Sleep disorders are a major complaint and are among the most common reasons for
consulting a doctor. Patient may experience difficulties in falling a sleep, frequent
awakening during the night, or early morning awakening. The result of a disturbed
nigh's sleep is an impairment of daytime wellbeing. The loss of the restorative function
of sleep in this way leads to impaired daytime performance and affects vital function.
As a direct consequence of this interdependence of sleep and daytime wellbeing,
insomnia is a 24-hour problem and the treatment of insomnia may now be considered 2
24-hour therapy.
Although treatment of insomnia should be an individualized treatment approach,
besides behavioral treatment of insomnia, sedative hypnotics certainly occupy a place in
the treatment of insomnia.
The ideal hypnotic should induce and maintain sleep, respect the physiology of sleep,
improve daytime wellbeing, induce minimal or no side effects, and be devoid of
dependence and abuse potential. There, however, is no such ideal hypnotic. Although
effective hypnotics are available their use still leaves the prescribing doctor with
unresolved problems. Some of the hypnotics are very potent in inducing sleep but they
do not maintain sleep overnight ; others are effective in inducing and maintaining sleep,
but leave patients with residual effects on awakening, which interfere with their daytime
mental and physical functioning.
The short-acting benzodiazepines appear to have significant advantages over the
long-acting agents in several areas including daytime sedation, propensity for falls in
the elderly, and respiratory depression. And short-action agents may be more effective
on the first night of administration compared with long-acting agents such as
flurazepam. Theses reason have been significant in leading to their widespread
popularity. In contrast, the long-acting agents may be preferable when daytime sedation
is desired. They are often associated with a delayed and milder withdrawal sleep
disturbance. When the short-action agents are given, however, this difficulty can be
minimized by tapering the dose.
This paper reviews the proper use of sleeping pills in the primary care setting in the
context of current controversy involving sedative hypnotics in general and
benzodiazepine hypnotics in particular. It is concluded if the physician feels a patients
insomnia warrants symptomatic relief with medication, it is appropriate toprescribe the
lowest effective dose of a hypnotic for several nights. depending on the circumstances,
the physician cam specify either a short-acting or a long-action hypnotic.
Hypnotic medication is indicated for the treatment of transient and short-term
insomnia. It could be also used for chronic insomnia as adjunctive treatment.
Pharmacotherapy for insomnia is often not only appropriate and safe, but highly
desirable if it is selected and used properly.
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