Many people these days have trouble sleeping. This is due to constant stress, worries, in a sedentary manner life, poor nutrition and poor ecology. To get rid of insomnia, you must first eliminate its cause. But, unfortunately, not everyone is able to, for example, travel out of town because they are busy at work or not worry when they are sick close person. Therefore, many resort to sleeping pills.

Some, without understanding the composition of the product and without familiarizing themselves with the contraindications, receive not only an increase in existing symptoms, but also complications in the form of allergies, as well as exacerbation of chronic diseases.

Therefore, it is better to give preference to safe remedies for insomnia without side effects. We will find out below which sleeping pills are the most effective and harmless.

The main requirement for sleeping pills is safety. What is hidden behind this term? Security is absence negative influence on the body, a minimum number of contraindications and undesirable effects.

Medicines with hypnotic effects should not cause drowsiness in daytime, cause fatigue, irritability, bad mood. Another important requirement for sleeping pills is the absence of an effect on sleep phases, memory, and concentration.

As is known, most potent drugs with a hypnotic effect are addictive. This, in turn, leads to increased symptoms of insomnia. Therefore, you should not take strong drugs. This is especially true for people who experience short-term sleep problems. For these purposes, natural-based drugs sold without a prescription are suitable.

Types of drugs

Medicines that combat insomnia are divided into several types:

1. Barbiturates. Render positive result if a person has serious problems falling asleep. This group includes "Reladorm", "Phenobarbital". However, it should be remembered that these drugs cause physical and mental dependence. A prescription from a doctor is required upon purchase. A group of barbiturates shorten the cycle REM sleep.
2. Tranquilizer group. This includes Sibazon, Phenazepam, Midazolam, Nitrazepam. Long-term use can also cause addiction. Doctors prescribe such medications for insomnia, the cause of which is anxiety, worries, and unreasonable fears.
3. Z-drugs. They have practically no undesirable effects, only in some cases, if taken for too long, an addiction syndrome may develop. IN this group includes Zopiclone, Adante, Ivadal, Zolpidem.
4. Medicines containing melatonin. This includes Melarena, Melaxen, Circadin. Drugs in this group do not affect sleep cycles, speed up the process of falling asleep, and reduce the number of night awakenings. Do not cause drowsiness during the day.

Another least safe group sleeping pills are considered blockers histamine receptors. This includes Donormil. Such drugs are not addictive, do not affect sleep phases and have a minimum of unwanted effects and contraindications.

List of safe drugs

No matter how many manufacturers of sleeping pills claim that their products are completely safe, you still don’t need to believe them. Doctors recommend taking medications in the most extreme cases, when sleep disorders reach a severe stage.

If you have minor difficulties falling asleep, it is better to reconsider your life - stick to proper nutrition, play sports, go for walks more fresh air, maintain sleep hygiene, etc.

Over-the-counter medications

The main active ingredient of this medicine is melatonin. The drug successfully fights insomnia, speeds up the process of falling asleep, and has a mild sedative effect. It is also used to restore biological rhythms.

Among the main advantages of Melaxen are:

1. The main active ingredient after taking the drug is quickly absorbed in full.
2. After removing the main component from the body, the person continues to sleep soundly. Therefore, sleep can be considered physiological.
3. This remedy for insomnia does not cause drowsiness during the day.
4. It is not addictive, unlike antidepressants and tranquilizers.

Among the disadvantages, one can note an easy contraceptive effect. Therefore, girls who want to become mothers in the near future should be careful when taking this drug. In addition, pregnant and breastfeeding women should not take Melaxen.

Take a whole or half tablet 40 minutes before bedtime.

The cost of the drug is 650 rubles. Analogs are: “Melaritm”, “Sonnovan”, “Melarena”, “Melaxen Balance”.

Important! After taking the drug, you should not be in a room where there is a bright light on.

According to reviews from those who took this medicine, we can conclude: it is very effective. "Melaxen" promotes falling asleep quickly, does not cause drowsiness, irritability and fatigue during the day, is very calming, and does not have any unwanted effects.

Another product that can be bought at a pharmacy without a prescription is Afobazol. This is one of the safest tranquilizer drugs, which will not only speed up the process of falling asleep, but also eliminate the symptoms of angina pectoris, and also reduce high blood pressure.

The main active ingredient of Afobazol is fabomotizole. Prescribed for insomnia caused by irritability, anxiety states, neurosis. The drug is available in tablet form. Taken at night half an hour before bedtime. Dosage – 1 tablet 3 times a day.

Advantages of Afobazole:

1. Relieves somatic disorders.
2. Reduces blood pressure.
3. Eliminates intestinal bloating.
4. Eliminates arrhythmia.
5. Eliminates autonomic disorders.
6. Reduces the excitability of some parts of the central nervous system.
7. Blocks the activity of the part of the brain responsible for anxiety, anxiety, and excitement.
8. Does not inhibit reactions.

Among the disadvantages, it can be noted that the positive effect is not observed immediately. It can be noted only after the second week of taking the drug. The duration of treatment for insomnia associated with anxiety is 1 month.

The drug is not allowed to be taken by breastfeeding women, children under 18 years of age and pregnant women.

The cost of Afobazol is 435 rubles.

Many people note the positive effect of the drug only after several days of use. The medicine relieves anxiety, helps relieve irritability, and improves sleep. Not suitable for single use.

One more thing good remedy without side effects - “Novo-passit”. The drug is completely plant based. It acts very quickly and is well tolerated. The drug contains the following components:

• elder;
• St. John's wort;
• hop;
• hawthorn;
• old flower;
• valerian.

Among the advantages, one can note the possibility of providing a hypnotic and sedative effect after taking one tablet.

Here are some more advantages of the medicine:

1. Minimum side effects.
2. The ability to eliminate anxiety, irritability, and unreasonable worry.

In addition, Novo-Passit is not addictive. Take 1 tablet (20 ml syrup) before bedtime.

Important! As the dosage increases, fatigue, drowsiness, and depression are noted. Patients with chronic alcoholism are not allowed to use the drug.

The cost of the medicine in tablets is 600 rubles, in the form of syrup – 350 rubles.

According to reviews, the medicine really eliminates sleep disorders. And most importantly, it is absolutely safe. Novo-Passit quickly calms you down and promotes almost instantaneous sleep.

One more thing safe remedy to improve the quality of sleep – “Persen night”. This sleeping pill is dispensed without a prescription from a doctor.

The main substances that make up the medicine are:

• mint;
• Melissa;
• valerian.

The product can relieve nervous excitability, improve the quality of sleep, help speed up the process of falling asleep, and also eliminate cramps in the stomach and intestines. Take 1 tablet 20 minutes before bedtime. Side effects are rarely observed, only when the dosage is exaggerated.

Many claim that it is very good and safe drug, which even after a one-time dose produces a positive result.

The drug may be more effective than expensive and chemical sleeping pills. Well relaxes, calms, improves sleep, blocks the excitability of the central nervous system. Among the advantages are the ability to:

• lower blood pressure;
• eliminate autonomic disorders;
• restore the functions of the cardiovascular system;
• relieve increased excitability;
• eliminate tachycardia.

Among the disadvantages, one can note the alcohol content, as a result of which the drug is not allowed to be taken by pregnant women, children under 12 years of age and lactating women.

The medicine is available in the form of tinctures and tablets. For insomnia, take 1 tablet or 20-30 drops of tincture half an hour before bedtime.

The price of the drug is 25-60 rubles.

According to numerous reviews, motherwort tincture is an alternative to many medications with sleeping pills. The product helps you fall asleep quickly, relax and calm down. Can be taken for a long time. Does not contain side effects.

An absolutely safe sleeping pill. To achieve a positive effect, the drug must be used in a course. Available in the form of tablets and drops. For insomnia and psychoemotional disorders, 3 tablets per day are prescribed. Duration of treatment – ​​1.5 months.

The advantage of valerian is its complete safety. This remedy does not cause drowsiness, fatigue, or irritability.

Among the disadvantages, one can note the onset of a positive effect after 1 week of use.

For tablets in pharmacies they charge up to 105 rubles, for drops – 40-60 rubles.

Many people who take valerian claim that a positive effect from the pills can be expected only after a few days from the start of use. But as for the infusion, its effect begins within 20-40 minutes. Sleep after taking is deep, there is no drowsiness during the daytime. Can be taken throughout the day as a sedative.

"Sleep Formula"

The composition of this dietary supplement is dominated by traditional “sleepy” herbs, such as hops and passionflower, as well as vitamins B and Magnesium. This composition makes it easier to fall asleep and get deeper and better quality sleep. There is also a version of the drug enhanced with phytomelatonin.

Advantages of the drug: natural herbal composition, available in various forms (tea, tablets, syrup), suitable even for children (from 3 years old), improves sleep quality, relieves stress. What is important is that the sleeping pills have passed clinical trials based on the clinics of the State Research Institute of Mental Health of the Tomsk Scientific Center of the Siberian Branch of the Russian Academy of Medical Sciences, they are not addictive.

The disadvantages include a cumulative effect, that is, they do not act immediately.

Contraindications include intolerance to the components, pregnancy, and breastfeeding.

The price for a package of 40 pieces is about 393 rubles.

"Tryptophan Calm Formula"

A drug based on the amino acid L-tryptophan, which affects the sleep-wake cycle. Also contains vitamin B and pantothenic acid, which are important for maintaining anti-stress functions of the body.

It lifts your mood during the day, reduces irritability, helps you calm down and fall asleep during insomnia due to stress, good composition. The only significant drawback of Tryptophan from Evalar is the rather high price for a course of administration.

Contraindications include intolerance to components, pregnancy, and breastfeeding.

The average price for 15 tablets is 339 rubles, 1166 rubles for 60 tablets.

Safe prescription sleep aids

Some prescription drugs are also considered safe sleep aids. The best of these, according to patients, are:

"Ivadal" is one of the prescription drugs. It is prescribed only for sleep disorders and insomnia. It has virtually no side effects.

It is prescribed to speed up the process of falling asleep and slow down psychomotor reactions. The duration of action of the main substance, zolpidem, is about 5 hours. Taken 20-30 minutes before bedtime. Dosage – 0.1 g.

Advantages of the drug:

1. Has a slight sedative effect.
2. Almost instantly absorbed from the gastrointestinal tract.
3. After taking Ivadal, a person falls asleep almost instantly, sleeps soundly, and the duration of sleep increases.
4. Does not disrupt the natural cycle of sleep and wakefulness.
5. Does not cause drowsiness or weakness during the daytime.

Important! The drug should not be taken by pregnant women, breastfeeding women, or people who suffer from apnea ( temporary stop breathing at night).

The cost of the drug is 830 rubles.

An excellent drug that helps you fall asleep almost instantly. And most importantly - no side effects. This is what most people who take Ivadal say for insomnia. However, there is also negative reviews O this means. Many people complain of dizziness and weakness in morning time, which go away after a few hours.

The product relieves irritability, improves sleep quality, promotes rapid sleep, eliminates smooth muscle spasms, and relieves nervous excitability. The drug easily copes with the situation and reduces the number of awakenings during a night's rest, eliminates anxiety and fears.

The medicine should not be taken by people with:

• apnea;
• respiratory and heart failure.

In addition, pregnant, lactating women and children under 15 years of age should not use Imovan. Single dosage – 7.5 mg. If the violations are severe, the doctor will prescribe maximum dose– 15 mg.

Among the disadvantages, one can note the presence of undesirable effects. If the dosage and contraindications are not observed, disturbances in the functioning of the central nervous system may occur, digestive system. The drug should not be taken together with alcoholic beverages.

Price – 600 rub.

According to reviews, “Imovan” is a good remedy that allows you to quickly fall asleep. However, some complain about difficulty waking up in the morning and slight fatigue during the day.

The drug is included in the category of pyrazolo-pyrimidines. Prescribed by a doctor to get rid of insomnia, frequent awakenings during the night, shallow sleep and long periods of falling asleep. In pharmacies it can only be found in the form of tablets. The drug begins to act after 25 minutes. Therefore, it is recommended to take it before bed – a quarter of an hour.

Andante should not be used by nursing and expectant mothers, as well as by those who are allergic to the components of the drug, or have kidney or pulmonary failure.

It is not recommended for people who are intolerant to the components that make up the drug, as well as for expectant mothers. In addition, it is not allowed to take sleeping pills fast action“Andante” for pulmonary and renal failure, as well as for girls breastfeeding, children under 18 years of age.

If contraindications and the dosage prescribed by the doctor are not observed, problems may arise in the functioning of the central nervous system and the digestive tract.

Important! If you use the drug for more than 2 weeks, it can become addictive.

The dosage of the medicine is 10 mg. The price of the drug is 450 rubles.

Opinions about this tool are divided. Some talk about its safety and effectiveness. The rest complain of drowsiness during the day, irritability, and slight dizziness after waking up.

The best means are natural remedies, which do not have side effects and have a minimum of contraindications. However, they should be taken initial stage and for minor sleep disorders. If insomnia has become chronic, then drug treatment is prescribed only by a doctor.

About half of people suffer
. There are many reasons for sleep disturbance. Many people decide on their own
about taking sleeping pills, because there are sleeping pills that are sold without
prescription And rarely does anyone consult a doctor about sleep disorders and selection
drugs. wants to talk about sleeping pills, about how to correctly them
take, about side effects.

What is a sleeping pill?

Certain drugs are prescribed for
insomnia treatment. They should be taken immediately before going to bed at night. Their
should not be taken in the morning, as they cause severe drowsiness, y
a person's concentration is reduced, so it can be dangerous when driving
car, when working on machines, etc.

It is important to understand that sleeping pills are
An effective remedy to solve short-term sleep problems. Very
it is important to know all the information about sleeping pills in order to take them correctly and
avoid side effects. You should also remember that if you start
Taking sleeping pills does not mean that you no longer need to maintain hygiene
sleep and daily routine.

Sleeping pills are classified as sedatives
medications that are used to improve or support normal sleep.
There are three groups of drugs:

1. 
   Benzodiazepines. This
   a type of antidepressant that increases sleepiness and promotes rapid
   falling asleep. These drugs are used only for short-term treatment, as
   How are they addictive?
2. 
   Barbiturates. This
   This type of medication causes drowsiness by suppressing the nervous system. Eat
   preparations of long and short acting, are used as a sedative and
   sleeping pills. But most often this type drugs used in
   quality of anesthesia.
3. 
   Other types
   sleeping pills. New look drugs that reduce the time spent
   to fall asleep. Such drugs are not addictive.

Side effects of sleeping pills

Like any medicine, sleeping pills too
has side effects.

If a person suffers from asthma, he is given sleeping pills
with extreme caution, as some drugs may slow down breathing,
make breathing less deep. For asthmatics and people with obstructive conditions
lung diseases are very dangerous.

Most common side effects
actions:

• Tingling
  in the arms and legs
• Violation
  appetite
• Diarrhea
  or constipation, flatulence
• dizziness,
  headaches
• Dryness
  mucous membranes
• Pain
  in the stomach, heartburn
• Weakness
• Uncontrollable
  movements of body parts
• Unusual
  dreams

These potential side effects
you need to know in order to prevent their occurrence or choose others
medications, and know when to see a doctor.

But besides the above, side
actions, there are more serious violations. And these include parasomnia,
which is uncontrollable behavior and actions of a person,
Moreover, the person is absolutely unaware of what is happening to him. A person can
unconsciously eat food, can make calls and perform any other actions while
during sleep.

Incorrect use of sleeping pills,
An overdose can lead to sleep disturbances and side effects.

Some people may experience
allergy to sleeping pills. Therefore, when the following symptoms should
Contact your doctor immediately:

• Deterioration
  vision
• Pain
  in the chest
• Difficulty
  breathing or swallowing, shortness of breath
• Rash
  or itching
• Nausea
  and vomiting
• Hoarseness
• Rapid
  or loud heartbeat
• Swelling
  mucous membranes

At the first such signs, you should
Stop taking these medications immediately.

The most dangerous complication, which can
giving sleeping pills is anaphylaxis. It is an acute allergic
reaction. Severe swelling of the mucous membranes may occur. This condition is
deadly. Therefore, if you are allergic, then the doctor who prescribes you
sleeping pills, you should definitely tell this.

When to take sleeping pills

Before using sleeping pills
drug, be sure to read the instructions, because each drug has its own
specific features. The drug is taken shortly before bedtime.

One more thing important condition reception
sleeping pills - you need to be sure that you can get the sleep you need
amount of sleep, i.e. you will definitely have 8 hours of sleep, and you won’t have to early
get up and get behind the wheel.

Sleeping pills and alcohol

The combination of sleeping pills and alcohol is very
dangerous because alcohol increases the sedative effect of sleeping pills.
This condition can be life-threatening.

Who knew that during the reception
sleeping pills, you should not eat grapefruit or drink grapefruit juice. It turns out that he himself
grapefruit affects the amount of medicine that is concentrated in the blood and on
the time this medicine remains in the blood. Therefore, grapefruit can cause
drug overdose.

Sleeping pill addiction

If you long time torments
insomnia and your doctor decides that you take medication for
over several weeks, then in this case addiction may occur
body to this drug. A person may also develop psychological
addiction to sleeping pills. And often many people think that they will have to fall asleep
without sleeping pills, it begins to cause fear in a person. Therefore, so that there is no
such dependence, it is very important to follow the doctor's instructions and finish the appointment
medications when the doctor said.

Sleeping pills include drugs from the groups of barbiturates, benzodiazepines and drugs not included in these two groups (benzothiazines).

Classification of sleeping pills

Benzodiazepine derivatives

• Brotizolam
• Lorazepam
• Midazolam
• Nitrazepam
• Triazolam
• Flunitrazepam
• Flurazepam
• Estazolam

Barbiturates

• Amobarbital
• Phenobarbital

Preparations of different chemical groups

• Bromized
• Glutethimide
• Doxylamine
• Zolpidem
• Zopiclone
• Clomethiazole
• Methaqualone

Since the 60s XX century Drugs from the benzodiazepine group began to take the place of barbiturates. They were less toxic than barbiturates. More recently, even safer hypnotics that do not belong to the benzothiazine group have appeared: zopiclone and zolpidem.

According to their strength, sleeping pills can be classified as follows. The most pronounced hypnotic effect is possessed by barbiturates, as well as those containing them. combined agents. Zopiclone, lorazepam, methaqualone, nitrazepam, triazolam, flunitrazepam, flurazepam have a very significant hypnotic effect; less pronounced - zolpidem, midazolam, clomethiazole; even weaker - brominated.

Depending on the time of onset of the hypnotic effect, fast-acting drugs are distinguished (sleep onset 15-30 minutes after taking the hypnotic drug) and relatively slow-acting hypnotics (sleep onset 60 minutes later). The first group includes amobarbital, bromizoval, glutethimide, doxylamine, zopiclone, lorazepam, methaqualone, midazolam, nitrazepam, flunitrazepam, flurazepam; to the second - phenobarbital.

According to the duration of the hypnotic effect, hypnotic drugs are distinguished that cause short and long sleep. Most short nap(4-5 hours) cause midazolam and triazolam. Typically, these drugs do not have a post-somnia effect. Bromizoval and lorazepam, as well as glutethimide and zopiclone, induce longer sleep (5-6 hours). Sleep of average duration (6-8 hours) is induced by amobarbital, lorazepam, methaqualone, nitrazepam, phenobarbital and flurazepam.

The longest sleep (7-9 hours) occurs after taking flunitrazepam.

Severity and frequency side effects sleeping pills encourage, if possible, to try to correct disturbances in night sleep with sedatives (such as preparations of motherwort herb, rhizomes with roots of valerian officinalis, peppermint leaves), as well as various non-drug methods (in particular, adherence to the regime and creating conditions for sleep) and some tranquilizers with a sedative effect. However, with true insomnia (), the use of sleeping pills is more effective and therefore widespread.

Currently, some of the previously used hypnotic drugs (glutethimide, clomethiazole, methaqualone), as well as certain benzodiazepine derivatives (brotizolam) are not registered.

Mechanism of action and pharmacological effects of hypnotics

By modern ideas, sleep is a process in which the activity of hypnogenic (synchronizing) brain structures is increased, and the awakening effect of the reticular formation, causing an increase cerebral cortex tone big brain and electroencephalogram (EEG) desynchronization is reduced.

Barbiturates act predominantly at the level of stem structures, benzodiazepine derivatives - at the level of the limbic system and its connections with other structures that ensure the cyclic change of sleep and wakefulness.

The hypnotic effect of benzodiazepine derivatives is associated with their interaction with the corresponding benzodiazepine receptors and activation of the GABAergic system, due to which the functional activity of hypnogenic structures becomes relatively predominant. In addition, an important role is played by a decrease in intracellular energy metabolism as a result of a decrease in mitochondrial activity.

A decrease in the activity of intracellular metabolism also underlies the antihypoxic effect of barbiturates. However, they simultaneously reduce the excitability of the respiratory center, reducing its sensitivity to physiological stimulus (CO2), which, with increasing doses of the drug, leads to inhibition of cardiorespiratory activity. In addition, barbiturates increase the activity of microsomal liver enzymes involved in the metabolism and inactivation of other drugs (drugs) used simultaneously, which helps to reduce the effectiveness of the latter.

As established in the 60s, sleeping pills usually distort the sleep formula by suppressing REM sleep. The sleep they provoke differs significantly from natural sleep. A significant lack of sleep under the influence of sleeping pills is a feeling of fatigue and weakness noted after waking up, which negatively affects the general condition.

Along with the hypnotic effect, all drugs in this group are not large doses have a sedative effect, normalize mild forms of autonomic dysfunction. For this purpose, phenobarbital is more often used in a dose of 10-30 mg 3 times a day (usually as part of combination drugs).

Benzodiazepine derivatives, primarily lorazepam, in addition to sleeping pills, have significant tranquilizing, antineurotic, and anxiolytic effects, and they are often used for this purpose. The antiepileptic effect is characteristic of zolpidem, phenobarbital and benzodiazepine derivatives (nitrazepam, flunitrazepam, clomethiazole). A significant muscle relaxant effect is characteristic of benzodiazepine derivatives (nitrazepam, flunitrazepam), as well as zolpidem. Methaqualone has analgesic properties, and phenobarbital has antispasmodic properties (at a dose of 10-50 mg 3 times a day). Antihistamine action characteristic of doxylamine. Barbiturates have antioxidant properties. Lorazepam has an antiemetic effect.

Pharmacokinetics of sleeping pills

Drugs with a hypnotic effect taken orally enter the blood mainly from small intestine. The speed of this process depends on the properties of the drug, the condition of the intestinal mucosa, its motility, the characteristics of the contents and the pH of the environment. As a result, hypnotic drugs inhibit the activity of cells of the activating system of the reticular formation and stimulate the production of endogenous chemical compounds, promoting the emergence and maintenance of sleep.

In the patient's body, most drugs, including hypnotics, undergo biotransformation, in which the role of the corresponding enzymes, in particular, microsomal liver enzymes, is significant. In the process of metabolism, drug molecules are transformed through conjugation and oxidation. In this case, from larger molecules, often lipophilic, relatively small molecules are formed, mainly hydrophilic, excreted from the body mainly through the kidneys. The processes of metabolism of sleeping pills largely depend on many circumstances, in particular on the age of the patient, liver function, food intake and other drugs administered simultaneously. Drugs and their metabolites are excreted by the kidneys, to a lesser extent through the digestive tract, and in a nursing mother, through milk, which can affect the child’s condition.

The duration of action of sleeping pills is determined by the half-life, which in turn depends on many conditions. This is important for determining the dose and time of taking the drug, as well as the tendency for its accumulation.

The place of sleeping pills in the treatment of diseases

The main indications for the use of sleeping pills are sleep disorders with difficulty falling asleep, intrasomnic disorders and early awakening.

For transient and short-term disorders sleep, it is recommended to take short-acting benzadiazepines, zopiclone or zolpidem, as well as tranquilizers with sedative effects. For chronic sleep disorders, the choice of drug depends on the severity and persistence of these disorders, their nature and the possibility of their correction. For persistent, severe sleep disorders, drugs with a strong hypnotic effect are used. high doses, sometimes approaching the maximum permissible: flunitrazepam, zolpidem, zopiclone, as well as barbiturates in combination with tranquilizers with sedative and anxiolytic effects in average therapeutic doses. For moderately severe sleep disorders, the same drugs are used in smaller doses or lorazepam, nitrazepam in average therapeutic doses. For mild sleep disturbances, it is often sufficient to prescribe bromizal, sedatives, tranquilizers with sedative and anxiolytic effects.

Difficulty falling asleep is usually associated with psycho-emotional stress, anxiety and rigidity affective reaction. Therefore, to relieve them in most cases, it is enough to take tranquilizers with a sedative effect 1-2 hours before bedtime. For more pronounced difficulties falling asleep, it is recommended to take benzodiazepine sleeping pills 30-40 minutes before going to bed: nitrazepam, lorazepam, flunitrazepam.

For intrasomnic disorders (shallow sleep, frequent awakenings, leading, as a rule, to insufficient sleep quality, drowsiness, a feeling of dissatisfaction with sleep), it is advisable to use long-term active drugs(nitrazepam, lorazepam, flunitrazepam). The choice of drug within this list is determined by the severity of the sleep disorder; start with milder drugs.

When waking up early, medications with long-term action. Good effect suppositories are provided, since due to slower absorption the drug begins to act after 3-5 hours. Short-acting drugs are also used when waking up at night. To take after waking up, you can select a dose of the drug that provides therapeutic effect(often half the therapeutic dose when taken at night).

For sleep disorders in patients with pain syndrome zolpidem is effective, as well as other sleeping pills in combination with non-narcotic analgesics in average therapeutic doses.

Elderly patients should not be prescribed barbiturates. First of all, we need to eliminate everything possible reasons sleep disturbances (such as pain, cough, need to warm feet). Benzodiazepine derivatives are prescribed in minimal doses. If necessary, the dose is increased by combining with other drugs to enhance the hypnotic effect (for example, with sedatives or analgesics, as indicated). The craving for sleeping pills in older people, due to the usual decrease in natural sleep with age, is especially significant. At the same time, side effects caused by the use of sleeping pills are, as a rule, more pronounced in them and include, in particular, dizziness, memory loss and disorientation, which are often mistakenly regarded as manifestations of senile dementia. Thus, the use of sleeping pills is advisable only for valid indications. During their use, you should use minimal doses of drugs, taking them in short courses (within 3 weeks).

There are different opinions about rational drug treatment dissomnia. It is carried out both occasionally and in courses, which, however, should not become protracted. When carrying out courses of treatment, drugs must be discontinued with a gradual reduction in the dose of the sleeping pill (prevention of withdrawal syndrome). This is especially significant when using sleeping pills from the barbiturate group.

The question of the duration of use of sleeping pills is complex. Usually the course of treatment does not exceed 3 weeks. With simultaneous adequate pathogenetic and etiotropic therapy, as well as measures to develop conditioned reflex on the onset of sleep (for example, going to bed at the same time, warm bath, reading before bed) you can achieve normalization of sleep with the gradual abolition of sleeping pills. In the future, they can be used sporadically in special situations, with psycho-emotional stress.

In addition to direct indications for taking sleeping pills, their use is advisable in other cases:

• For nausea and vomiting caused by chemotherapy, lorazepam can be used. The drug is prescribed 6 hours and 12 hours after taking chemotherapy, at a dose of up to 4 mg per day.
• When using nitrazepam (for minor seizures in children), clomethiazole.
• For neuroses, lorazepam, nitrazepam, and estazolam are appropriate as anxiolytic drugs.
• To relieve agitation and anxiety in elderly patients, benzodiazepine derivatives are used in minimal doses.
• To relieve withdrawal symptoms in patients, it is advisable to use benzodiazepine drugs.
• For premedication and short-term surgical interventions Sometimes they use drugs such as lorazepam, midazolam, nitrazepam, flunitrazepam.
• Barbiturates are sometimes used as antihypoxants and to reduce intracranial pressure with the brain.

Tolerance and side effects of sleeping pills

When using sleeping pills, post-somnia disorders (feeling of weakness, drowsiness in the morning, dissatisfaction with sleep) are often observed, especially characteristic of barbiturates, and less often of other long-acting sleeping pills. For post-somnia disorders, it is recommended to reduce the dose of the hypnotic drug or replace it with a hypnotic drug with a relatively short action: zopiclone, zolpidem, lorazepam, midazolam, nitrazepam. In case of post-somnic side effects, it is advisable to take caffeine (at a dose of 100 mg), mesocarb (at a dose of 5 mg), Eleutherococcus senticosus rhizomes and roots, or other tonic and psychostimulating drugs; sometimes it is enough to limit yourself to a cup of strong coffee during breakfast.

Significant disadvantages of sleeping pills include the changes in sleep structure they cause. Normal sleep includes two alternating phases: orthodox sleep and paradoxical, or REM (Rapid Eye Movement) sleep. For good sleep Both phases are significant, while the significant role of REM sleep in personal adaptation is recognized.

Most sleeping pills suppress REM sleep. A particularly significant suppression of REM sleep is observed when taking barbiturates. Zopiclone affects sleep patterns less than other sleeping pills.

The disadvantage of many sleeping pills is the relatively rapid (sometimes after 2 weeks) development of tolerance to them, necessitating increasing the dose or replacing the drug. Tolerance to lorazepam and flunitrazepam develops relatively slowly. The development of tolerance often coincides with the emergence of dependence, which is especially common for barbiturates with a euphoric effect. Abrupt withdrawal of the drug in such cases leads to the development of withdrawal syndrome, manifested by feelings of anxiety, fear, psychomotor agitation, sometimes hallucinations, profuse sweating, gastrointestinal disorders, small-amplitude tremor, decreased blood pressure, vomiting and convulsions are possible. Withdrawal syndrome occurs 1-10 days after abrupt cessation of treatment and can last several weeks. If withdrawal symptoms develop, it is necessary to resume taking the sleeping pill at the same dose with its gradual withdrawal as the condition improves. Sometimes detoxification therapy is needed. To prevent the development of withdrawal syndrome, the dose of sleeping pills with an intermediate duration of action should be reduced gradually: by 5-10% every 5 days. Long-acting medications can be discontinued more quickly. When using short-acting drugs, when the likelihood of withdrawal syndrome is greatest, the dose must be reduced especially slowly. When discontinuing barbiturates, it is recommended to reduce the dose daily by an amount equivalent to 3 mg of phenobarbital.

Other side effects include anticholinergic disorders when taking doxylamine: dry mouth, exacerbation of glaucoma, urinary retention with adenoma prostate gland. Many barbiturates have some hypotensive effects when used in large doses.

Respiratory depression with a decrease in minute respiratory volume by 10-15%, practically significant for patients with COPD, is sometimes provoked by taking barbiturates, in particular phenobarbital or nitrazepam. A decrease in diuresis is possible with the use of barbiturates, which cause an increase in the secretion of vasopressin and a decrease in blood supply to the kidneys.

When taking flurazepam, swelling of the eyelids is sometimes observed. Metallic taste observed when taking zopiclone.

Dyspeptic disorders (nausea, rarely vomiting, diarrhea) are possible when taking zolpidem, zopiclone, triazolam, flurazepam, clomethiazole.

At long-term treatment barbiturates may have a toxic effect on parenchymal organs, sometimes accompanied by the development of hepatitis and deficiency folic acid. Large doses of barbiturates can cause thrombocytopenia (for example, phenobarbital at a dose of more than 0.45 g per day). With excessive doses or accumulation of barbiturates, zolpidem and flunitrazepam, the appearance of nystagmus, incoordination and ataxia is observed.

When taking certain drugs (midazolam, zolpidem), sometimes after waking up, confusion and elements of hypomnesia appear for some time.

Paradoxical reactions (insomnia, agitation) are possible as an individual reaction to certain drugs, in particular flunitrazepam. Flunitrazepam has a locally irritating effect and, when administered intraarterially, can cause necrosis; at intravenous administration There is a risk of phlebitis with clomethiazole.

At long-term use Large doses of hypnotics with slow metabolism (many barbiturates) may result in drug accumulation and the development of chronic intoxication. Chronic intoxication is manifested by lethargy, apathy, drowsiness or increased excitability during the day, decreased memory and perception of information, headache, dizziness, tremors of the limbs, and in severe cases, dysarthria. Hallucinations, convulsions, psychomotor agitation, liver, kidney and heart disorders are possible. It should be noted that in elderly patients these phenomena may occur after the first doses of barbiturates. Then it is necessary to discontinue the drug (if dependent on the drug, the dose should be reduced gradually) and prescribe detoxification, symptomatic therapy. The prognosis is usually favorable.

The phenomena of bromism in case of bromine intolerance can be observed when taking bromizal.

Barbiturates, zolpidem, and flunitrazepam sometimes cause skin reactions.

An increase in the incidence of neoplasms has been reported in newborns whose mothers took barbiturates; in addition, taking these drugs during pregnancy leads to fetal respiratory depression. Since sleeping pills pass into the milk of nursing mothers, they can cause undesirable changes in the baby's condition.

Contraindications for sleeping pills

Sleeping pills are contraindicated in hypersensitivity to them and their components (or to any drug of the same chemical group).

Sleeping pills with a duration of action of more than 6 hours that cause post-somnia disorders should not be prescribed to patients whose activities require a quick and adequate response (for example, transport drivers, dispatchers).

For myasthenia gravis, all hypnotics are contraindicated, especially those with a muscle relaxant effect: barbiturates and benzodiazepine derivatives such as lorazepam, midazolam, nitrazepam.

An absolute contraindication for the use of barbiturates is porphyria.

Severe liver and kidney diseases are also contraindications for the use of many sleeping pills, in particular barbiturates and zolpidem. At the same time, it is necessary to remember the special danger of using drugs with a long action in case of renal failure (they are excreted unchanged by the kidneys) and short-acting drugs in case of renal failure. liver failure(metabolized mainly in the liver).

At respiratory disorders The use of nitrazepam, barbiturates and zolpidem is especially dangerous. Zopiclone should be used with caution.

Due to the danger of a decrease in diuresis in heart failure, it is undesirable to prescribe barbiturates, as well as midazolam (since it has some depressant effect on cardiovascular system). At arterial hypotension The use of barbiturates in large doses is undesirable (they have a hypotensive effect). In addition, to avoid the risk of toxic effects on the blood, barbiturates are contraindicated in cases of infection and hyperthermia. Barbiturates should not be prescribed to elderly patients, since when these drugs are used in small doses in old age, psychotic disorders, anxiety, agitation and impaired consciousness may develop. The use of barbiturates is also contraindicated in children with hyperactivity syndrome.

If you have a tendency to urinary retention, prostate adenoma and glaucoma, the use of drugs with anticholinergic effects, in particular doxylamine, is not recommended.

Somatically weakened patients, with organic damage brain and severe depression, the use of midazolam is contraindicated.

If the patient is prone to drug addiction or is dependent on alcohol, sleeping pills should not be prescribed, especially barbiturates, benzodiazepines, methaqualone and other sleeping pills, to which addiction is more likely to develop.

To avoid a teratogenic effect during pregnancy, the use of benzodiazepine derivatives, barbiturates, doxylamine, zolpidem and zopiclone, and, to a lesser extent, other sleeping pills is contraindicated. Taking sleeping pills, especially barbiturates, in late dates pregnancy can lead to fetal respiratory depression. In addition, the use of all sleeping pills during lactation is not indicated.

Cautions

Sleeping pills, especially long-acting ones, should not be taken by transport drivers and patients whose work involves urgent decision-making.

Interaction of sleeping pills with other medications

Barbiturates induce liver enzymes, which leads to accelerated metabolism some drugs used simultaneously, in particular, anticoagulants, tricyclic antidepressants, sulfonamides, hypoglycemic drugs, glucocorticoids and oral contraceptives. As a result, the usual therapeutic dose of these drugs often becomes insufficient. If the dose of the drug is increased, then the withdrawal of barbiturates may be accompanied by clinical signs overdose of accompanying drugs.

All sleeping pills enhance the effect of psychotropic drugs with a sedative effect, analgesics, and alcohol. The simultaneous use of sleeping pills and alcohol is not recommended due to the risk of developing sometimes difficult to predict, individual reactions. Flunitrazepam is incompatible with monoamine oxidase inhibitors.

The article was prepared and edited by: surgeon

Dr. Marshall Folstein, a psychiatrist at Johns Hopkins Hospital and an expert on Alzheimer's disease, says it's "extremely rare to find older people who actually need them."

Another danger is excessive dosages. A study of dosages of sleeping pills found that the majority (almost 80%) of people 65 years of age and older took an “overdose” of flurazepam (30 mg), although a dose of 15 mg was recommended for older people. (In this book, we include flurazepam in the "Do Not Use" category.) Given the recommendations of the National Academy of Sciences, which state that sleep medications should be used only in a limited number of cases, the increasing frequency of these drugs is prescribed to older people - especially in the elderly. long periods of time - poses a serious threat to their health.

Side effects of sleeping pills and tranquilizers.

Drug addiction, daytime sleepiness, amnesia, increased risk of car accidents, poor coordination leading to falls and hip fractures, impaired learning ability, slurred speech and even death are side effects of these drugs. This is especially likely when these drugs are taken with alcohol or other CNS depressants. This can happen to anyone at any age.

The body of older people cannot excrete similar drugs as quickly as younger people. Older people are also more sensitive to the side effects of medications. Despite the obviousness of this fact, older people, firstly, are more often prescribed tranquilizers and sleeping pills, secondly, they usually receive a standard rather than a reduced dose, which could reduce the risk of side effects, and thirdly, they are prescribed these drugs for more than long periods time than younger people. Therefore, it is not surprising that older people are more at risk of experiencing negative effects, and when such effects do occur, they tend to be more pronounced. One of the biggest obstacles to detecting and eliminating these problems is that the problems that arise are attributed to the aging process rather than to medications. Deterioration of thinking processes, amnesia, impaired learning or loss of coordination in younger people when taking the drug is perceived as an alarm signal. If the same symptoms appear in older people, especially if they develop slowly enough, the doctor's reaction often boils down to the remark: “well, he (she) is already old, what did you expect?” This approach leads to worsening negative effects, since the doctor continues the previously started drug therapy.

A study of older adults with hip fracture found that 14% of these injuries were associated with the use of psychotropic drugs, including hypnotics, tranquilizers, antipsychotics and antidepressants, especially drugs such as sibazone, chlozepid and flurazepam.

Another serious negative effect of benzodiazepines is respiratory depression. Older people often experience episodes of sleep apnea, when breathing stops after falling asleep. Dr. William Dement, a sleep research expert, has found that in older people using sleeping pills, breathing can stop for dangerously long periods of time as a result of the sleeping pills suppressing the respiratory center. He also speaks of the national importance of this issue: people over 65 years of age should not use flurazepam due to increased risk apnea attacks. The second problem in this category is lung disease. People with serious lung disease should not use benzodiazepines because they depress respiratory center, which can be life-threatening. Patients suffering from asthma should also avoid sleeping pills and tranquilizers.

Reducing the side effects of sleeping pills and tranquilizers

The best way to reduce the risk of negative effects is to avoid taking these drugs unless absolutely necessary.

Alternative Treatments for Chronic Anxiety

As British psychiatrist Dr Malcolm Lader noted, "Until recently, most patients with symptoms of chronic anxiety in the UK were prescribed tranquilizers, usually benzodiazepines. However, there are increasing reports of drug addiction even when prescribed at normal therapeutic dosages, have led to a revision of the treatment strategy for chronic anxiety in favor of non-drug methods treatment."

Two UK doctors used non-drug therapies to mild treatment or medium shape chronic anxiety syndrome and similar diseases. They claim that "it is likely the best method treatment is consultation with a doctor general practice or any other medical worker. Such consultation should not be overly intensive and it does not require any special training. Such a consultation should always include a thorough identification of the causes of the disease. When this is done, insomnia can often be reduced to acceptable levels using standard psychotherapeutic interventions."

What else can be done? Talking with people outside the medical field—a friend, spouse, relative, or clergy member—can help identify the causes of concern and find a solution. Having the courage to talk about difficulties is best solution than taking pills. In some cases, insomnia can be treated with psychotherapy. Regular physical exercise can also improve the process of falling asleep.

In addition, ingestion of foods, drinks and medications that have significant stimulant effects can also cause insomnia.

What tranquilizers and sleeping pills can still be used? Although we are against the use of such drugs in most cases, especially by older people, in strictly defined cases these drugs can be prescribed by competent specialists for a short period of time. The FDA annotation for all tranquilizers states: “insomnia or tension due to stress in everyday life do not usually require the use of anxiolytics (tranquilizers)." As stated at the beginning of this section, barbiturates should never be used by older adults as sleep aids or tranquilizers. Other drugs such as meprobamate, hydroxyzine (ATARAX), and chloral hydrate should also not be used by older adults Therefore, only benzodiazepines remain in the doctor’s arsenal - eight tranquilizers and five sleeping pills (in addition, it should be noted that zopiclone (IMOVAN) is one of the safest sleeping pills. All these drugs are equally effective as tranquilizers and sleeping pills). or other drugs for tranquilizers or sleeping pills - this is a question of marketing, not pharmacology."

Sleeping pills are medications that slow down your work various departments central nervous system and cause a state close to natural sleep. Small doses of sleeping pills have a sedative (calming) effect. Hypnotics are benzodiazepine derivatives (nitrozepam, or eunoctine), barbiturates (for example, phenobarbital), as well as substances that have other chemical structure. Calming and sedatives are also used as sleeping pills, which relieve feelings of tension and anxiety and make it easier to fall asleep. Benzodiazepines are not as addictive as barbiturates and are less dangerous if the dose is exceeded, so lately they almost replaced the latter. However, benzodiazepines cannot be considered safe, since 15-44% of patients who take them for a long time develop addiction to them. In addition, in case of overdose, these drugs can cause severe poisoning and death.

Despite the abundance of sleeping pills on the shelves of our pharmacies, none of them are safe; they are all addictive to one degree or another and, in case of overdose, impair brain function.

Although sleeping pills put the body to sleep, they do not remove the cause of insomnia. In addition, the sleeping pill disrupts the natural physiological cycle of sleep and suppresses some of its phases. If a person gets used to falling asleep with the help of pills, his body will no longer be able to reproduce its own sleep as quickly as before. chemicals, which induce natural sleep. This is why sleeping pills provoke even more severe insomnia. Due to the fact that drugs do not stop production active substances and the brain is simultaneously stimulated and suppressed, artificial sleep will not be as deep and calm as natural, which means it will not bring complete restoration to the body.

Contraindications when using sleeping pills!

Sleeping pills are contraindicated for people suffering from cardiovascular diseases, respiratory diseases and various psychoses. However, even completely healthy person medicines for insomnia will cause a lot of harm. If you drink them daily, substances gradually accumulate in the body, causing constant drowsiness. Even after sleeping long enough, a person does not feel rested and will suffer from headaches. Among side effects of sleeping pills - dizziness, decreased visual acuity, impaired speech and sensitivity in lower limbs, changes in blood composition, as well as jaundice. As a result of taking a number of sleeping pills latest generation Amnesia and sleepwalking may develop.

After a long course of treatment, the medicine simply stops working, and in order to fall asleep, you have to increase the dose. The addiction to sleeping pills can be so strong that refusing it will lead not only to new sleep disturbances, but also to more unpleasant consequences:

• hallucinations;
• convulsions;
• depression;
• mental disorders such as paranoia;
• irritability;
• nervousness.

Insomnia is one of the five most common complaints that patients see their doctor.

You can take sleeping pills only under the supervision of a doctor, who will select the correct drug and its dose. The latter should be as small as possible, and the course of treatment should be short (usually 1-3 days). Even with severe chronic insomnia Doctors do not recommend taking sleeping pills for more than 2 weeks.

You should not resort to medications if you can get rid of insomnia without them, for example, by increasing physical activity during the day, giving up coffee, tea or alcohol before bed, evening TV watching or reading books. Helps you fall asleep natural remedies, For example, warm milk, drunk at night. Substances contained in sleeping pills are found in regular foods, such as tryptophan, which doctors prescribe to their patients when they have difficulty falling asleep. large quantities found in regular bananas and turkey meat.

Long-term studies on the effects of sleeping pills do not show encouraging results. In fact, one big conclusion needs to be made that it is better to fight insomnia without sleeping pills than with them. One study of more than 2,000,000 people found that chronic use of sleeping pills is as lethal as smoking cigarettes. Those who use sleeping pills have significantly more high level mortality than those who do not use them.

Sleeping pills reduce the activity of brain cells during the day, affect short-term memory, and also cause a hangover effect.

Sleep apnea

Sleep apnea is a disease manifested by frequently recurring partial (hypopnea) or complete (apnea) collapse (fall) of the upper respiratory tract during sleep, this is a blocking process airways during sleep. People having sleep apnea should never take sleeping pills. Sleeping pills increase the pause and length of the pause in breathing. In people with sleep apnea, it can cause damage to the brain or eyes, lack of oxygen, or even death.

Anyone over the age of 40 should be warned against taking sleeping pills, and anyone over 65 should not take sleeping pills. Research shows that almost all people over 40 have some symptoms of sleep apnea, and anyone over 65 often has a clinical diagnosis of sleep apnea.

When can sleeping pills be used?

Of course, there are situations when the use of sleeping pills may be appropriate, such as after a traumatic psychological episode (sudden death in the family, violent crime) or severe impairment due to illness. However, this should be short-lived and should not lead to long-term use sleeping pills

Help with insomnia

Natural products are becoming increasingly popular in consumer market, to solve problems with insomnia.

We can include such productswhich contains all eight essential amino acids, including tryptophan. Tryptophan is responsible for the production of serotonin in the brain and is used as a natural antidepressant. IN Aloe Vera contains the following list of amino acids, enzymes, minerals, polysaccharides, vitamins and others essential components of natural origin, which can form an encyclopedia of nutrition! The fantastic healing and nutritional properties of aloe vera are due to the synergistic interaction of all of its useful components for healing the whole body.

Low serotonin levels cause insomnia, depression, constant feeling hunger and attention deficit disorder. Tryptophan is found in sunflower seeds, cheese, oats and Brazil nuts.

Griffonia is an exotic plant native to West and Central Africa that contains the natural substance 5-hydroxytryptophan (5-HTP). 5-HTP molecules easily penetrate brain cells, turning into serotonin. Studies have shown that 5-HTP is as effective as synthetic antidepressants. This substance together with () increases the synthesis of endorphins responsible for positive emotions, helps improve mood and restore all phases healthy sleep: falling asleep, rapid and shallow sleep. In European countries, this substance has been used for many years to improve memory. 5-HTP also suppresses the stimulation of the appetite control center in the brain, reducing cravings especially for carbohydrate foods. In addition, this amino acid is effective: reduces feelings of depression, tension, anxiety, emotional instability, irritability that arise in last week cycle.

Sleeping pills - pharmaceuticals or nature? updated: 032220178601 by: Alexander