From clinical psychology, insomnia problems, whether they involve falling asleep or maintaining sleep, are preferably treated using behavioral techniques such as stimulus control, sleep hygiene, and Jacobson’s progressive muscle relaxation.
However, in cases of insomnia that are severe or resistant to psychological therapy, it may be necessary to combine it with the use of medications. In this article we will talk about the most used and known types of hypnotic drugs
Below we will describe the most common groups of hypnotic medications at the present and in the second half of the 20th century. Although today Benzodiazepine analogues are the pharmacological treatment of choice for insomnia in some places classic hypnotics such as benzodiazepines and barbiturates are still used.
It is important to keep in mind that not all of these drugs are used to treat insomnia, but some of them are very powerful and specific medications for the management of other disorders. We include these cases in the list because of the significance of the hypnotic effects associated with their consumption or their relevance in the history of sleeping pills.
1. Benzodiazepines
Benzodiazepines include some of the most commonly used drugs to treat insomnia symptoms, especially the short-lived variants. However, long-term use of these medications leads to risk of dependence and withdrawal syndrome, since it acts in a similar way to alcohol and just like this one, it ends up altering sleep.
The use of benzodiazepines as hypnotics has been in decline since the 1990s, a time when benzodiazepine analogues were developed, which we will refer to in the following section. Currently, drugs in this class are used primarily to treat symptoms of anxiety and alcohol withdrawal for short periods of time.
2. Benzodiazepine analogues (Z drugs)
Benzodiazepine analogues are drugs with properties very similar to those of benzodiazepines, although they cannot be classified in this group due to their different chemical structure. In recent years they have become the most used hypnotics in many places in the world since they have been attributed high security.
Three medications mainly stand out in this category: zolpidem, zaleplon and eszopiclone. Another of the best-known Z drugs, zopiclone, has been withdrawn in some countries because of its side effects, which are not very different from those of benzodiazepines.
3. Orexin receptor antagonists
Various recent medications They have antagonistic effects on the neuropeptide receptors called orexin or hypocretin, which is associated with alertness and wakefulness, as well as appetite. The degree of effectiveness of these drugs has yet to be assessed, although the use of Suvorexant has been approved and research on Lemborexant is promising.
4. Barbiturates
Barbiturates were the most commonly used medications to treat insomnia until the advent of benzodiazepines, which cause fewer side effects. Currently, different types of barbiturates are used as surgical anesthetics and as anticonvulsants in cases of epilepsy, but Their application as hypnotics has become very unusual
The continued consumption of these drugs carries a high risk of physical and psychological dependence, which in turn explains the intense withdrawal syndrome associated with barbiturates. Another factor that contributed to the loss of popularity of these medications was the worrying number of suicides due to overdoses.
Quinazolinones are chemical compounds with diverse medical properties: they can have anti-inflammatory, analgesic, antibacterial, antifungal and anticonvulsant effects. In addition, the anticancer properties of some quinazolinones, such as Idelalisib, have been investigated, although these studies have been abandoned due to side effects.
In the 1960s and 1970s it was very popular Methaqualone, better known by its trade name “Quaalude” This hypnotic drug was widely used as a recreational drug during this era, especially in nightclubs.
6. Anesthetics
Medications used as anesthetics are often considered members of the same category as hypnotics and sedatives. Within this group we find propofol, etomidate and ketamine; the first two are frequently administered to people, while ketamine is more used in veterinary medicine.
7. Cannabinoids
Chemical compounds derived from cannabis, such as tetrahydrocannabinol and cannabidiol, are sometimes used as psychotropic drugs because of their sedative, hypnotic and analgesic properties. In recent years, medicines have been developed from marijuana that carry a relatively low risk of dependency.
8. Melatonin
Melatonin is a hormone that is involved in the regulation of biological rhythms, especially in the sleep-wake cycle. Currently there are medications based on melatonin that They are used as an alternative treatment for insomnia ; However, despite the ease of access to these products, they must be used with a medical prescription.
