Popular Science Knowledge: Can you take sleeping pills casually? Will you be addicted?

With the development of society and the change of people's lifestyle, the proportion of people with sleep disorders has increased year by year. According to the latest figures released by the World Health Organization, nearly 1/4 of the world's people often suffer from insomnia, of which nearly 860 million people suffer from insomnia and depression every year, 75 million of them in China alone, and the total sales of sleeping pills in the world each year is as high as several billion US dollars. In addition, many health problems are inseparable from insomnia.

Many people are afraid of sleeping pills, mainly because they don't know much about them and are afraid of getting addicted. In fact, if you take the medicine strictly under the guidance of a doctor, most people will not become dependent on it. In fact, drug treatment can even correct sleep disorders and achieve the effect of having a good dream every day . The following is an introduction to the classification of common sleeping pills.

Sleeping pills, also known as sedative hypnotics, are a class of drugs that have an inhibitory effect on the central nervous system and can cause sedation and physiological sleep. As the dose increases, sedation, hypnosis, anticonvulsant, anti-epileptic and central muscle relaxant effects are produced in turn. The "ideal" sedative hypnotic has the following characteristics: it can quickly induce hypnosis and fall asleep within 30 minutes after taking it; it does not cause sleep structure disorders; it has no hangover effect; it does not inhibit breathing; it does not cause drug dependence; and it does not interact with other drugs.

According to the pharmacological characteristics of different sedatives and hypnotics, they can be divided into the following three categories:

Phenobarbital: It has strong sedative and hypnotic effects, but has the following disadvantages: ⑴ Rebound phenomenon may occur after long-term use; ⑵ It is difficult to wake up and has sequelae; ⑶ It is addictive and has high tolerance; ⑷ It can cause anesthesia; ⑸ It is highly toxic and has a small safety range. The main ones are phenobarbital, amobarbital, secobarbital, etc. After the invention of benzodiazepines in 1961, they are no longer routinely used as sedatives and hypnotic drugs .

Benzodiazepines are currently commonly used sleeping pills in clinical practice , with the following characteristics: a small amount of sedation, a larger amount of hypnosis; shortening the time to fall asleep; prolonging sleep time; reducing the number of awakenings during sleep; large doses can shorten rapid eye movement sleep, and after long-term use and discontinuation of the drug, "rebound" dreaming may occur. They include diazepam (Valium), flurazepam (Flurazepam), chlordiazepoxide, oxazepam, clonazepam, lorazepam, alprazolam, estazolam, triazolam, midazolam, etc.

Non-benzodiazepines: They have the characteristics of rapid onset of action, little effect on sleep structure, and minimal effect on memory and psychomotor function. Examples are as follows:

Zolpidem: A short-acting imidazopyridine drug with a strong sedative effect, but weak anti-anxiety, anticonvulsant and muscle relaxant effects. It can significantly shorten the sleep latency period and has a half-life of 2.4 hours. It is mainly used clinically to treat insomnia patients who have difficulty falling asleep. It has mild adverse reactions and is a higher-level sleeping pill .

Zopiclone: ​​A medium-acting cyclopyrrolone drug that can shorten the latency period of falling asleep, prolong the slow-wave sleep time and the total sleep time, reduce mid-sleep awakening and early awakening, and improve sleep quality. It is suitable for insomnia caused by various reasons. The adverse reactions are dizziness and bitter taste in the mouth, which can usually disappear on their own. Clinically, it has been found that there is no tolerance to zopiclone after continuous use for 6 months. It is the first hypnotic drug with no time limit for use.

Other drugs with hypnotic effects: melatonin and its receptor agonists, antihistamines, orexin receptor agonists, antidepressants with sedative effects, etc., will not be discussed here.

In general, sleeping pills can be taken intermittently, when important, or when necessary.

1. Intermittent use: Sleeping pills mainly have a calming and tranquilizing effect and can help patients fall asleep. Common drugs include zopiclone tablets, zolpidem tartrate tablets, lorazepam tablets, etc. These drugs need to be used in stages and cannot be used continuously to prevent the body from developing corresponding drug resistance. In addition, the drugs need to be taken at least half an hour before going to bed.

2. Use when it is important: If the patient has important things to do or work the next day, in order to prevent lack of sleep from affecting the mental state of the next day, use sleeping pills at this time, and try not to take drugs on weekends.

3. Use when necessary: ​​If the patient has severe sleep disorders and needs to use sleeping pills frequently, it is necessary to choose two short-acting non-benzodiazepine sleeping pills to use alternately to avoid long-term use of the same drug or long-acting drugs, which may cause addiction and drug resistance.

In addition, patients should choose medication according to the doctor's instructions and their own conditions. They do not need to develop a dependence on sleeping pills . They should maintain a regular life. The dosage during medication should be small rather than large. Do not increase the dosage at will or use only one sleeping pill. When stopping taking sleeping pills, the dosage should be gradually reduced. If you have become addicted to a certain drug, you can use other sleeping pills or other treatment methods to gradually replace it before stopping the medication.

With the progress of medical research, in addition to sleeping pills, more and more insomnia treatment methods are being used in clinical practice, which will be gradually recommended to you in the following chapters. Finally, I wish you all a good sleep every day!

Liu Minqiang, Department of Anesthesiology, Shenzhen Third People's Hospital

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