Hypnotic, SedativeThe group of drugs commonly known as sleeping pills covers a wide range of active ingredients used to treat insomnia or sleep disorders. On the one hand, there are herbal remedies that are said to have a calming effect, on the other hand, there are also drugs that are used, for example, as pre-medication for sedation (attenuation) before the induction of anesthesia. In the course of this article, we will discuss the very different classes of active ingredients and their effects and side effects.
These include substances containing extracts of valerian, hops, balm and passion flower. The effect of herbal substances in the treatment of sleep disorders is largely not scientifically proven and is probably based to a not inconsiderable extent on the placebo effect. The placebo effect means that the mere fact that a “drug” is taken gives the feeling that sleep must improve and that this happens to a greater or lesser extent.
This does not mean, however, that herbal remedies are generally ineffective and nonsensical. With some – and by no means few – humans they can be sometimes very helpful. Therefore, in the case of sleep disorders – if other, non-drug therapy options that affect sleep hygiene were not helpful – an attempt can be made with a herbal remedy to treat the sleep disorder before a drug is used.
Since herbal sleeping pills are not medicines in the true sense of the word, their great advantage is that they have hardly any side effects. Rarely it can come to rather unspecific complaints such as headache, light drowsiness and stomach intestine complaints. Generally speaking, the effect of sleep-inducing drugs can be enhanced when they are taken in combination with alcohol.
This is rather less problematic with vegetable means, should be nevertheless kept nevertheless in the eye. For patients suffering from sleep disorders in the context of depression, St. John’s wort is sometimes used – often as self-medication. This should always be reported to the treating physician, since St. John’s wort has numerous interactions with other medications – especially psychotropic drugs.
Patients are often not aware of this, as they consider herbal remedies available without a prescription to be completely harmless and not worth mentioning. There are no specific contraindications for taking herbal remedies. Nevertheless, the attending physician should always be informed about the use of herbal substances so that he or she can see for himself or herself any possible interactions and contraindications.
Herbal sleeping pills do not require a prescription and are only partially available in pharmacies, so some of them can also be purchased in drugstores. As a price example, tablets containing valerian extract are mentioned here. The cheapest price for 60 tablets here is about 7 euros.
120 passion flower capsules are available for about 17 Euro. Some of the drugs from the group of antihistamines are – just like the herbal sleeping pills – available without prescription in pharmacies, but they are – in contrast to these – considered to be drugs in the conventional sense and have a scientifically proven effect. Antihistamines act by blocking certain histamine receptors and thus cause, among other things, sedation (attenuation).
Originally, they were developed to contain allergic reactions – for example, in hay fever. Sedation occurred here as an undesirable side effect. However, especially the first generation of antihistamines, i.e. the older ones, are now mainly used in the treatment of sleep disorders.
The active ingredients available without a prescription include diphenhydramine and doxylamine. Both active ingredients are also partly used to treat nausea. They are only very rarely used in the treatment of allergic reactions, as newer active ingredients such as cetirizine or loratadine are available today.
Since first-generation antihistamines do not only act on the histamine receptor, so-called anticholinergic side effects are not uncommon.These include dry mouth, difficulties in urination (micturition disorders), constipation and difficulties in the proximity reaction of the eyes (accommodation). Headaches, dizziness and drowsiness may also occur. The ability to react is reduced, therefore it is strongly recommended not to actively participate in road traffic after ingestion and within the next hours (driving a car).
It is therefore advisable to take it in the evening hours before going to bed. This usually applies to all sleeping pills, regardless of which group they belong to. Due to the danger of increasing the sedative effect, antihistamines should not be taken together with alcohol.
A combination of several sedative drugs should also be avoided or only be taken after consultation with the treating doctor. A combination with drugs that can also cause anticholinergic side effects should also be critically examined, as this can lead to a significant increase in these side effects. Due to the anticholinergic side effect profile, patients with an enlarged prostate (prostate hyperplasia) and patients with glaucoma (glaucoma) should avoid taking antihistamines as far as possible or only take them after consulting their treating physician.
Otherwise, there is a risk of an increase in symptoms up to acute urinary retention or glaucoma attack. There are numerous preparations that contain the above-mentioned active ingredients, only a few of which are mentioned here as examples. Vivinox sleep contains the active ingredient diphenhydramine.
20 dragees cost about 6.50 euros. The preparation Betadorm also contains diphenhydramine. Here 20 Dragees cost about 7.50.
To the preparations those the active substance Doxylamin contain rank among other things sleep tabs, here 20 Dragees cost about 4 euro. Benzodiazepines are nowadays among the most common medicines prescribed as sleeping pills or sedatives. However, this is not necessarily good to be called, since they – in contrast to other sleeping pills – have a strong potential for dependence.
Benzodiazepines are always available only on prescription; higher doses are subject to the Narcotics Law (BtM). A distinction is made between short-, medium- and long-acting benzodiazepines. All act at the so-called GABA receptor and thus increase the activity of a damping ionic current.
They have a damping effect (sedating), sleep-inducing (hypnotic), anxiety-relieving (anxiolytic) and, in higher doses, muscle-relaxing (muscle tone decreases). This explains their use in numerous areas, including short-term treatment of sleep disorders, anxiety disorders, restlessness and as premedication before anaesthesia. Due to their anticonvulsant (anticonvulsive or antiepileptic) effect, they are also used in the acute treatment of seizures.
In cases of insomnia, short-acting benzodiazepines such as triazolam or nitrazepam are used in particular. Depending on the half-life of the respective substance, there may be a so-called hangover, i.e. tiredness the day after taking the drug. This is particularly common when using longer acting substances such as diazepam or lorazepam.
Each of the benzodiazepines can temporarily make you unfit to drive (active participation in traffic) due to an increase in reaction time. In high doses, respiratory depression may occur. Nevertheless, intoxication with benzodiazepines alone is very rare and difficult to achieve.
However, combinations of benzodiazepines and other sedative substances are dangerous (see interactions). Benzodiazepines have a high potential for dependence, so their use should not normally last longer than 3-6 weeks. A combination of benzodiazepines with other sedative or hypnotic substances, such as some antidepressants (especially tricyclic ones), other sleeping pills, some neuroleptics and especially alcohol, can cause serious side effects, including respiratory arrest.
Contraindications to benzodiazepines include current or past benzodiazepine dependence and other addictions, acute alcohol intoxication, myasthenia gravis (a muscle disease) and sleep apnoea. Among the short-acting benzodiazepines used in the treatment of sleep disorders is triazolam. This is available under the trade name Halcion ®.With a cash prescription there is a prescription fee of 5 Euro for 10 tablets with 25 mg active ingredient each.
10 tablets on private prescription cost 12.82 Euro. The active ingredient Nitrazepam is available in the form of various preparations. For example, as Nitrazepam 5 mg, 10 tablets cost 5 Euro prescription fee on a cash prescription, 11.80 Euro on a private prescription.
This group of active substances has a similar profile to that of benzodiazepines, but they are structurally different. They are called Z-Drugs because of their names: Zolpidem, Zopiclon and Zaleplon. It is still disputed whether Z-drugs have the same potential for dependence as benzodiazepines.
In any case, there is a clear potential for dependence, although probably not as pronounced. Z-drugs act on the same receptor as benzodiazepines, the GABA receptor, and thus amplify an inhibitory ion current which has a sedative and sleep-inducing effect. Side effects include a hangover the day after ingestion, a metallic or bitter taste in the mouth, gastrointestinal problems such as nausea and vomiting, and others.
There is a significantly increased potential for addiction, therefore the application should not be used for more than 3-6 weeks. A combination of Z-Drugs with other sedative hypnotic substances such as some antidepressants, some neuroleptics, other sleeping pills and alcohol should be avoided, otherwise the sedative effect may be significantly increased to life-threatening levels. Non-benzodiazepine agonists are also considered highly addictive and should not be used in people with a current or past history of addiction, as they are at increased risk of developing a new addiction.
Other contraindications are sleep apnea syndrome and severely impaired liver function. 10 tablets with the active ingredient Zopiclon, each containing 7.5 mg of Hexal, cost 5 Euro prescription fee on cash prescription and 13.23 Euro on private prescription. 10 tablets containing the active ingredient zolpidem in an amount of 10 mg per tablet cost 5 Euro prescription fee on cash prescription and 13.23 Euro on private prescription. The listed preparations are examples, there are numerous others which are equivalent.