According to statistics, 45.4% of the respondents had experienced different degrees of insomnia in the past month. As many as 10% to 15% of adults meet the diagnostic criteria for insomnia, it is very important to choose and use hypnotics rationally.
1. How to choose hypnotics?
There are two types of sedative-hypnotics commonly used in clinical practice: benzodiazepines and non-benzodiazepines.
Non-benzodiazepines:
- Features: Sedation and hypnosis
- Representative drug: zaleplon, half-life: 1 hour
- Zopiclone, half-life: 5 hours
Benzodiazepines:
Features: sedative hypnotic anxiolytic muscle relaxation cognitive impairment drug dependence
Representative drug: triazolam, half-life: 2~6 hours
Estazolam, half-life: 10~24 hours
Diazepam, half-life: 20 to 70 hours
2. Non-benzodiazepine drugs are preferred.
Only patients with difficulty falling asleep (>30 minutes) can choose zaleplon. The elimination half-life of zaleplon is only 1 hour, and the next day residual effect is small. For patients with difficulty falling asleep and/or sleep maintenance disorders, eszopiclone, zopiclone or zolpidem can be used.
Sleep maintenance disorder mainly refers to: the number of awakenings ≥ 2 times throughout the night, the total sleep time < 6.5 hours, accompanied by daytime dysfunction. Zolpidem varies greatly among individuals (the elimination half-life is 0.7-3.5 hours), and Zopiclone can be tried for those who are ineffective. Eszopiclone is the “active ingredient” in zopiclone, and its adverse reactions are less than that of zopiclone.
3. Benzodiazepines
For patients who are ineffective or intolerant to non-benzodiazepine drugs, or are accompanied by anxiety, moderate-effect benzodiazepine drugs can be used.
Commonly used intermediate-effect benzodiazepines include estazolam, alprazolam, lorazepam, etc. (the second category of psychotropic drugs, generally, each prescription should not exceed 7 daily doses).
Triazolam is a benzodiazepine drug with a short half-life and high incidence of addiction and amnesia. It has been listed as a class I psychotropic drug management (each prescription should not exceed 3 daily doses).
Diazepam (stable) has a long half-life and a large residual effect the next day, so it has been rarely used clinically for the treatment of insomnia.
4. The elderly try to avoid using benzodiazepines.
Benzodiazepines can not only cause cognitive impairment and drug dependence, but also have muscle relaxant effects, which can increase the risk of falls in the elderly.
5. How long can hypnotics be used?
Chronic insomnia patients:
Non-benzodiazepines (zolpidem, zopiclone, eszopiclone, zaleplon) are recommended.
Under the guidance of a physician, use intermittent dosing or an as-needed regimen.
Intermittent dosing: Take 3 to 5 times a week.
Take as needed: If you have important work or affairs the next day, you can take it before going to bed. Do not take if not necessary.
Continuous use, no more than 4 weeks, more than 4 weeks need to be re-evaluated.
Patients who take the drug for a long time should not stop the drug suddenly, otherwise withdrawal symptoms may occur.
6.How to explain the use of hypnotics?
- Go to bed immediately after taking the medicine and stay in bed for 7 to 8 hours.
- No alcohol allowed!
- Avoid driving vehicles and operating machinery!
- During the medication, if chest tightness, shortness of breath, tremor, unsteady standing, depression, mental
- confusion, diplopia, hallucinations, urinary incontinence and other problems occur, please seek medical attention.
- Seek medical attention in case of complex sleep behaviors!
- Zolpidem, zopiclone, eszopiclone, and zaleplon can all cause complex sleep behaviors. Complex sleep behavior mainly refers to patients who sleepwalk, drive or eat while falling asleep, make phone calls, and have sexual intercourse after taking the drug, and have no memory of the occurrence of these behaviors.
- Zopiclone and eszopiclone can be secreted through saliva, and the most common adverse reaction is bitter taste in the mouth.
Conclusion:
While various medications are available for treating insomnia, the drug of choice depends on individual needs, preferences, and health considerations. Prioritizing non-pharmacological approaches like and discussing treatment options with a healthcare provider are essential steps toward achieving restful and rejuvenating sleep.
