Hypnotics: Sleeping Pills, Part 1

Hypnotics – Sleeping Pills. 

Part 1

From the Greek word hypnotikos meaning “inclined to sleep, putting to sleep, sleepy” [Wordbook.com]. 

From the late Latin word hypnoticus  also referring to the inclination to sleep. 

From the 17^th century word hypnotic meaning the induction of sleep usually with drugs. 

From the mid-twentieth century United States, Las Vegas term “Amazing Hypnosis Phenomenon”, referring to cheesy shows in which members of the audience are fooled into clucking like a chicken for the entertainment of the crowd. 

Hypnotics are a class of medications that are intended to sedate and induce sleep.  There are several presumptions regarding hypnotics that are worth stating. 

1.       Sleep is best done without others getting involved in the process, no matter how well intentioned.  It is much like golf in this way.   Once sleep… or a golf swing… has been directed to relax and progress smoothly, nothing is going to make it work better.  Anything else, like sleeping pills, will only get in the way. 

2.       Nearly everything that prevents people from sleeping needs to be solved by changing their habits and behavior.   A sleeping pill will not solve unmanaged stress, poor sleep habits, turmoil in the household, psychological issues, or using tech (computers, phones, TV, etc) late at night.  Arguing that it works well for you even though it is devastating to the sleep of everyone else is not going to get you to sleep any faster. 

3.       Alcohol does not improve sleep.  It makes people drowsy.  Enough will make a person pass out.  It worsens sleep quality.  People with poor sleep need to stop alcohol. 

4.       Caffeine keeps some people awake.  Avoid late day caffeine. 

5.       If you are using a drug that shows up on a drug screen, stop it.  For about a hundred reasons.  But they will mess up your sleep, too. 

6.       Unlike the beliefs of many patients, there are no pills which are completely safe and guaranteed to induce sleep.  I am often asked for something “strong” but “safe” and I wonder if that was what Michael Jackson was after. 

7.       Everything that causes a physiologic effect on the brain could potentially be habit forming.  When patients ask for a sleeping pill that isn’t habit forming, I want to suggest Skittles.  Just don’t go to bed with them in your mouth, you might choke.  Actual pharmaceuticals have a habit forming potential.  So does cough syrup.  So does coffee.  So do pain killers.  Yet most people with coughs, breakfast beverages, and pain do not end up as junkies.  The same is true with sleep medications.  Most people use the medication correctly.  Even the people who use it incorrectly do not tend to develop substance abuse problems.  Sometimes their prescriptions run out early, but it is often because of the “if one is good, two must be better” philosophy.  In my career I have very rarely seen anyone abuse or sell their prescription for their sleeping medication.  I have never seen anyone suffer serious consequences from sleeping pill abuse.  I know it happens, but I believe other drugs are abused more frequently.  Patients should use their sleeping medications correctly and worry less about ending up in rehab. 

8.       It is normal to wake in the night.  It may take a while to return to sleep.  No medication will prevent the normal phenomenon of occasional nighttime awakenings. 

9.        ALL sleeping medications have side effects.  Don’t ask for one without side effects.  They made a seedless orange.  They made a seedless watermelon.  They made seedless grapes.  Now you can enjoy them without pesky seeds.  However, you are never going to have medicine without side effects.  The reason there will always be the potential for side effects is that if a medication is active in your body, it means it is changing the way your body’s physiology functions.  It is more accurate to say desired and undesired medication effects.  When taking any medication, some of the medication physiologic effects you were hoping to get (less prominent wrinkles following a botox injection).  Some medication physiologic effects you do not want (frozen face and loss of the ability to smile).  The medication is having the effects on the physiology, some are desired, some are not.   Some people call them side effects, but they are actually still the same physiologically active drug effects as the principal effect you were trying to get.  For example, when a sleeping pill makes you sleepy, you are happy about that.  It is doing its job.  When it makes you lose your memory for the details of a conversation you have while you are lying in bed and just about to go to sleep, you call it a side effect.  In fact, it is the same sedating physiologic effect.  Both consciousness and memory are affected.  Be alerted for all of the physiologic effects (side effects, if you will) of sleeping medications.  Typically, they are mild and tolerable, but one should be aware of them before taking the medication. 

10.   Do not Michael Jackson me.  What I mean is:  do take sleeping medication and then complain it doesn’t work and ask for more or stronger medication.  When a patient tells me that a very effective sleep aid taken in double or triple the usual dose “doesn’t work” I am 99% certain at that moment that the problem is not that there is too little medicine, the problem is that there is too little therapy dealing with the cause if the insomnia.  (For those of you with short memories or little interest in the King of Pop, Michael Jackson died due to a massive overdose of sedatives and the injectable anesthetic propofol administered by his doctor.  Mr. Jackson apparently suffered from insomnia for a long time and had a history of insisting on high doses of sedatives from his doctors.)