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Sedative Hypnotics

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Reviewed By: Barbara Rexer, DSW, LCSW, LCADC, CCS, ICCS, DRCC

When a person has trouble sleeping, a doctor may prescribe medication to make falling or staying asleep easier. Sedative hypnotics are one class of drug a physician may use. If you have been prescribed a sedative hypnotic and are wondering how these drugs work, here’s what you need to know.

What Are Sedative Hypnotics?

Sedative hypnotics, also called depressants, represent a wide-ranging class of drugs used to help people fall asleep. In some cases, doctors also use them to relieve anxiety. Several drugs fall into the category, including benzodiazepines, non-benzodiazepine receptor agonists, and barbiturates: 

Benzodiazepines 

Benzodiazepines are psychoactive drugs that enhance the effect of gamma-aminobutyric acid (GABA), the primary neurotransmitter in the central nervous system. Approved for short-term use for anxiety and sleep disorders, benzodiazepines (sometimes called “benzos”) are highly addictive. Because of the risk of dependence, doctors typically don’t prescribe these drugs for more than a few weeks.  

Examples: Estazolam, Flurazepam, Quazepam (Doral), Temazepam (Restoril), Triazolam (Halcion)

Nonbenzodiazepine Receptor Agonists (Nonbenzodiazepines)

Nonbenzodiazepines have a different chemical structure from benzodiazepines, but they work in the same way: by enhancing the effect of the GABA neurotransmitter. These drugs are also highly addictive, producing similar withdrawal symptoms to benzodiazepines when stopped abruptly. Because of the risk of physical dependence, non-benzodiazepines are also strictly for short-term use. 

Examples: Eszopiclone (Lunesta), Zaleplon (Sonata), Zolpidem (Ambien)

Barbiturates 

Developed in the 19th century, barbiturates were once widely used to promote sleep and relaxation. However, because of the risk of toxic overdose, doctors now more commonly use benzos and nonbenzodiazepines. In most cases today, barbiturates are only used as an anticonvulsant and general anesthetic. 

Examples: Amobarbital (Amytal), Butabarbital (Butisol), Pentobarbital (Nembutal)

 

What Are Common Side Effects?

Sedative hypnotics can produce a variety of side effects, ranging from mild to severe. Although some are potentially deadly, the most common are mild to moderate. They include:

  • Apprehension or nervousness
  • Changes in heart rhythm (rapid heart rate)
  • Chest pains
  • Confusion
  • Coordination issues
  • Depression
  • Digestive issues (constipation, diarrhea, heartburn, nausea)
  • Dizziness
  • Dry mouth
  • Euphoria
  • Headaches
  • Irritability
  • Loss of appetite
  • Reduced ability to concentrate
  • Tremors
  • Weakness

More dangerous side effects include:

  • Abnormal behaviors (sleepwalking or other sleep activities)
  • Abnormal thinking
  • Anemia
  • Sleep paralysis
  • Suicidal thoughts or actions
  • Worsening depression

In higher doses than prescribed, sedative hypnotics can depress the central nervous system and certain body systems may fail. When that happens, overdose can be fatal. Barbiturates carry the highest risk of dangerous side effects and fatal overdose, which is one reason this drug class has fallen out of favor. 

Risk of Abuse

Sedatives in general carry a high risk of abuse. As many as 18% of Americans have abused sedatives or tranquilizers at least once in their lifetime, according to the National Center for Biotechnology Information. Nearly 10% have met the criteria for substance abuse. 

Benzodiazepines have led to the highest rates of recent abuse. Admissions to treatment programs for benzos nearly tripled between 1998 and 2008.  As of 2018, nearly 20% of people benzodiazepines did not have a prescription, according to a survey published in the Psychiatric Services in Advance

Alarmingly, benzodiazepine abuse often occurs alongside recreational drug and alcohol use. Mixing drugs can lead to an increased risk of blackouts, overdose and physical injury. Other health effects, such as dangerously low blood pressure, may also occur.

Nonbenzodiazepines carry less risk than benzos, but studies have shown that people with a history of addiction are at an increased risk of abusing these drugs. Barbiturates can also lead to abuse, particularly in the long-term. 

Because of their risk of dependence, a majority of sedative hypnotics are controlled substances. That’s why it is important to speak with your doctor before taking any drug to help you sleep, particularly if you have a history of addiction.

 

Alternatives

Prescription sedative hypnotics aren’t the only option to treat insomnia. Many people find relief with over-the-counter solutions, including melatonin supplements and antihistamines such as diphenhydramine (Benadryl) or doxylamine (Unisom). 

Other prescription alternatives include certain antidepressants, which doctors may prescribe off-label to treat insomnia. However, this can carry risk, so it’s wise to discuss these options with a doctor before proceeding.

Tips for Natural Sleep

By taking the right steps, some people can improve their sleep quality without medications. Avoiding stimulants, including caffeine and nicotine, for at least a few hours before bedtime can help. Similarly, it’s best not to use electronic devices before bed, as the blue light emitted from screens can disrupt natural melatonin production, making it harder to fall asleep. It’s also best to avoid physical exercise, which can trigger adrenaline production and leave your body feeling more alert and less ready for bed. 

By sticking to a consistent sleep/wake schedule, it is possible to create a pattern that leads to better sleep quality. Similarly, taking part in relaxing activities before bedtime could make falling asleep easier, increasing the odds you’ll feel rested when you wake up the next day.

Written By: Tracie Heffernan