills have other undesirable effects typical of the substance group. There are interactions with numerous medicinal substances, among which the enhancement of the effect with simultaneous intake of other central depressant substances or alcohol should be emphasized.

Regular use of sleeping pills increases the risk of developing cancer , according to one study .

Overdosing can lead to intoxication with sleeping pills , which can be life-threatening, especially due to the narcotic effect on the central nervous system.

abuse

There are several reasons and forms of abuse of sleeping pills. Sleeping pills taken for more than two weeks often lead to dependence. More than a million people in Germany are dependent on benzodiazepines. Fatally, stopping the medication leads to severe withdrawal symptoms and additional sleep disorders, which leads to a vicious circle when you take the sleeping pills again. It should therefore only be taken and discontinued under medical supervision.

There are cases in which symptoms of physical overload (insomnia etc.) are treated with sleeping pills. However, this is only useful as an immediate measure (maximum two weeks), since only the symptoms are combated; the actual cause must also be eliminated in a second step.

The so -called knockout drops are a criminal abuse of sleeping pills .

Other sleep-promoting substances and measures

In addition to the listed herbal and synthetic sleeping pills, there are other substances that promote sleep. For example, antidepressants (such as mirtazapine , amitriptyline , doxepin , trimipramine , trazodone ), phenothiazines (such as promethazine ) or analgesics (pain relievers, including herbal substances such as opium from opium poppies or preparations from nightshade plants ) can have a sleep-promoting side effect.

See also

Sleep · Sleep disorders · Sleep hygiene · Circadian rhythms · Sleep medicine

literature

swell

  • Peter Spork: The Sleep Book - Why we sleep and how we can best succeed. Rowohlt, 2008, ISBN 978-3-499-62121-5 , pp. 179-183, sleeping pills and pills.
  • O. Benkert: Psychotropic drugs. 4th, revised. and updated edition. CH Beck, Munich 2001, ISBN 3-406-47547-7 , chap. VIII Hypnotics.
  • G. Laux, O. Diemeier, W. König: Psychopharmaka. 7th edition. Urban & Fischer, Munich / Jena 2002, ISBN 3-437-22490-5 , chap. 2.5 Hypnotics, side effects and contraindications.
  • Hermann J. Roth, Helmut Fenner: Medicines. Thieme, Stuttgart / New York 1988, ISBN 3-13-673501-3 .
  • Doris Schwarzmann-Schafhauser: Sleeping aid (modern times). In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. Walter de Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1299.
  • J. Zehentbauer: Psychopills. 5th updated edition. Zenit, Munich 1998, ISBN 3-928316-07-9 , chap. 7 sleeping and sleeping pills.

Generally understandable

Web links

Wiktionary: sleeping pills  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ Hans Bangen: History of the drug therapy of schizophrenia. Berlin 1992, ISBN 3-927408-82-4
  2. ↑ T. Dingermann, K. Hiller, G. Schneider, I. Zündorf: Schneider drug drugs. 5th edition. Elsevier, 2004, ISBN 3-8274-1481-4 .
  3. ^ A b E. Mutschler, G. Geisslinger, HK Kroemer, P. Ruth, M. Schäfer-Korting: drug effects. Textbook of pharmacology and toxicology. 9th edition. Wissenschaftliche Verlagsgesellschaft, Stuttgart 2008, ISBN 978-3-8047-1952-1 , p. 209.
  4. ^ Therapy with cannabis and Co. In: Pharmazeutische Zeitung . 05/2009, January 29, 2009.
  5. ↑ TB Huedo-Medina, I. Kirsch, J. Middlemass, M. Klonizakis, AN Siriwardena: Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. In: BMJ (Clinical research ed.). Volume 345, 2012, p. E8343. PMID 23248080 . PMC 3544552 (free full text).
  6. ↑ J. McCleery, DA Cohen, AL Sharpley: Pharmacotherapies for sleep disturbances in Alzheimer's disease. In: The Cochrane database of systematic reviews. Volume 3, 2014, pp. CD009178, doi: 10.1002 / 14651858.CD009178.pub2 . PMID 24659320 .
  7. ↑ Aftermath: Barbiturates only for epileptics and under anesthesia . arznei-telegram 7/94 of July 14, 1994 ( PDF ).
  8. ^ A b c Claudia Dellas: Crash course in pharmacology. 2nd Edition. Elsevier, Urban & Fischer, Munich 2006, ISBN 3-437-43181-1 , p. 36.
  9. ^ A b Claus-Jürgen Estler, Harald Schmidt: Pharmacology and Toxicology. 6th edition. Schattauer, Berlin 2007, ISBN 978-3-7945-2295-8 , p. 214.
  10. ↑ Beate Herpertz-Dahlmann, Franz Resch, Michael Schulte-Markwort , Andreas Warnke: Developmental Psychiatry: Biopsychological Basics and the Development of Mental Disorders. 2nd Edition. Schattauer, 2007, ISBN 978-3-7945-2358-0 , p. 388.
  11. ^ Eduard Burgis: Intensive course in general and special pharmacology. 4th edition. Urban & Fischer, Munich 2008, ISBN 978-3-437-42613-1 , p. 315.
  12. ↑ Boris Stuck, Joachim T. Maurer, Michael Schredl , Hans-Günter Weeß: Practice of sleep medicine: sleep disorders in adults and children; Diagnostics, differential diagnostics and therapy. Springer, Heidelberg 2009, ISBN 978-3-540-88699-0 , pp. 107-108.
  13. ↑ Red List (online): Entry D 49 - Diphenhydramine. Retrieved July 18, 2010.
  14. ^ T. Bennett et al .: Suvorexant, a dual orexin receptor antagonist for the management of insomnia . Pharmacy & Therapeutics, Volume 39 (2014), pp. 264-266. PMC 3989084 (free full text).
  15. ↑ Suvorexant: First Global Approval. In: Drugs. 2014, doi : 10.1007 / s40265-014-0294-5 . PMID 25227290 .
  16. ↑ Sleeping pills increase the risk of cancer. In: Spiegel online. June 6, 2012. (Source: British Medical Journal. 2012 )
  17. ^ Helmut Schubothe: Poisonings. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid. 1961, pp. 1195–1217, here: pp. 1196–1198 ( sleep medication poisoning ).
  18. ^ German headquarters for addiction issues: "Benzodiazepine" leaflet ( Memento from July 5, 2016 in the Internet Archive )
  19. ↑ Information brochure helps with sleep pill withdrawal. In: Spiegel online. 17th April 2014.
  20. ↑ See also ways out of dependency in Das Schlafmagazin , cf. #Literature .
  21. ↑ Claudia Richter: Sleeping pills. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. Walter de Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1298 f.