When Counting Sheep Fails: The Latest Sleep Medications

Insomnia has been around as long as sleep has. Some even believe that William Shakespeare was an insomniac, writing as vividly as he did about sleeplessness, tossing and turning, and sleepwalking in plays like Hamlet and Macbeth. Today, old Will has millions of fellow sufferers.

• The 2007 Sleep in America Survey from the National Sleep Foundation found that 67% of women say they frequently experience a sleep problem.
• The 2005 Sleep in America poll found that 35% of adults experience insomnia every night.

One option today’s insomniacs have that Shakespeare didn’t, of course, is the sleeping pill. Over the last 10 to 15 years, the market has been inundated with new and improved sleep medications — ones that don’t come with the same degree of hangovers, side effects, and risk of dependency that previous sleep drugs did.

But that doesn’t mean they’re risk-free, or ideal for everyone who has problems getting a solid forty winks.

A Good Night’s Sleep, Without the Hangover

The older classes of sleep medications, particularly the benzodiazepines — think Valium and Xanax — do more than just help you sleep. They affect how you sleep, altering your actual “sleep architecture,” says Donna Arand, PhD, clinical director of the Kettering Sleep Disorders Center in Kettering, Ohio.

“They tend to decrease the amount of time spent in certain stages of sleep, particularly stages three and four (the deepest, most restful stages of sleep),” says Arand, who serves on the boards of the American Academy of Sleep Medicine and the American Insomnia Association. “People also complained of hangover effects from these medications.” That’s because they tend to have a longer “half-life,” which is the length of time the drug stays in your body.

Non-benzodiazepine hypnotics like Ambien, Ambien CR, Rozerem, Sonata, and Lunesta, however, share key advantages over previous generations of sleep drugs:

• They have a relatively short half-life, so you won’t wake up groggy the next day. “There are minimal reports of ‘hangover’ effects with these new drugs,” says Arand.
• They are less likely than the older sleeping pills to cause addiction, withdrawal symptoms, or a buildup of tolerance (when you require more and more drug to have the same effect).

Why? The newer medications act only on specific receptors in your brain that are focused on sleep, while older groups of drugs have a more generalized effect on multiple brain receptors. “These new drugs are among the safest medications in medicine,” says Thomas Roth, MD, Director of the Sleep Disorders and Research Center at Henry Ford Health System in Detroit.

New Sleeping Pills Aren’t Right for Everyone

“If you have insomnia due to sleep-related breathing disorders [sleep apnea] or restless legs syndrome, for example, these drugs won’t address your underlying problem,” says Roth. Pregnant women, of course, shouldn’t take these medications. And if you’re “on call,” frequently getting up in the middle of the night for work or for a child, they might not work for you.

They’ve also recently been linked to some unusual side effects. In March 2007, the FDA issued a warning that prescription sleep medications like Ambien and Lunesta can cause bizarre behaviors during sleep. Some people have reported that they drove cars and went on eating binges — literally cleaning out the refrigerator with no awareness of taking a bite. The FDA has asked drugmakers to strengthen their product labels with warnings about these side effects. The FDA notes that severe allergic reactions and facial swelling have also been linked to these medications.

If your doctor prescribes one of these drugs for you, be aware that these side effects are a possibility. Consider asking your partner or other adults who live with you to keep an eye out for nocturnal disturbances.

A Tour of Today’s Sleep Aids

The array of prescription sleep medications available to today’s groggy insomniac can be truly bewildering. Which one might be right for you? The best person to answer that is your doctor, or a specialized sleep center if your struggles have left your doctor baffled. But to give you an idea of some questions to ask, here is a quick introduction to the medications now on the market:

Rozerem: If you’ve seen the “your dreams miss you” ads featuring a bedraggled insomniac talking to Abraham Lincoln and a chess-playing beaver, you’ve heard about Rozerem. Rozerem is the first in a new class of drugs designed to act on the body’s melatonin receptors. (Melatonin is a hormone that affects sleep by helping to regulate the body’s circadian rhythms.)

Rozerem is more specifically targeted than regular melatonin supplements, specifically affecting the sleep center of your brain. Its biggest plus: safety. Resesarch shows Rozerem has no side effects or withdrawal effects. “It’s a very safe drug to use, so particularly for people who are on other medications or who may have a concern about substance abuse, it’s a great drug,” says Arand. (But Rozerem is also included in the FDA’s list of drugs that should include a warning about unusual sleep behaviors. )

Sonata: Of all the new sleeping pills, Sonata has shortest half-life, which is the amount of time it takes for half of the drug to be eliminated from your body. Its half-life ranges between 30 and 60 minutes. That means you can try to fall asleep on your own. Then, if you’re still staring at the clock at 2 a.m., you can take it without feeling drowsy in the morning.

Ambien: The most commonly prescribed sleeping pill, Ambien has a moderate half-life of less than two-and-a-half hours. This means that Ambien is great for helping you get to sleep but, like Sonata, could be less helpful if your problem is waking up wide-eyed in the wee hours.

Ambien CR: Ambien CR, approved by the FDA in 2005, was designed to target both common sleep problems: difficulty falling asleep and difficulty staying that way.Think of it as a layer cake: one layer dissolves quickly to help you fall asleep, while the second layer dissolves more slowly to help you stay asleep. Clinical trials showed that Ambien CR decreased wake time after sleep onset for the first seven hours during the first two nights it was taken, and for the first five hours after two weeks of treatment.

Lunesta: Of all the newer sleeping pills approved so far, Lunesta has the longest half-life — about six hours. This means you may feel groggy in the morning if you take it in the middle of the night, or at a time when you can’t get a full night’s sleep. On the other hand, this pill could help you if you tend to wake up in the middle of the night a lot. Lunesta is approved by the FDA for long-term use and has been found to help menopausal women sleep through the night.

Benzodiazepines: These older sleeping pills, which include drugs like Valium and Halcion, are useful when you want a drug that stays in your system longer. For instance, they have been effectively used to treat sleep problems such as sleepwalking and night terrors, says Arand. “The biggest problem with these is daytime sleepiness, although you also have to monitor them more closely for dependence as well,” she says. (Dependence means that you always need the drug to go to sleep.)

These drugs aren’t all created equal: Valium, for example, has a much longer half-life (about 6-8 hours) and therefore stays in your system a lot longer than Halcion, which has a 3-4 hour half-life.

Antidepressants: Insomnia is a common symptom of depression. Thus, some antidepressant drugs, such as Trazodone, are particularly effective in treating sleeplessness and anxiety that’s caused by depression, even though they are not specifically approved by the FDA for the treatment of insomnia.

“In those cases, the antidepressant helps treat the sleep problem, but is really treating the underlying cause,” says Arand. Could your insomnia be linked to depression? If you think you have other symptoms, talk to your doctor about this possibility.

Over-the-Counter Sleep Aids: Most of these sleeping pills, such as Sleep-Eze, are antihistamines. This means they’re somewhat sedating and can cause some drowsiness the next day. They’re safe enough to be sold without a prescription, but if you’re taking other drugs that have similar effects — like cold or allergy medications — you could inadvertently take too much.

The American Academy of Sleep Medicine reviewed research on these sleep aids in 2006 and concluded that they may provide “modest, short-term benefits,” but “sufficient evidence does not exist to support over-the-counter sleep aids as an effective treatment for insomnia.”

Combining Medicine With Good Sleep Habits

Roth suggests that it’s time to start thinking about insomnia as a chronic disorder — which he notes that it is in at least 10% of the population — and treating it that way. “For people who have high cholesterol, you don’t just give them a drug to lower their cholesterol and that’s the end of it,” he says. “You also work with them on other factors in their life that may be elevating their cholesterol. “

Similarly, he says, sleep medications for insomnia should not be used in isolation. “You want to use them in conjunction with good sleep practices, good behavioral therapies, and treating accompanying conditions,” he says. That means, among other things, practicing “good sleep hygiene”:

• Use your bed only for sleeping, not for paying bills or working on your laptop.
• Avoid caffeine, nicotine, and alcohol for four to six hours before going to bed, and don’t exercise too late in the evening.
• Make sure your bedroom is restful and quiet. Get a sleep mask or white noise machine if you can’t block out light or noise from outside.
• Get up and go to bed at the same time every day — yes, even on weekends!

Studies have also found that cognitive behavioral therapy (CBT) can be a very effective treatment for insomnia, making it easier to fall asleep more quickly and stay asleep longer.

“In fact, some research shows that medications aren’t as effective in the long term as behavioral treatment of the insomnia problem,” says Arand. “Changing behavior can have a greater impact and longer duration of effectiveness. But that doesn’t mean you can’t use these remedies in combination.”

Alprazolam: MedlinePlus Drug Information

Alprazolam may increase the risk of serious or life-threatening breathing problems, sedation, or coma if used along with certain medications. Tell your doctor if you are taking or plan to take certain opiate medications for cough such as codeine (in Triacin-C, in Tuzistra XR) or hydrocodone (in Anexsia, in Norco, in Zyfrel) or for pain such as codeine (in Fiorinal), fentanyl (Actiq, Duragesic, Subsys, others), hydromorphone (Dilaudid, Exalgo), meperidine (Demerol), methadone (Dolophine, Methadose), morphine (Astramorph, Duramorph PF, Kadian), oxycodone (in Oxycet, in Percocet, in Roxicet, others), and tramadol (Conzip, Ultram, in Ultracet). Your doctor may need to change the dosages of your medications and will monitor you carefully. If you take alprazolam with any of these medications and you develop any of the following symptoms, call your doctor immediately or seek emergency medical care immediately: unusual dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. Be sure that your caregiver or family members know which symptoms may be serious so they can call the doctor or emergency medical care if you are unable to seek treatment on your own.

Alprazolam may be habit forming. Do not take a larger dose, take it more often, or for a longer time than your doctor tells you to. Tell your doctor if you have ever drunk large amounts of alcohol, if you use or have ever used street drugs, or have overused prescription medications. Do not drink alcohol or use street drugs during your treatment. Drinking alcohol or using street drugs during your treatment with alprazolam also increases the risk that you will experience these serious, life-threatening side effects. Also tell your doctor if you have or have ever had depression or another mental illness.

Alprazolam may cause a physical dependence (a condition in which unpleasant physical symptoms occur if a medication is suddenly stopped or taken in smaller doses), especially if you take it for several days to several weeks. Do not stop taking this medication or take fewer doses without talking to your doctor. Stopping alprazolam suddenly can worsen your condition and cause withdrawal symptoms that may last for several weeks to more than 12 months. Your doctor probably will decrease your alprazolam dose gradually. Call your doctor or get emergency medical treatment if you experience any of the following symptoms: unusual movements; ringing in your ears; anxiety; memory problems; difficulty concentrating; sleep problems; seizures; shaking; muscle twitching; changes in mental health; depression; burning or prickling feeling in hands, arms, legs or feet; seeing or hearing things that others do not see or hear; thoughts of harming or killing yourself or others; overexcitement; or losing touch with reality.

Xanax (Alprazolam) | Anxiolytics

Xanax (alprazolam) is an anxiolytic (antipanic and antianxiety) benzodiazepine medication classified as a schedule IV controlled substance by the U. S. Drug Enforcement Administration (DEA). According to the DEA, a schedule IV drug has a low potential for abuse and a low risk for dependence. Alprazolam does have the potential for misuse, although some experts claim that the risk is low and similar to that of other benzodiazepine drugs.

This drug possesses antianxiety, sedative, muscle relaxing, and anticonvulsant properties. It slows down the chemical movement within the central nervous system, which results in the reduction of anxiety.

History of Xanax

Dr. Leo Sternbach is credited with the discovery benzodiazepines. Alprazolam was first released by Upjohn Laboratories (now a part of Pfizer) in 1981, as the first approved drug for panic attacks. Within two years, it became a “blockbuster” drug in the United States. Now, this medication is the most prescribed benzodiazepine in America.

Dosage FAQs

• What is a safe does of this medication?
  This medication comes in immediate and extended release formulas. The following dosage information is for the immediate release version:
  • Anxiety: An initial dose of 0.25 mg to 0.5 mg of Xanax is administered orally, three times a day. The dose can be increased gradually every three to four days up to maximum daily dose of 4 mg in divided doses.
  • Panic: An initial dose of 0.5 mg of Xanax is administered orally, three times a day. This dose can be increased every three to four days. The maintenance dose of Xanax is between 1 mg to 10 mg per day in divided doses (with an average dose ranging between 5 mg to 6 mg per day).
  • Depression: An initial dose of 0.5 mg of Xanax is administered orally three times a day. The dose can be increased by no more than 1 mg every three to four days. An average dose of 3 mg of Xanax daily in divided doses has shown to be most effective. Maximum dose should not exceed 4.5 mg daily in divided doses.
  • For elderly individuals (adults aged 65 years or older) dosage should not exceed 2 mg per day without consent from a doctor because of a greater sensitivity to the effects of benzodiazepines.
     
• How does my body process this drug?
  Xanax is readily-absorbed from the gastrointestinal tract. It has a rapid onset of action and a bioavailability of 80% to 90%. About 80% of Xanax binds to albumin in the blood. The peak serum concentration is reached in one to two hours for immediate release tablets and nine hours for extended release tablets. The drug is metabolized in the liver and removed from the body in the urine.
   
• How can I get the most out of my treatment with Xanax?
  This medication is primarily prescribed to treat the debilitating effects of anxiety and panic—two conditions that are treated using various types of psychotherapy. There is a growing body of research that highlights the efficacy of a combined approach to mental health treatment using both medication and therapy. Medication can dull the effects of mental health conditions while finding a therapist to work with may help a person learn more about their experiences, how to develop a self-care routine, and healthy coping strategies for when symptoms arise or become triggered.
   
• How is this drug structured chemically?
  Xanax is a chemical analog of triazolam differing by the absence of a chlorine atom in the ortho-position of the 6-phenyl ring. Xanax has an average molecular mass of 308.765 and a molecular formula C17h23ClN4. It has a crystalline structure and is soluble in alcohol and insoluble in water.

Adverse Effects of Xanax

Xanax shares the adverse effects of many other benzodiazepines. The follow are some of the common adverse effects at higher doses:

• Drowsiness
• Depression
• Headache
• Constipation
• Diarrhea
• Dry mouth

At low doses this medication can exhibit some adverse effects. Some of these are listed below:

• Impaired coordination
• Increased or decreased appetite
• Fatigue
• Memory impairment
• Anxiety and increased heart rate
• Sleeplessness
• Headache or lightheadedness
• Nausea, vomiting, or diarrhea
• Noticeable changes in sex drive
• Menstrual irregularities
• Urinary retention

Drug Interactions of Xanax

Xanax has several drug interactions you should be aware of. If you are prescribed this drug, make sure you cover the following interactions with your doctor and/or pharmacist:

• Alcohol and Caffeine: Avoid alcohol and excessive caffeine consumption while being treated with this medication.
• Antidepressants: This medication combined with antidepressants may increase sedation.
• Sodium Oxybate: Xanax and sodium oxybate, on concomitant administration, increases effects of each other by pharmacodynamic synergism. Never use both in combination.

Additionally, the following medications affect the metabolism, increase or decrease the effects of the drug, and/or increase the toxicity of Xanax:

• Indinavir
• Fosamprenavir
• Etravirine
• Amprenavir
• Clarithromycin
• Cimetidine
• Erythromycin
• Mephenytoin
• Ethotoin
• Fosphenytoin
• Phenytoin
• Ketoconazole
• Itraconazole
• Fluconazole
• Quinupristin
• Rifampicin
• Telithromycin
• Ticlopidine

Disclose all medications, vitamins, and supplements you regularly take with your physician before taking this medication.

Safe Withdrawal from Xanax

Stopping this drug abruptly is hazardous to your safety. In addition to agitation, insomnia, a return of anxiety symptoms, depression, and nervousness, rapid withdrawal from this medication may cause an increase in the risk of seizures. If you need to stop taking this medication, please consult with your physician and develop a safe plan to slowly taper down your dosage. Doing so may reduce the occurrence and severity of debilitating withdrawal symptoms.

References:

1. Caplan, J. P., Epstein, L. A., Quinn, D. K., Stevens, J. R., & Stern, T. A. (2007). Neuropsychiatric effects of prescription drug abuse. Neuropsychology Review, 17(3), 363-80. doi:http://dx.doi.org/10.1007/s11065-007-9037-7
2. Glod, Carol A,R.N., M.S.C.S. (1992). Xanax: Pros and cons. Journal of Psychosocial Nursing & Mental Health Services, 30(6), 36-37. Retrieved from http://search.proquest.com/docview/1026707787?accountid=1229
3. Mui, H. Z., Sales, P., & Murphy, S. (2014). Everybody’s doing it: Initiation to prescription drug misuse. Journal of Drug Issues, 44(3), 236-253. Retrieved from http://search.proquest.com/docview/1540952982?accountid=1229
4. Olin, B. R., PharmD. (2014). The drug book: From arsenic to xanax, 250 milestones in the history of drugs. American Journal of Pharmaceutical Education, 78(5), 1. Retrieved from http://search.proquest.com/docview/1544417081?accountid=1229

Page content reviewed by James Pendleton, ND.

When to take sleeping tablets

Given what we know about the negative impact on your health if you aren’t sleeping well, sleeping tablets may help. However, there can be a real stigma attached to the notion of sleeping tablets. A possible reason for this stigma is that when we read about sleeping pills, it is often attached to a negative story of misuse. Nevertheless, if used correctly there could be significant benefits to the individual’s health and well-being.

What do sleeping tablets do?

Sleeping tablets are designed to induce drowsiness. They are usually short-acting and are not necessarily effective in maintaining sleep (keeping you asleep).

Some sleeping tablets are made specifically to aid sleep, while others are used because their side effect includes sedation.

You must only ever use sleeping tablets when prescribed by a qualified doctor.

Types of sleeping pills

Sleeping pills may be prescribed by a doctor to help in the temporary treatment of mild sleeping disorders like infrequent insomnia.

Sleeping pills are NOT recommended to treat chronic sleep problems as they can have severe side effects and can become addictive.

The following are just a few examples of the types of sleeping pills that are often used to manage insomnia.

Benzodiazepines

These pills have sedative effects that are typically short acting and therefore can quickly help you fall asleep. You can only get them on prescription because they can cause physical dependence and addiction. Common brand names are Temazepam, Mogadon, Serepax. Some benzodiazepines (Xanax and Valium) are primarily prescribed to treat anxiety (see anxiolytics below).

Non-benzodiazepines

These pills also have sedative effects but have a different mechanism that regulates inhibitory GABA receptors in the brain. They are prescription-only. Some common brand names are Ambien, Stilnox, Lunesta, Sonata.

Anxiolytics

Two of the most commonly prescribed tablets, Xanax and Valium are not designed to aid with sleep; instead, they are used to treat anxiety. Since they are benzodiazepines, they also have sedative effects and as such may induce drowsiness and help someone get to sleep. Unfortunately for this reason, they are often misused. Xanax is the number one prescribed medication in the US across all kinds of drugs.

Anti-depressants

Tri-cyclic anti-depressants are primarily used to treat depression (in Australia and the UK) but can also be used to treat insomnia in the USA. Some common brand names are Silenor and Sinequan.

Anti-histamines

These drugs are typically used to treat allergic reactions (e.g., itching, sneezing) and inflammatory responses and can typically be bought over the counter. They have sedating effects however, which can sometimes be long-lasting and may affect activities like driving in the hours after waking.

Side effects of sleeping tablets

This list is not exhaustive and not all types of sleeping tablets result in all of the following. Side effects are dependent on the type of tablet you have, how often you take it, and your own personal health. They may include:

• Dizziness
• Blurred vision
• Headache
• Stomach pains
• Shaking
• Headache

If you suffer from any of the above, consult your doctor.

How sleeping pills are misused

When they are used as a long-term solution

As you likely already know, you should not take sleeping pills for more than a few weeks as they are what we call “habit-forming”. Those who take sleeping pills beyond when they need to can quickly develop a reliance on them, resulting in severe withdrawal when use is stopped.

Once a habit is formed, it is even harder to break. Stopping chronic use of sleeping tablets can result in anxiety, shaking and an increased risk of injury and accidents. Ironically, it can also worsen insomnia.

The body will develop a tolerance to sleeping tablets after three to 14 days. This means that within two weeks you will require a higher dosage to get the same effect as earlier. Other potential effects include developing a physical dependence on the pills which can lead to difficulty getting to sleep and anxiety when stopping use of the pills.

When they are mixed with other medication or alcohol

We all know this: mixing sleeping tablets with alcohol can be dangerous.

Both are sedatives, and a potent combination may cause someone to stop breathing and suffer cardiac arrest. It can also result in sleepwalking which can end in injury and accidents.

Finding solutions to a sleeping issue

While sleeping tablets can help with mild or short-term insomnia, if your sleeping problems persist for longer than a week or two, sleeping tablets will not help.

They should not be used to treat chronic sleep issues – there are other things you should do if you are persistently suffering from sleep problems and we explore them below.

Improving your sleep habits

Sleeping pills aren’t the only choice you have when it comes to resolving persistent sleep issues or improving the quality of sleep you receive.

Relaxation techniques

• Do something relaxing in the 30-60 minutes leading up to bedtime
• Avoid working on a laptop or using your smartphone before bed – the short wavelength blue light emitted from the screens can suppress melatonin production
• If you can’t fall asleep within 20 minutes, get up, leave your bedroom and do something relaxing like reading a book or listening to music (but don’t use electronic devices)
• Read this blog post to find out why you may be having trouble sleeping.

Develop (and stick to) a sleep schedule

• Try to go to sleep and get up at roughly the same time every day
• Avoid caffeine in the afternoon and evenings
• Restrict daytime naps to 20-30 minutes

Look at your bedroom

• Remove the TV
• Make sure your room is not too hot or cold
• Make sure window coverings are sufficient to block out light and help muffle external sound
• Do not eat or use your laptop in bed

If sleeping problems persist, the best thing you can do is see your doctor who will be able to prescribe or recommend treatment, or ascertain whether there is any underlying sleep disorder, like insomnia or sleep apnoea.

How Over-the-Counter Sleep Aids Can Hurt Your Brain

Over-the-counter sleep aids are marketed as a safe, effective and non-habit-forming way to get some zzz’s when sleep seems hard to come by. But what are the long-term effects on your brain? We asked Dan Kaufer, MD, a neurologist and director of the UNC Memory Disorders Program.

Are over-the-counter sleep aids safe? What effects do they have on your brain?

There are three classes of medications that are notorious for causing cognitive side effects. The most common one is benzodiazepines, which includes Valium and Xanax. These are prescribed to treat anxiety and sometimes sleep. Drugs in this class are generally not recommended for long-term use as a sleep aid because they can impair memory and require higher doses over time to achieve the same effect. The other class of medications is narcotic analgesics. These are getting a lot of attention right now—like hydrocodone or oxycodone—because they are very addictive.

Another drug class people don’t realize may undermine brain health is antihistamines. They are commonly used to treat allergies and are generally safe. However, one of these drugs, Benadryl (diphenhydramine), is commonly used in over-the-counter sleep agents. Taking an over-the-counter sleep aid with diphenhydramine once in a while is generally not going to cause problems, other than a possible hangover the next day.

Older people, however, can get confused when taking diphenhydramine because it also blocks a brain chemical called acetylcholine, which plays a big role in attention and short-term memory. Taking diphenhydramine over a long period of time can actually predispose people to dementia. You should be careful not to use these types of medicines all the time in order to get good sleep.

Does that mean it’s not safe to take over-the-counter antihistamines to treat allergies? The pollen is everywhere, and I can’t stop sneezing!

There are different antihistamines, and Benadryl (or diphenhydramine) is among the worst in terms of cognitive side effects. Other types of antihistamines are used to treat allergies, but none of them are used in sleep aids. It’s important to find one that allows you to function well and control your allergy symptoms. The best way to do that is to consult your physician.

Why is a good night’s sleep so important to overall brain health?

One of the things we’re learning more about is that neurocognitive disorders arise from little perturbations in brain metabolism that lead to the gradual buildup of protein deposits over many years. Exposure to diphenhydramine over the short term can make older folks a little squirrely, but long-term use over many years may lead to Alzheimer’s disease.

If people are unable to achieve a good night’s sleep, they really need to consult with a physician. We’re learning more and more how important sleep is for not just short-term brain functioning, but for long-term brain functioning as well.

One of the current theories about what contributes to the development of neurodegenerative disorders is the accumulation of toxic substances in our brains over many years. We’ve learned that sleep plays a role in eliminating these toxic substances. One of the consequences of not getting enough sleep is that these substances stay in the brain and cause a little bit of damage, which, multiplied over many years, can lead to a neurodegenerative disorder.

So a good night’s sleep isn’t just important for how you do the next day, but not sleeping well over a long period of time can have very dire consequences.

Is there anything I can take safely if I’m having trouble getting sleep?

If sleep is a problem, there are several things people can do. There are other natural products people can take to help them get some sleep, such as melatonin. As far as we know, melatonin in general is a perfectly good substitute for diphenhydramine. It’s a natural supplement. It’s the chemical in the brain that actually induces sleep in a natural way.

If you’re having trouble sleeping, talk to your doctor about enrolling in a sleep study. We have locations in Chapel Hill or Wake County.

To Sleep or not to Sleep: Here are your Questions

To Sleep or not to Sleep: Here are your Questions

The Therapeutics Initiative is at arms length from government
and other vested interest groups. Our function is unbiased
review and dissemination of therapeutic evidence. Assessments
apply to most patients; exceptional patients require
exceptional approaches. We are committed to evaluate the
effectiveness of our educational activities using the
Pharmacare database without identifying individual
physicians, pharmacies or patients.

Therapeutics Letter, issue 11, November/December 1995

Many psychiatric
and medical disorders present with symptoms of insomnia and
associated daytime impairment. It is essential to first identify
such disorders if present (e.g. depression, chronic anxiety or
obstructive sleep apnea) so that they can be treated
specifically. The remaining cases represent primary transient or
chronic insomnia. An approach to management of this common
condition in the primary care setting follows.

What are the goals of therapy in
managing a patient with transient or chronic insomnia?

• To promote a sound and satisfying sleep.
• To decrease daytime drowsiness and impairment.
• To reinstate a normal sleep pattern without medication.
• To prevent dependence on drug therapy.

What approaches are essential in
managing all patients?

An improvement in sleep habits is the initial and continuing
goal in all patients. This includes appropriate caffeine, alcohol
and nicotine restriction, daily physical aerobic exercise, regular
sleep and awakening times (including weekends), avoidance of
large meals late in the evening, and maintaining a good sleep
environment. Counseling, encouragement and reinforcement are
essential to achieve compliance with this program.(1)

What non-prescription drugs are useful
in treating insomnia?

Most over-the-counter hypnotics are antihistamines in which
sedation is a significant dose related side effect.
Anticholinergic side effects also occur with these drugs,
including confusion, especially in the elderly. The principles
for their appropriate use are similar to prescription hypnotics; never
combine hypnotic drugs.

Alcohol does not improve sleep; despite initial sedation,
alcohol is associated with an increased number of awakenings. (1)

Are there clinically significant
differences between available prescription hypnotics?

The recommended drugs, benzodiazepines and zopiclone, have a
similar mechanism of action on the benzodiazepine receptor
complex in the brain. They differ in potency, duration of effect
(half-life), side effects and cost (see Table).
The difference in duration of effect is the most clinically
relevant. The drugs with the shortest half-lives (2-3 hours) are
more appropriate when the main difficulty is falling asleep.
Drugs with intermediate half-lives (4-10 hours) are more
appropriate when the goal is to reduce nocturnal awakenings.
Drugs with half-lives >10 hours are likely to have residual
effects after awakening and to be associated with accumulation if
taken on a daily basis. They should be limited to patients with
chronic anxiety (a secondary cause of insomnia) when one wants an
anxiolytic effect the next day.

The fact that a benzodiazepine, (eg. oxazepam) is marketed as
an anxiolytic, does not diminish its usefulness as a hypnotic.

What pharmacological actions of these
drugs are important to appreciate before prescribing?

Objective evidence of effectiveness of hypnotics in
double-blind placebo controlled sleep laboratory trials is small;
total sleep duration is only 15 minutes longer with active drug
than placebo.(2)

Because of the development of tolerance, most hypnotic drugs
rapidly lose effectiveness with continuous nightly use. It makes
sense, therefore, to prescribe hypnotics to be taken
intermittently for short periods (e.g. once every second or
third night for 1-3 weeks). This approach is widely
recommended(3), however, randomized
controlled trials of the effectiveness of this approach are
needed.

The major adverse effect of hypnotics, residual or carry-over
effects upon awakening, should be avoided as much as possible.
The potential risks of residual effects are manifest in the
Saskatchewan study(4), which showed that
current users of long half-life benzodiazepines have a 1.7
relative risk of hip fracture as compared to current users of
short half-life drugs. To minimize such risks use short half-life
drugs in the lowest effective dose; start at of the usual
recommended dose (see Table). Remember that
the response rate to placebo in chronic insomnia is high (~33%)
so you can anticipate a good rate of response to low doses.

How should I manage a new patient with
insomnia?

Work on long term improvements in sleep habits. If adjunctive
medication is needed in the short term use low doses and explain
why it should be taken intermittently to maintain effectiveness.
Don’t prescribe enough for continuous nightly use. A major goal
in new patients is to avoid regular nightly use.

How should I manage the patient who is
taking a hypnotic every night?

The patient who is already a nightly user is a more difficult
problem. Some of these patients can be motivated to stop (as
mentioned above the medication is unlikely to be improving the
duration of sleep). Before stopping, the dose must be reduced by
every 1-2 weeks until the lowest dose in the dose range (see Table) is achieved. Even after tapering, the
patient should be warned that they might experience mild rebound
insomnia for the first 2-3 nights after stopping.(3)

What about older sedative-hypnotics?

The following drugs are still prescribed in British Columbia
in order of decreasing use: chloral hydrate (Noctec),
secobarbital (Seconal), meprobamate (Equanil), ethchlorvynol
(Placidyl), butabarbital (Butisol), pentobarbital (Nembutal), and
amobarbital (Amytal). These drugs are dangerous in overdose,
have no advantages over benzodiazepines and are not recommended.

Conclusions:

Manage insomnia in your practice by education and
encouragement of appropriate sleep habits. If indicated prescribe
hypnotics with short half-lifes, in low doses, for short
duration, and not for regular nightly use.

TABLE: SEDATIVES-HYPNOTICS
IN BRITISH COLUMBIA

Generic Name	Trade Name	Dose Range	Mean Elim* t(hr) (5)	Cost** for Single Lowest Dose ($)
Triazolam	Halcion/Novotriolam	0.0625-0.5 mg	3	0.03
Zopiclone	Imovane	3. 75-7.5 mg	5	0.34
Oxazepam	Serax	7.5-30 mg	7	<0.01
Alprazolam	Xanax	0.125-1.0 mg	12	0.05
Bromazepam	Lectopam	0.75-6.0 mg	12	0.06
Temazepam	Restoril	7. 5***-30 mg	13	0.20
Lorazepam	Ativan	0.25-2.0 mg	14	0.03
Estazolam	Prosam	0.5-2 mg	15	0.22
Clonazepam	Rivotril	0.25 mg	23	0.08
Nitrazepam	Mogadon	2. 5-10 mg	26	0.08
Diazepam	Valium	2.0-10 mg	43	<0.01
Ketazolam	Loftran	7.5***-30 mg	43	0.62
Chlordiazepoxide	Librium/Corax/Solium	2.5-25 mg	64	<0.01
Clorazepate	Tranxene/Novoclopate	1. 9-15 mg	64	0.04
Flurazepam	Somnol/Dalmane	7.5***-30 mg	74	0.02

* Ranked according to half-life of most
slowly eliminated active metabolite.

** 1994 Pharmacare Data.

*** Appropriate low starting dose for this
drug is not possible, as it is only available as a capsule.

REFERENCES

1. Maczaj M. Pharmacological Treatment of
   Insomnia. Drugs. 45(1):44-55; 1993.
2. Nicholson AN, Stone BM. Zopiclone: Sleep
   and performance studies in healthy man. Pharmacology.
   27: suppl. 2, 92-97; 1982.
3. Kryger MH, Roth T, Dement WC. Principles
   and Practice of Sleep Medicine. Second edition, 1994.
   Chapter 30: Hypnotics: Clinical pharmacology and
   therapeutics. 355-363.
4. Ray WA, Griffin MR, Downey W.
   Benzodiazepines of long and short elimination half-life
   and the risk of hip fracture. JAMA.
   262(23):3303-3307; 1989.
5. Goodman Gilman A, Rall TW, Nies AS, Taylor
   P. The pharmacological basis of therapeutics.
   Eighth edition, 1990. Appendix II. Design and
   optimization of dosage regimens; pharmacokinetic data.
   1655-1715.

Please send feedback!

Back to Therapeutics Letter.

Back to the Therapeutics
Initiative Home Page.

Therapeutics Initiative. Last updated: December 20,
1995.

Prescription CNS Depressants DrugFacts | National Institute on Drug Abuse (NIDA)

What are prescription CNS depressants?

Central Nervous System (CNS) depressants are medicines that include sedatives, tranquilizers, and hypnotics. These drugs can slow brain activity, making them useful for treating anxiety, panic, acute stress reactions, and sleep disorders.

CNS depressants cause drowsiness; sedatives are often prescribed to treat sleep disorders like insomnia and hypnotics can induce sleep, whereas tranquilizers are prescribed to treat anxiety or to relieve muscle spasms.

Some examples of CNS depressants grouped by their respective drug class are:

How do people use and misuse prescription CNS depressants?

Most prescription CNS depressants come in pill, capsule, or liquid form, which a person takes by mouth. Misuse of prescription CNS depressants means:

• taking medicine in a way or dose other than prescribed
• taking someone else’s medicine
• taking medicine for the effect it causes — to get high

When misusing a prescription CNS depressant, a person can swallow the medicine in its normal form or can crush pills or open capsules.

How do CNS depressants affect the brain?

Most CNS depressants act on the brain by increasing activity of gamma-aminobutyric acid (GABA), a chemical that inhibits brain activity. This action causes the drowsy and calming effects that make the medicine effective for anxiety and sleep disorders. People who start taking CNS depressants usually feel sleepy and uncoordinated for the first few days until the body adjusts to these side effects. Other effects from use and misuse can include:

• slurred speech
• poor concentration
• confusion
• headache
• light-headedness
• dizziness
• dry mouth
• problems with movement and memory
• lowered blood pressure
• slowed breathing

If a person takes CNS depressants long term, he or she might need larger doses to achieve therapeutic effects. Continued use can also lead to dependence and withdrawal when use is abruptly reduced or stopped. Suddenly stopping can also lead to harmful consequences like seizures.

Can a person overdose on CNS depressants?

Yes, a person can overdose on CNS depressants. An overdose occurs when the person uses enough of a drug to produce life-threatening symptoms or death (read more on our Intentional vs. Unintentional Overdose Deaths webpage).

When people overdose on a CNS depressant, their breathing often slows or stops. This can decrease the amount of oxygen that reaches the brain, a condition called hypoxia. Hypoxia can have short- and long-term mental effects and effects on the nervous system, including coma and permanent brain damage.

How can a CNS depressant overdose be treated?

The most important step to take is to call 911 so a person who has overdosed can receive immediate medical attention. Flumazenil (Romazicon^®) is a medication that medical personnel can use to treat benzodiazepine overdose and has also been shown effective in treating overdose from sleep medicines. The drug might not completely reverse slowed breathing and can lead to seizures in some patients who are taking certain antidepressants. Flumazenil is short acting, and the patient may need more of it every 20 minutes until he or she recovers. For barbiturates and nonbenzodiazepines, body temperature, pulse, breathing, and blood pressure should be monitored while waiting for the drug to be eliminated.

Can prescription CNS depressant use lead to addiction and substance use disorder?

Yes, use or misuse of prescription CNS depressants can lead to problem use, known as a substance use disorder (SUD), which takes the form of addiction in severe cases. Long-term use of prescription CNS depressants, even as prescribed by a doctor, can cause some people to develop a tolerance, which means that they need higher and/or more frequent doses of the drug to get the desired effects. A SUD develops when continued use of the drug leads to negative consequences such as health problems or failure to meet responsibilities at work, school, or home, but despite all that the drug use continues.

Those who have become addicted to a prescription CNS depressant and stop using the drug abruptly may experience a withdrawal. Withdrawal symptoms-which can begin as early as a few hours after the drug was last taken—include:

• seizures
• shakiness
• anxiety
• agitation
• insomnia
• overactive reflexes
• increased heart rate, blood pressure, and temperature with sweating
• hallucinations
• severe cravings

People addicted to prescription CNS depressants should not attempt to stop taking them on their own. Withdrawal symptoms from these drugs can be severe and—in the case of certain medications-potentially life—threatening.

How can people get treatment for prescription CNS depressant addiction?

There isn’t a lot of research on treating people for addiction to prescription CNS depressants. However, people addicted to these medications should undergo medically supervised detoxification because the dosage they take should be tapered gradually. Counseling, either in an outpatient or inpatient program, can help people through this process. One type of counseling, cognitive-behavioral therapy, focuses on modifying the person’s thinking, expectations, and behaviors while improving ways to cope with life’s stresses. Cognitive-behavioral therapy has helped people successfully adapt to stop using benzodiazepines.

Often prescription CNS depressant misuse occurs along with the use of other drugs, such as alcohol or opioids. In those cases, the person should seek treatment that addresses the multiple addictions.

Points to Remember

• Prescription CNS depressants are medicines that can slow brain activity to treat anxiety and sleep disorders.
• Prescription CNS depressants act on the brain by increasing activity of GABA, a chemical that slows brain activity.
• People who start taking prescription CNS depressants usually feel sleepy and uncoordinated at first. They can also have poor concentration, confusion, lowered blood pressure, and slowed breathing.
• A person can overdose on prescription CNS depressants. Flumazenil (Romazicon®) can be used to treat benzodiazepine and sleep medicine overdoses. Body temperature, pulse, breathing, and blood pressure should be monitored while waiting for the drug to be eliminated.
• Prescription CNS depressant use or misuse can lead to a substance use disorder, which takes the form of addiction in severe cases, even when used as prescribed by a doctor.
• Withdrawal symptoms include: seizures; shakiness; anxiety; agitation; insomnia; overactive reflexes; increased heart rate, blood pressure, and temperature; hallucinations; and severe cravings.

Learn More

For more information about prescription CNS depressants, see our:

This publication is available for your use and may be reproduced in its entirety without permission from NIDA. Citation of the source is appreciated, using the following language: Source: National Institute on Drug Abuse; National Institutes of Health; U. S. Department of Health and Human Services.

90,000 instructions, use, analogues of the drug, composition, indications, contraindications, side effects in the reference book of medicines from UNIAN

Application of Xanax

Xanax – composition and release form of the drug

Xanax: how to take the drug

Xanax – contraindications, side effects

Xanax’s analogs

Anxiolytics. Benzodiazepine derivatives. Anxiety disorders, mixed anxiety-depressive disorders, neurotic reactive-depressive disorders, panic disorders.

Application of Xanax

• Anxiety disorders (anxiety neuroses) accompanied by feelings of anxiety, tension, agitation, insomnia, a sense of danger, irritability and somatic symptoms.
• Mixed anxiety-depressive disorders.
• Neurotic reactive-depressive disorders, accompanied by a depressive affect, a growing loss of interest in the world around them, anxiety, psychomotor agitation and insomnia, impaired appetite, changes in body weight, somatic disorders, feelings of inferiority or guilt, suicidal thoughts.
• Anxiety states, mixed anxiety-depressive states, neurotic reactive-depressive disorders develop against the background of somatic diseases.
• Panic disorder, with or without phobic symptoms.

Xanax – composition and release form of the drug

Active ingredients : 1 tablet contains alprazolam – 0.25 mg.

Tablets of 0.25 mg – white elliptical tablets with a break line; 0.5 mg tablets – pink elliptical tablets with a break line.

0.25 mg tablets No. 30

Xanax: how to take the drug

• Anxiety: 0.25 – 0.5 mg three times a day
• 0.5 – 4.0 mg / day in several doses
• Depression: 0.5 mg three times a day
• 1.5 – 4.5 mg / day in divided doses
• Elderly and debilitated patients: 0.25 mg two or three times a day
• 0.5 – 0 , 75 mg / day in several doses with a gradual increase in the dose if necessary
• Panic disorder: 0.5-1.0 mg before bedtime or 0.5 mg three times a day
• The dose should be individually selected depending on the effect , it is possible to increase the dose of no more than 1 mg every 3-4 days. The average dose is 5.7 ± 2.27 mg / day.
• Maximum – 10 mg / day.

Xanax – contraindications, side effects

Xanax is contraindicated in patients with hypersensitivity to benzodiazepines.

Side effects , if they occur, are observed at the very beginning of Xanax therapy and gradually disappear with further use of the drug or with a decrease in dose.

In patients with anxiety, anxiety-depressive syndrome and neurotic depression, drowsiness and dizziness are most often observed.Less commonly, there are effects such as headache, depression, blurred vision, insomnia, nervousness / anxiety, tremors, changes in body weight, memory impairment, coordination disorders, gastrointestinal disorders and autonomic manifestations are possible.

Along with this, there may be undesirable phenomena such as dystonia, irritability, anorexia, fatigue, blurred speech, jaundice, muscle weakness, libido changes, menstrual dysfunction, urinary incontinence (or, conversely, urinary retention) and liver dysfunction. Increased intraocular pressure is very rare.

In patients with panic disorder, among the side effects, sedation, drowsiness, fatigue, ataxia, impaired coordination and blurred speech are more common. Less commonly, mood changes, gastrointestinal symptoms, dermatitis, memory impairments, sexual dysfunctions, intellectual disabilities, and confusion are observed.

When taking Xanax, like other benzodiazepines, side effects such as difficulty concentrating, confusion, agitation, hallucinations and reactions such as irritability, agitation, tantrums, aggressive or hostile behavior are rarely reported.In many of these cases, the patients also received other psychotropic drugs and / or had other mental disorders.

A small number of reports suggest that patients with a history of aggressive behavior, alcohol or drug abuse patients are at a higher risk of developing such reactions. The occurrence of episodes of irritability, hostility, and obsessive thoughts have been reported in patients with post-traumatic reactive disorders upon discontinuation of therapy with alprazolam.

Analogs of Xanax

• Alprazolam
• Zolomax
• Neurol
• Helex

Source: State Register of Medicines of Ukraine. The instructions are published with abbreviations for information only. Before use, consult your doctor and read the instructions carefully. Self-medication can be harmful to your health.

“Witness”: every fifth resident of small towns over 55 years old is on sedatives | Archive

There are more and more people in our society who cannot start their day without taking an antidepressant or sedative.The main reason is depression, which affects 88 thousand inhabitants of Estonia, that is, almost as many as the inhabitants of Tartu. A recent study confirms that, following the example of Western countries, the consumption of mood-altering drugs is in a steady growth trend in Estonia. On the one hand, this is good, because people began to receive the necessary help, but on the other hand, the use of certain drugs began to cause addiction, which gave rise to a phenomenon that was called “housewives addiction. “

The topic of mental health is particularly delicate, with the main characters in this story acting under pseudonyms. They are all successful people with excellent jobs. Looking at them, it is impossible to understand that something is wrong with them. But in their lives, depression and drugs to treat it left an indelible mark. Two of the three heroes of the program took a pill in the morning, just to be able, for example, to give interviews.

To understand what this is about, you need to start with the basics of the problem. Peeter Jaanson, a member of the special psychiatric commission, practicing mainly in South Estonia, explains that a typical patient suffering from depression complains that he has lost the ability to enjoy, he always has a bad mood, it is very difficult for him to concentrate, to collect his thoughts, he feels powerless. often suffers from sleep disturbances, lack of appetite and excessive feelings of guilt.

From the point of view of chemical processes in the body, depression is caused by a lack of serotonin, the so-called. hormone of happiness, and trendy antidepressants such as Prozac regulate serotonin levels. Eduard Maron, a psychiatrist from the Psychiatric Clinic of the North Estonia Regional Hospital, who has worked in England for many years, noted that depression is one of the most common problems in the world. 20% of the world’s people may suffer from it at some point in their lives.

To overcome fear and anxiety, special drugs such as Xanax have been developed.In fact, it often happens that different drugs are used and both anti-anxiety and antidepressant drugs are prescribed to the patient at the beginning of treatment. Katya, who has been using antidepressants for a long time, claims that since an antidepressant can increase anxiety in the initial stages, sedatives are prescribed along with it.

“The danger is that if you take a sedative for longer than the prescribed time, you can become addicted to it,” warns Kati.

A very important difference, according to doctors, in the duration of the course of treatment. Sedatives should be taken for at least 4-6 weeks in a row, and antidepressants should be taken for a year.

The situation often gets out of control

Unfortunately, in many cases the situation gets out of control. Living in the small town of May in her 30s, she admits to being passively addicted to sedatives. Mother Mai, a decent-looking retired woman, has been taking sedatives for 20 years in a row.It all began in the 1990s, when the transition from one life order to another hit middle-aged women especially hard – in the end, May’s mother was diagnosed with depression.

The mother of 12-year-old Mai was admitted to a hospital in Tallinn and prescribed a course of antidepressants. Then Mai believed that the problems would be solved soon, but in reality it was only their beginning. Mother returned to work, new difficulties arose, followed by prostration. A psychiatrist in her hometown prescribed Xanax along with antidepressants.

“This meant that at one point I lost my mother as a person who could be relied on,” May regrets. Mai explained that after taking the medicine, her mother lost her ability to empathize and turned into a robot. Since May was in puberty, disputes arose between mother and daughter. At one point, alcohol abuse was added to the Xanax addiction.

“A person who consumes Xanax and drinks at the same time turns into a monster.I went to high school, and every weekend my mother told me that she was going to commit suicide, ”recalls May.

Another example. Katya, who lives in the capital, was diagnosed with depression 7 years ago. There was a difficult period in a woman’s life at that time – mourning, overwork and communication problems. According to Katya, she herself did not want to take the medicine, but it was explained to her that if something went wrong, she could easily refuse them.

A young woman was prescribed antidepressants, underwent therapy, changed her lifestyle and felt improvements.Together with the doctor, a year later, she decided to stop taking medications.

“When I stopped taking the medication, according to the doctor’s orders, very strong symptoms arose – fatigue, sleep disturbances, irritability, mood swings, depression,” Katy recalls.

This happened several times – a year of taking medications and even more, and then an attempt to stop. Each time the withdrawal symptoms were worse and worse. Once it was like falling into the abyss. In just a week, Katya turned from a more or less normally functioning person into a wreck.

“For about two months I had such a period when every second I felt anguish in my body, a very strong depression,” Katya described her then state.

Katya’s life collapsed overnight. Even earlier, due to illness, her personal life did not work out, but now she was officially recognized as disabled. Together with the doctor, Katya began to try special medications.

“The new medicines did not give anything good. Only terrible side effects – sleep disturbances, apathy, fatigue, insensibility, I actually turned into a vegetable, ”says Kati.

When the woman recovered a little, she began to look for information about the medications she was taking. Katya, who considers herself a serious person who believes in science, has discovered many interesting things for herself.

Are antidepressants addictive?

“The fact that depression occurs due to a lack of serotonin in the brain, which we are constantly being told, is in fact a myth. No study has ever proven that people with depression have serotonin, or the like, in their brains.n. the hormone of happiness, less, ”says Kati.

According to Katya, she learned that long-term use of these drugs can cause various problems, including the urge to commit suicide or manifestations of unmotivated violence.

May with her sick mother lived to middle age. To date, Mai’s mother, twice a grandmother, has repeatedly tried to stop taking sedatives, but each time she returns to them. Two years ago, Mai’s mother suffered a stroke but is still on medication.

“A stroke survivor in her 60s comes to her family doctor and says that she wants to start taking Xanax again every day, and the doctor is prescribing her medication. I cannot imagine that with this doctor who does this, it happens in the mind or psyche. Just prescribes Xanax for years, not months. We are talking now about 20 years, ”May says indignantly.

Doctors who agreed to comment on this situation for the Pealtnägija program condemn such cases.

“It is absolutely clear that this is not normal,” Edouard Maron confirmed.

According to Peeter Jaanson, the Special Psychiatric Commission recommends that all doctors who prescribe sedatives, at the slightest suspicion that the patient may become addicted to drugs, take into account that further prescribing sedatives will not lead to anything good.

Statistics confirm the spasmodic increase in the consumption of drugs that affect mood in recent years. According to a recent study by the Institute for Health Development, nearly 5% of the Estonian population take antidepressants, and one in ten use sedatives.The statistics of consumption among women over 55 years old in small settlements is especially highlighted – every fifth, and among them is mother May. So this phenomenon arose – drug addiction among housewives.

Peeter Jaanson emphasizes that it is often forgotten that prescribing sedatives is easy, and stopping treatment is much more difficult.

Doctors recognize that sedatives can be addictive and abuse is a problem in Estonia, but the cases of Katya and others like her are viewed in a different light.They call stories about terrible withdrawal symptoms after using antidepressants as erroneous.

“Antidepressants cannot be addictive,” said Edouard Maron.

According to Peeter Jaanson, patients often mistakenly equate long-term treatment with addiction.

However, Katya is not at all alone. There are enough skeptics about antidepressants in the world. In addition, negative stories from time to time emerge in the Western media in which antidepressants are linked to suicides and even a recent plane crash that occurred due to inappropriate actions of the co-pilot.

There are also doubters in Estonia who have their own community on the Internet. One of those calling for caution with antidepressants is Tiit, who was diagnosed with depression six years ago while attending university. Tiit is also an example that this is not only a woman’s problem.

Tiit used four different medications over the years with varying success, went to a psychologist and underwent therapy. Some medications have had unpleasant side effects.For example, the feeling that you are about to lose consciousness. Other medications have been associated with severe weight gain.

Doctors do not deny that the effect can be individual and unpleasant side effects can occur.

“It often happens that an antidepressant is simply not suitable for the patient,” says Eduard Maron.

From time to time there is a feeling that the parties call the same thing by different names. When, after the end of long-term treatment, a patient develops anxiety symptoms, he calls it addiction, and doctors say that this is a disease that has come back.Doctors cite the example of diabetics or people with high blood pressure who cannot live without medication, but no one calls it addiction.

Katya and the doctors argued about this for a long time. Her way is to reduce the dose of drug intake in small steps over time.

“I don’t know what lies ahead of me, how this process will go, but presumably it will take another couple of years,” she said.

Psychiatrists welcome the increase in antidepressant use, but the widespread use of sedatives is treated with caution.Last year, family doctors, psychiatrists and the Health Insurance Fund jointly developed a new guideline for the treatment of mental disorders, which once again highlights all the main dangers associated with the use of special drugs.

What manufacturers of sleeping pills are silent about :: Coronavirus :: Dni.ru

After a hard day at work, a person’s greatest desire is to quickly and soundly fall asleep. But here’s the bad luck: the brain stubbornly does not want to turn off the internal monologue.All the lambs and elephants are counted, but the long-awaited dream never arrives. Then the last resort remains – to take sleeping pills. At the same time, few people know that this simple manipulation can cause premature death.

Insomnia is one of the most pressing medical problems that physicians around the world are working on. There is no single cause of sleep disturbance. The tense rhythm of life, stress, inadequate rest – all this leads to chronic fatigue and disturbances in the psychophysical state of a person.

The easiest way to get rid of this scourge is to take sleeping pills. However, this can be done not always and not for everyone. Which drugs are safe and which should be taken with extreme caution? Can traditional medicine become a full-fledged alternative to “chemistry”? What effect does the use of sleeping pills have on the heart? Dni.Ru decided to investigate and asked for clarification from the head of the emergency cardiology department of the Central Clinical Hospital of the Administrative Department of the President of Russia Nikita Lomakin .

Is it a side effect of death?

According to the cardiologist, the use of sedatives and sleeping pills increases the risk of premature death. This is especially true for people with heart disease. Large-scale studies conducted in many European and Eastern countries show that cardiovascular risk – that is, the likelihood of death – increases with prolonged use of sleeping pills, Lomakin said. For example, in 2015 in China, as part of a large meta-analysis, scientists examined the condition of about one million three hundred thousand patients who received various sleeping pills.

This large sample showed that the use of sleeping pills is associated with an increased risk of death. In this case, we are talking about the chronic daily intake of sleeping pills. That is, episodic or single intake of sleeping pills does not lead to such risks, the chief cardiologist of the Central Clinical Hospital emphasized.

Earlier, experts from Japan, led by Dr. Masashiko Setoguchi, found out that in people suffering from heart failure, taking sleeping pills significantly increases the risk of developing cardiovascular complications.At the Heart Failure Congress 2014, held in Athens, it was reported that Japanese doctors followed 111 patients hospitalized with complications of cardiovascular diseases for 180 days after discharge.

Photo: Mario Tama / Gettyimages.ru

It was found that taking benzodiazepine hypnotics in patients with heart failure increased the risk of hospital readmission eightfold compared to those who were not prescribed such drugs.Also in this group, while taking it, there was an increase in the risk of death from cardiovascular diseases – stroke and heart attack. Scientists note: it is necessary to conduct larger studies that could confirm the results obtained.

Meanwhile, the first place in the list of causes of premature death belongs to oncological diseases, and there is also a connection between the occurrence of a tumor and taking sleeping pills, notes Nikita Lomakin. Why the risk of getting cancer increases while taking these drugs is unknown, but this fact has been established and is currently being discussed, the expert added.

In addition, the use of sleeping pills is fraught with another threat: a link has been revealed between the use of these drugs and an increase in mortality from various kinds of injuries. The fact is that sleeping pills worsen attention and slow down the reaction, so people after taking them are more likely to get into accidents and disasters.

Let’s understand in terms of

All hypnotics are fundamentally divided into benzodiazepine hypnotics (for example, Phenazepam, Diazepam, Closepid, Mezapam, Tofizopam) and non-benzodiazepine (Zolpidem, Atarax, Afobazol).If we compare these groups with each other, then benzodiazepines will be slightly more dangerous than non-benzodiazepines, the expert believes.

Benzodiazepines appeared on sale in pharmacies in the 60s of the last century in the form of tranquilizers, such as Librum, Elenium, Seduxen. Several years later, doctors came to the conclusion that the sedative effect of these drugs can be used to combat sleep disorders.

It is now known that it is impossible to draw a clear line between the tranquilizing and hypnotic effects of benzodiazepines.An overdose of these substances can cause poisoning, and if taken constantly, they cause drug dependence. At the same time, an overdose of these drugs is rarely fatal, but the danger increases significantly when a large dose is combined with alcohol or another psychotropic drug.

With the use of benzodiazepine hypnotics, you need to be extremely careful: with prolonged use, they are addictive, and some of them can even lead to drug dependence.For example, Phenazepam has a general relaxing effect on the body, which causes shortness of breath, as well as prolonged confusion, coma, or even death. In March 2016, this drug was included by the UN Commission on Narcotic Drugs in the list of substances under special control.

Photo: GLOBAL LOOK press

There are also so-called anxiolytics – anti-anxiety drugs, or tranquilizers, which can also have a hypnotic effect.Tranquilizers – for example, Xanax, Lorazepam, Elenium, Diazepam, Tenoten, Relanium – are used to relieve panic attacks, anxiety, stress and depression and can also normalize sleep.

Getting to know better

Many sedatives, such as Phenozepam, Zolpidem, Zaleplon, Zopiclone, are not dispensed from the pharmacy without a prescription, others can be bought on the open market (Persen, Dormiplant, Novo-Passit). How to understand this variety and which sleeping pills to prefer?

The list of over-the-counter sleeping pills is quite large.Among such drugs, Donormil and Melaxen occupy a special place. They are considered effective remedies for insomnia. Moreover, in some cases, the minimum dosage is enough to obtain the desired result.

Melaxen is an over-the-counter sleeping pill based on the artificially synthesized hormone melatonin, which is structurally identical to human melatonin. Since melatonin is the main regulator of circadian rhythms, and its production directly affects falling asleep and the quality of sleep, the effect of Melaxen is as natural as possible.This determines its safety and explains the fact that Melaxen can be purchased at any pharmacy without a prescription.

Despite the fact that the drug is an analogue of the human hormone melatonin, which is synthesized in the pineal gland (pineal gland) of the brain and is responsible for the regulation of circadian rhythms, such as sleep-wakefulness, it is created from plant materials and is not hormonal.

Melaxen is especially effective for insomnia associated with shift work, long-distance flights, jet lag and other causes of biorhythm failure.It also helps to fall asleep well in cases of so-called situational insomnia, when anxious thoughts and feelings interfere with leaving the kingdom of Morpheus.

Photo: GLOBAL LOOK press / Oleksiy Maksymenko

You do not need a doctor’s approval to start taking artificial melatonin. This remedy does not threaten daytime sleepiness, morning headaches, lack of coordination and other negative reactions inherent in other drugs. In addition, Melaxen can be used for a long time – addiction and addiction do not arise.

Donormil, known since 1948, is a worthy alternative to other sleeping pills. It has a pronounced sedative effect, promotes rapid falling asleep and cessation of frequent nighttime awakening. Donormil improves sleep, promotes, increases its duration and improves quality, without affecting sleep phases.

At the same time, Donormil has many contraindications. For example, it should not be taken by men with diseases of the urethra or prostate gland, children under 15, women during lactation and during pregnancy.

Herbal remedies are created on the basis of soothing herbs: valerian, motherwort, lemon balm, St. John’s wort, hawthorn, passionflower, hops, elderberry. These are Persen, Dormiplant, Novo-Passit. Valerian and motherwort are also widely used separately, they are presented in pharmacies both in the form of tablets and in the form of a tincture.

In old age

Between 6% and 20% of European adults regularly take sleeping pills, and many do it uncontrollably, without being under the supervision of a doctor.Most often, the elderly take sleeping pills, because they are more likely to suffer from sleep disorders, are prone to depression and are prone to unreasonable anxiety.

Meanwhile, the health and life risks associated with the use of these drugs are very high in old age. For this reason, older people tend to increase their consumption of sleeping pills. At the same time, they often forget that the aftereffect of such drugs in old age can also be severe: confusion, dizziness, and memory loss are possible.

Doctors warn: patients over 65 should be especially careful with sleeping pills. In an elderly person, taking the drug may cause dizziness and a delayed reaction with the danger of falling (for example, with nighttime awakenings after taking sleeping pills).

In addition, excitability increases, confusion develops, memory, attention, coordination are impaired. A particular danger for the elderly is a possible fall while taking a sleeping pill with possible bone fractures – in the worst case, a hip fracture.

It is noteworthy that the risk of falls depends on the drug taken. Thus, it is significantly higher when using diazepam in comparison with other benzodiazepines, especially oxazepam.

In modern medicine, there are various approaches to the treatment of dependence on sleeping pills, but the main one is their gradual withdrawal in combination with psychotherapy. When treating anxiety and insomnia, antidepressants, including trazodone, can be an alternative to these drugs.

“Natural product”

The most famous home remedy for insomnia is alcohol.Despite the fact that serious scientific studies have not confirmed the hypnotic properties of alcoholic beverages, many people admit that a glass before bed helps to fall asleep.

However, the problem is that a small dose of alcohol is not effective for a serious sleep disorder, and a large dose is short-lived. Waking up within a few hours after taking alcohol, a person does not feel rested. He again cannot sleep, tormented until the morning. In addition, this “medicine” has a well-known side effect – hangover symptoms.

Traditional medicine is also ready to help those suffering from sleep disorders. Healers widely use various herbal medicines made according to old recipes. They are often touted as natural cures for natural sleep, as opposed to artificially created chemicals.

The most famous components of natural “sleepy” preparations are infusion of hop cones, cumin and dill seeds, valerian root and motherwort herb.However, such agents should be used with caution: the hypnotic properties of plants have not yet been fully studied and can have dangerous side effects.

To drink or not to drink?

So is it worth giving up all sedatives and sleeping pills? Experts note: hypnotics are good if you need to instantly improve the patient. However, in the long term, they recommend finding another way to cope with difficult life situations.

In some countries, more than 95% of patients suffering from insomnia are prescribed sleeping pills.In the meantime, it should be remembered that the sleeping pills prescribed by the doctor should be used for the shortest possible period of time – many sleeping pills are addictive.

Photo: GLOBAL LOOK press / Hans-Martin Dewitz

Sleep pills are powerful drugs, the effect of which is not limited to the regulation of sleep functions. It should be remembered that they exacerbate snoring and apnea (respiratory arrest) during sleep, affect brain function, so they should not be taken randomly and spontaneously, from time to time

Ideal sleeping pills should only affect the quality of night sleep and should not affect your physical condition during daytime wakefulness.However, any sleeping pill currently on the pharmacological market has an aftereffect: if a person takes a medication for insomnia in the evening, then the next morning, until noon, he will experience drowsiness, fatigue, and decreased mental performance.

This state is like a hangover. At the same time, the persistent sedative effect slows down the reaction, and the patient is not aware of his sluggish state. This can be dangerous in situations that require a high concentration of attention.In Finland, for example, a blood test of road traffic victims showed the presence of benzodiazepines in the blood. It is noteworthy that the aftereffect of these tranquilizers persisted even one day after administration.

In addition, after discontinuation of the drug, sleep for several nights becomes disordered and more superficial. Often, the patient can not stand it and returns to taking sleeping pills, maintaining dependence on the drug. You can eliminate this situation by gradually reducing the dose of sleeping pills taken.

READ “DNI.RU” IN INSTAGRAM – GIFTS AND EXCLUSIVES

XANAX tablets – instructions for use, price, dosages, analogs, contraindications, reviews

Composition and release form of the drug

10 pcs. – contour cell packaging (3) – cardboard packs.

Pharmacological action

Anxiolytic agent (tranquilizer), a triazolo-benzodiazepine derivative. It has anxiolytic, sedative, hypnotic, anticonvulsant, central muscle relaxant effect.The mechanism of action is to enhance the inhibitory effect of endogenous GABA in the central nervous system by increasing the sensitivity of GABA receptors to the mediator as a result of stimulation of benzodiazepine receptors located in the allosteric center of postsynaptic GABA receptors of the ascending activating reticular formation of the brainstem and interneurons of the lateral horns of the spinal cord; reduces the excitability of the subcortical structures of the brain (limbic system, thalamus, hypothalamus), inhibits polysynaptic spinal reflexes.

Pronounced anxiolytic activity (decrease in emotional stress, weakening of anxiety, fear, anxiety) is combined with a moderately pronounced hypnotic effect; shortens the period of falling asleep, increases the duration of sleep, reduces the number of night awakenings. The mechanism of hypnotic action is to inhibit the cells of the reticular formation of the brain stem. Reduces the impact of emotional, autonomic and motor stimuli that disrupt the mechanism of falling asleep.

Pharmacokinetics

After oral administration, alprazolam is rapidly and completely absorbed from the gastrointestinal tract. C _max in blood plasma is achieved within 1-2 hours.

Plasma protein binding is 80%.

Metabolized in the liver.

T _1/2 averages 12-15 hours. Alprazolam and its metabolites are excreted mainly by the kidneys.

Related news

Indications

Anxiety, neuroses accompanied by feelings of anxiety, danger, anxiety, tension, poor sleep, irritability, as well as somatic disorders; mixed anxiety-depressive states; neurotic reactive-depressive states, accompanied by a decrease in mood, loss of interest in the environment, anxiety, loss of sleep, loss of appetite, somatic disorders; anxiety and neurotic depression that developed against the background of somatic diseases; panic disorder with and without phobic symptoms.

Contraindications

Coma, shock, myasthenia gravis, angle-closure glaucoma (acute attack or predisposition), acute alcohol poisoning (with weakening of vital functions), opioid analgesics, hypnotics and psychotropic drugs, chronic obstructive respiratory diseases with initial insufficiency, acute respiratory failure, severe depression (suicidal tendencies may occur), pregnancy (especially the first trimester), lactation, children and adolescence up to 18 years, hypersensitivity to benzodiazepines.

Dosage

Individual. The minimum effective dose is recommended. The dose is adjusted in the course of treatment, depending on the achieved effect and tolerance. If it is necessary to increase the dose, it should be increased gradually, first in the evening, and then in the afternoon.

The initial dose is 250-500 mcg 3 times / day, if necessary, a gradual increase to 4.5 mg / day is possible.

For elderly or debilitated patients, the initial dose is 250 mcg 2-3 times / day, maintenance doses are 500-750 mcg / day, if necessary, taking into account tolerance, the dose can be increased.

Cancellation or reduction of the dose of alprazolam should be carried out gradually, reducing the daily dose by no more than 500 mcg every 3 days; sometimes an even slower cancellation may be required.

Side effects

From the side of the central nervous system: at the beginning of treatment (especially in elderly patients) drowsiness, fatigue, dizziness, decreased ability to concentrate, ataxia, disorientation, unsteadiness of gait, slowing of mental and motor reactions; rarely – headache, euphoria, depression, tremor, memory loss, impaired coordination of movements, depression of mood, confusion, dystonic extrapyramidal reactions (uncontrolled movements, incl.h. eyes), weakness, myasthenia gravis, dysarthria; in some cases – paradoxical reactions (aggressive outbursts, confusion, psychomotor agitation, fear, suicidal tendencies, muscle spasm, hallucinations, agitation, irritability, anxiety, insomnia).

On the part of the digestive system: possible dry mouth or salivation, heartburn, nausea, vomiting, loss of appetite, constipation or diarrhea, liver dysfunction, increased activity of hepatic transaminases and alkaline phosphatase, jaundice.

On the part of the hematopoietic system: leukopenia, neutropenia, agranulocytosis (chills, hyperthermia, sore throat, excessive fatigue or weakness), anemia, thrombocytopenia are possible.

From the urinary system: possible urinary incontinence, urinary retention, impaired renal function, decreased or increased libido, dysmenorrhea.

From the endocrine system: changes in body weight, libido disturbances, menstrual irregularities are possible.

From the side of the cardiovascular system: a decrease in blood pressure, tachycardia is possible.

Allergic reactions: possible skin rash, itching.

Drug interaction

With the simultaneous use of psychotropic, anticonvulsants, drugs and ethanol, an increase in the inhibitory effect of alprazolam on the central nervous system is observed.

With the simultaneous use of blockers of histamine H ₂ -receptors reduce the clearance of alprazolam and increase the inhibitory effect of alprazolam on the central nervous system; antibiotics from the macrolide group – reduce the clearance of alprazolam.

With the simultaneous use of hormonal contraceptives for oral administration increase T _1/2 alprazolam.

With the simultaneous use of alprazolam with dextropropoxyphene, a more pronounced depression of the central nervous system is observed than in combination with other benzodiazepines, because an increase in the concentration of alprazolam in blood plasma is possible.

Simultaneous intake of digoxin increases the risk of cardiac glycoside intoxication.

Alprazolam increases the concentration of imipramine in the blood plasma.

With the simultaneous use of itraconazole, ketoconazole enhance the effects of alprazolam.

With the simultaneous use of paroxetine, it is possible to enhance the effects of alprazolam, due to the inhibition of its metabolism.

Fluvoxamine increases the concentration of alprazolam in the blood plasma and the risk of developing its side effects.

With the simultaneous use of fluoxetine, it is possible to increase the concentration of alprazolam in the blood plasma due to a decrease in its metabolism and clearance under the influence of fluoxetine, which is accompanied by psychomotor disorders.

The possibility of enhancing the action of alprazolam while using it with erythromycin cannot be ruled out.

Special instructions

For endogenous depression, alprazolam can be used in combination with antidepressants. With the use of alprazolam in patients with depression, cases of the development of hypomanic and manic states have been noted.

Alprazolam should be used with caution in patients with impaired liver and / or kidney function.

In patients who have not previously taken drugs that affect the central nervous system, alprazolam is effective in lower doses than in patients who received antidepressants, anxiolytics or chronic alcoholism.

With prolonged use in high doses, addiction and drug dependence may develop, especially in patients prone to drug abuse.

With a rapid dose reduction or abrupt withdrawal of alprazolam, a withdrawal syndrome is observed, the symptoms of which can range from mild dysphoria and insomnia to a severe syndrome with abdominal and skeletal muscle cramps, vomiting, increased sweating, tremors and seizures. Withdrawal syndrome is more common in individuals for a long time (more than 8-12 weeks.) who received alprazolam.

Do not use other tranquilizers simultaneously with alprazolam.

The safety of using alprazolam in children and adolescents under the age of 18 has not been established. Children, especially at a younger age, are very sensitive to the inhibitory effect of benzodiazepines on the central nervous system.

Avoid alcohol consumption during treatment.

Influence on the ability to drive vehicles and use mechanisms

During the period of treatment, one should refrain from engaging in potentially hazardous activities that require increased attention and speed of psychomotor reactions (driving vehicles or working with mechanisms).

Pregnancy and lactation

Alprazolam has a toxic effect on the fetus and increases the risk of developing congenital defects when used in the first trimester of pregnancy. Continuous use during pregnancy can lead to physical dependence with the development of withdrawal syndrome in the newborn. Reception in therapeutic doses in later stages of pregnancy can cause depression of the central nervous system of the newborn. Application immediately before childbirth or during childbirth can cause respiratory depression, decreased muscle tone, hypotension, hypothermia and weak sucking in the newborn (sluggish sucking syndrome of the newborn).

It is possible that benzodiazepines are excreted in breast milk, which can make the newborn sleepy and make feeding difficult.

In experimental studies it was shown that alprazolam and its metabolites are excreted in breast milk.

Application in children

Contraindication: children and adolescents under 18 years of age.

In case of impaired renal function

Alprazolam should be used with caution in patients with impaired renal function.

In case of impaired liver function

Alprazolam should be used with caution in patients with impaired liver function.

Use in the elderly

For elderly or debilitated patients, the initial dose is 250 mcg 2-3 times / day, maintenance doses are 500-750 mcg / day, if necessary, taking into account the tolerance, the dose can be increased.

The description of the XANAX preparation is based on the officially approved instructions for use and approved by the manufacturer.

The price information provided for the drugs does not constitute an offer to sell or buy a product. The information is intended solely for comparing prices in inpatient pharmacies operating in accordance with Article 55 of the Federal Law “On Circulation of Medicines”.

Found an error? Select it and press Ctrl + Enter.

Alprazolam – terrible withdrawal syndrome

Alprazolam – better known as “Xanax”.

This is a medicinal tranquilizer from the benzodiazepine group, which practically does not cause drowsiness.

More popular with rappers and hip-hoppers in the celebrity hangout. It is used to treat panic disorder, neurosis and social phobia. Alprazolam is a prescription drug, but drug dealers somehow bypass this system and sell it on the black market for many times more.

Drug addicts have learned to use it with alcohol and opioid drugs.

Read the instructions carefully

Even if you take this medicine under the supervision of a doctor, it becomes very addictive, and the feeling of anxiety, anxiety and fear does not go away completely.The drug lowers the heartbeat and breathing rhythm, and if you have uncontrolled use and mix it with drugs or alcohol, the body begins to work incorrectly.

In America, according to statistics, Alprazolam is consumed by 5% of the population, approximately 12 million people . And that’s just the simple adult population. Of these, 10-25% cannot refuse taking the drug. People begin to feel panicky when they refuse and then they will continue to accept. Even not drug addicts, but ordinary people, are addicted to such substances.Starting to use the drug, you must definitely read the instructions and reviews on the Internet. Alprazolam has a terrible withdrawal syndrome. Below is a brief description of the cancellation, i.e. what happens to the person and how he coped with it.

The real story of the “cancellation”

(For privacy reasons, the photograph does not show the people mentioned in this article.)

A young man wanted to get off Xanax. Gradually, the doctor began to reduce his daily dose from 20 milligrams.But his friend dies and the guy breaks down. Starts using heroin. Constantly a swarm of thoughts in his head and he cannot come to a calm state, this lasted two weeks. A month later, after the start of reducing the doses of the drug, the amount was again reduced. The young man returned to work, but he constantly feels anxiety, confusion in his head, sits at home and plays computer games, only goes to the store. Two weeks later, the dose of Alprazolam was reduced again. The guy’s muscles twitch, his hands are trembling, he has no appetite. After another decline, euphoric hysteria sets in.His favorite singer died, his dose of the drug was reduced and irritation began, discomfort in the stomach, periodic muscle spasms do not stop.

Again, the dose was lowered, the guy understands that he must not throw abruptly, although it exhausts him terribly, he must hold on to the end. At the last stages, panic and anxiety increase. The head is spinning from thoughts, muscle spasms do not stop, there is practically no sleep. At 5 milligrams, the head slowly clears up, but thoughts are disordered, anxiety rolls over.At 3 milligrams, a feeling of happiness and normal communication with relatives appears, sleep lasts longer. Forces return, there is work, thoughts acquire order. The feeling of joy and happiness does not leave the young man, he is sure that he will not return to these pills anymore, he simply does not want to experience everything anew.

Reading the entire diary and trying to describe briefly what is happening with the person, terrible thoughts come over Xanax.