These are drugs that induce SLEEP. Before a hypnotic is prescribed, it is vital to establish - and, where possible, treat - the cause of the insomnia (see under SLEEP, DISORDERS OF). Hypnotics are most often needed to help an acutely distressed person (for example, following bereavement), or in cases of jet lag, or in shift workers.
If required in states of chronic distress, whether induced by disease or environment, it is especially important to limit the drugs to a short time to prevent undue reliance on them, and to prevent the use of hypnotics and sedatives from becoming a means of avoiding the patient's real problem. In many cases, such as chronic depression, overwork, and alcohol abuse, hypnotics are quite inappropriate, and some form of counselling and relaxation therapy is preferable.
Hypnotics should always be chosen and prescribed with care, bearing in mind the patient's full circumstances. They are generally best avoided in the elderly (confusion is a common problem), and in children - apart from special cases. Barbiturates should not now be used, as they tend to be addictive. The most commonly used hypnotics are the BENZODIAZEPINES such as nitrazepam and temazepam; chloral derivatives, while safer for the few children who merit them, are generally second choice and should be used in the lowest possible dose for the minimum period.
Side-effects include daytime drowsiness -which may interfere with driving and other skilled tasks; insomnia following withdrawal, especially after prolonged use, is a hazard. Occasionally benzodiazepines will trigger hostility and aggression. Zolpidem and zopiclone are two drugs similar to the benzodiazepines, indicated for short-term treatment of insomnia in the elderly. Adverse effects include confusion, incoordination and unsteadiness, and falls have been reported. FLUNITRAZEPAM is a tranquilliser/hypnotic that has been misused as a recreational drug.
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