How to take sleeping pills, safely and effectively?

The epidemic is recurring, and another group of people have joined the ranks of insomnia...

What are the commonly used sleeping pills? How to take them safely?

Treatment of insomnia is based on good sleep hygiene and psychotherapy.

Some short-term insomnia patients should choose drug treatment in time when they are unable to complete cognitive behavioral therapy for insomnia (CBT-I), because drug treatment can play a good hypnotic effect, quickly eliminate insomnia symptoms, and avoid prolonged course of the disease. Insomnia drugs are classified according to the duration of action:

Short-acting: triazolam, zolpidem, zopiclone, and eszopiclone.

Intermediate-acting: lorazepam, temazepam, estazolam, alprazolam.

Long-acting: diazepam, clonazepam, nitrazepam, flunitrazepam, flurazepam

With so many types of drugs, how do doctors decide which one to give their patients?

A basic principle is: fast, effective, safe, and not easy to cause drug dependence.
Summarizing evidence from various studies, the guidelines recommend considering the use of zolpidem, zopiclone, or eszopiclone first.

Because these three drugs have relatively good characteristics: fast onset of action, relatively short half-life, less daytime sleepiness, lower drug dependence than traditional sedatives and hypnotics, and improved safety.

As for which of these three drugs to choose, it depends on the situation of the hospital pharmacy, the doctor's medication habits, and the characteristics of the drug (for example, zopiclone may cause a bitter taste in the mouth, which many patients cannot accept).

Although they are the first recommended drugs, due to individual differences, the above three drugs cannot work for all patients. Some patients do not see ideal results or even no effect after taking the drugs. Some patients have poor tolerance to the drugs or have adverse reactions. At this time, doctors should consider switching to medium- to short-acting drugs with slightly different mechanisms of action. Some patients are sensitive to this type of short- to medium-acting benzodiazepines and have better effects.

From the perspective of pharmacological mechanism, short- to medium-acting benzodiazepines have a relatively rapid onset of action, but a relatively longer half-life, which may have a certain impact on daytime function, such as fatigue, dizziness, weakness, drowsiness, etc.; and the potential risk of drug abuse is relatively increased.

Short-acting benzodiazepines, such as triazolam, although they take effect quickly, are highly addictive and are classified as a Class I psychotropic drug in my country. They are not recommended as a drug for the treatment of insomnia.

In any case, no matter which drugs are chosen clinically, the principles to be followed are:

Dosage: Take the medicine on demand (for example, you still can't fall asleep 30 minutes after going to bed; you have important work the next day). Intermittent treatment is recommended, 3-5 days a week, rather than using it every night.

Medication course: Use as short a period as possible, generally no more than 4 weeks. If the medication lasts longer than 4 weeks, sleep status and medication use should be evaluated every month, and the treatment plan should be changed if necessary.

Medication change and discontinuation: Both should be done under the guidance of a doctor. Patients who use medications for a long time should avoid sudden discontinuation of medications, as sudden discontinuation of medications may cause severe withdrawal symptoms and rebound insomnia.

Note: Do not drink alcohol when using the above drugs, because alcohol will increase the inhibition of the nervous system; during the medication treatment stage, please temporarily stop high-altitude work, fine operations, driving, etc., because taking the medicine may affect concentration. After taking the medicine, especially the elderly, they need to go to bed immediately to prepare for sleep. Because some sleeping pills can cause ataxia or decreased muscle tone, increasing the risk of falling.