Summary
Benzodiazepines are a family of drugs used as
tranquilizers. Some of these drugs have
been shown to be effective for short-term
treatment of insomnia. The
particular drug prescribed to treat insomnia should depend
on a patient's diagnosis, medical condition, use of alcohol
or other drugs, age, and need to function when awakened
during the usual sleep period.
Older people, who cannot metabolize and
excrete drugs as well as younger people, may be more likely
to experience daytime drowsiness, slurred speech, and falls.
Therefore, doctors try to avoid prescribing long-acting
benzodiazepines, such as
chlordiazepoxidediazepam),
(flurazepam),
and nitrazepam, for older people.
Types of Hypnotics
Concerning the
prescription hypnotic drugs, a group of hypnotics called
benzodiazepine agonists were developed in the l960's.
These sleep-promoting drugs have since proven effective and
safe. Benzodiazepine agonists can be either
benzodiazepines or non-benzodiazepines; each
has a different chemical structure. All hypnotics induce and
maintain sleep. The benzodiazepines agonists work by acting
at areas in the brain believed to be involved in sleep
promotion. They are the drugs of choice because they have
the highest benefit and the lowest risk.
Rebound insomnia occurs when a person stops
taking the medication and experiences one or two nights of
insomnia that is worse than they experienced before
treatment. It only occurs with short half-life hypnotics and
can be avoided by gradually tapering the dose. Consult your
physician before increasing your dose or stopping high dose
treatment.
Brand names
Restoril, Halcion
Restoril (temazepam) is classified as
a benzodiazepine hypnotic and comes in capsule form in four
different does: 7.5 mg, 15 mg, 22.5 mg, and 30 mg. The 7.5
mg dose was developed to provide patients with an option for
taking the lowest effective dose of a sleep agent.
Generally, Restoril is prescribed for short-term use only
(7-10 days). One should not take this drug for long periods
without consulting their doctor.
Restoril has a low potential for side
effects. Unlike some other sleep medications, Restoril is
broken down in the liver using a system that allows the drug
to be easily distributed and carried away, so there is less
concern for drug interactions, which is especially important
in the elderly and patients taking multiple medications.
Halcion (triazolam) is another
benzodiazepine that may be used for sleep
problems in the short term. When Halcion is used every night
for more than a few weeks, it loses its effectiveness to
help you sleep (tolerance). Also, it can cause dependence,
especially when it is used regularly for longer than a few
weeks or at high doses.
How they work
Attaches to certain receptors on brain cells
that trigger sleepiness.
Side Effects & Risks
High risk of dependency with long term use.
Suppresses both REM and non-Rem (slow-wave) sleep. Often
causes next day sleepiness. Can cause dangerous behavior in
some users.
The side effects
of prescription sleep aids are related to the person's age,
dose and half-life. Selecting the proper dose is especially
important for older people. When hypnotics stay in the body
longer, they remain active and can cause daytime sleepiness
or forgetfulness.
Younger people can
be at risk for side effects too. People who use higher doses
and hypnotics with longer half-lives tend to experience more
side effects. To avoid these side effects, sleep specialists
often advise the use of hypnotics with short half-lives.
Best used for
People who were not helped by
non-benzodiazepines. Typically a second line of defense for
insomnia because of potential side effects.
