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52-727: This group of drugs is related to sedatives . Whereas the term sedative describes drugs that serve to calm or relieve anxiety , the term hypnotic generally describes drugs whose main purpose is to initiate, sustain, or lengthen sleep. Because these two functions frequently overlap, and because drugs in this class generally produce dose-dependent effects (ranging from anxiolysis to loss of consciousness ), they are often referred to collectively as sedative–hypnotic drugs. Hypnotic drugs are regularly prescribed for insomnia and other sleep disorders, with over 95% of insomnia patients being prescribed hypnotics in some countries. Many hypnotic drugs are habit-forming and—due to many factors known to disturb

104-418: A common event. As opposed to observing an entire population, a panel study follows a smaller, selected group - called a 'panel'. When longitudinal studies are observational , in the sense that they observe the state of the world without manipulating it, it has been argued that they may have less power to detect causal relationships than experiments . Others say that because of the repeated observation at

156-535: A first-line long-term treatment of insomnia. However, the UK National Institute for Health and Clinical Excellence (NICE) did not find any convincing evidence in favor of Z-drugs. A NICE review pointed out that short-acting Z-drugs were inappropriately compared in clinical trials with long-acting benzodiazepines. There have been no trials comparing short-acting Z-drugs with appropriate doses of short-acting benzodiazepines. Based on this, NICE recommended choosing

208-451: A leading source of adverse drug events (ADEs) seen in the hospital setting: Approximately 2.8% of all ADEs present on admission and 4.4% of ADEs that originated during a hospital stay were caused by a sedative or hypnotic drug. A second study noted that a total of 70,982 sedative exposures were reported to U.S. poison control centers in 1998, of which 2310 (3.2%) resulted in major toxicity and 89 (0.1%) resulted in death. About half of all

260-403: A lesser extent, temazepam (Restoril), and midazolam (Versed) — have been reported for their use as date rape drugs (also called a Mickey ) and being administered to unsuspecting patrons in bars or guests at parties to reduce the intended victims' defenses. These drugs are also used for robbing people. Statistical overviews suggest that the use of sedative-spiked drinks for robbing people

312-517: A molecular level. Examples include zopiclone (Imovane, Zimovane), eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien, Stilnox, Stilnoct). Since the generic names of all drugs of this type start with Z, they are often referred to as Z-drugs. Research on nonbenzodiazepines is new and conflicting. A review by a team of researchers suggests the use of these drugs for people that have trouble falling asleep (but not staying asleep), as next-day impairments were minimal. The team noted that

364-415: A much lower degree than the first ones. This results in their primarily affecting peripheral histamine receptors, and therefore having a much lower sedative effect. High doses can still induce the central nervous system effect of drowsiness. Some antidepressants have sedating effects. Examples include: While some of these drugs are frequently prescribed for insomnia, such use is not recommended unless

416-418: A period of time, even at therapeutic doses. Dependent users may get withdrawal symptoms ranging from restlessness and insomnia to convulsions and death. When users become psychologically dependent, they feel as if they need the drug to function, although physical dependence does not necessarily occur, particularly with a short course of use. In both types of dependencies, finding and using the sedative becomes

468-621: A side effect that are occasionally used for insomnia: A major systematic review and network meta-analysis of medications for the treatment of insomnia was published in 2022. It found a wide range of effect sizes ( standardized mean difference (SMD)) in terms of efficacy for insomnia. The assessed medications included benzodiazepines (e.g., temazepam , triazolam , many others) (SMDs 0.58 to 0.83), Z-drugs ( eszopiclone , zaleplon , zolpidem , zopiclone ) (SMDs 0.03 to 0.63), sedative antidepressants and antihistamines ( doxepin , doxylamine , trazodone , trimipramine ) (SMDs 0.30 to 0.55),

520-688: A term for a blunt weapon such as a club) is sometimes used colloquially for a strong sedative, particularly for: Doctors and veterinarians often administer sedatives to patients in order to dull the patient's anxiety related to painful or anxiety-provoking procedures. Although sedatives do not relieve pain, they can be a useful adjunct to analgesics in preparing patients for surgery , and are commonly given to patients before they are anaesthetized , or before other highly uncomfortable and invasive procedures like cardiac catheterization , endoscopy , colonoscopy or MRI . Some sedatives can cause psychological and physical dependence when taken regularly over

572-470: A withdrawal period typified by rebound insomnia and a prolonged period of anxiety and agitation. The list of benzodiazepines approved for the treatment of insomnia is fairly similar among most countries, but which benzodiazepines are officially designated as first-line hypnotics prescribed for the treatment of insomnia can vary distinctly between countries. Longer-acting benzodiazepines such as nitrazepam and diazepam have residual effects that may persist into

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624-534: Is a research design that involves repeated observations of the same variables (e.g., people) over long periods of time (i.e., uses longitudinal data ). It is often a type of observational study , although it can also be structured as longitudinal randomized experiment . Longitudinal studies are often used in social-personality and clinical psychology , to study rapid fluctuations in behaviors, thoughts, and emotions from moment to moment or day to day; in developmental psychology , to study developmental trends across

676-521: Is a factor in nearly one-third of all reported drug-related deaths. These include suicides and accidental drug poisonings. Benzodiazepines comparatively have a wider margin of safety and rarely result in overdose unless mixed with other CNS depressants. Accidental deaths sometimes occur when a drowsy , confused user repeats doses, or when sedatives are taken with alcohol . A study from the United States found that in 2011, sedatives and hypnotics were

728-455: Is actually much more common than their use for rape. Cases of criminals taking rohypnol themselves before they commit crimes have also been reported, as the loss of inhibitions from the drug may increase their confidence to commit the offense, and the amnesia produced by the drug makes it difficult for police to interrogate them if they are caught. Longitudinal studies A longitudinal study (or longitudinal survey , or panel study )

780-687: Is believed to be positive allosteric modulation of GABA A receptors. Examples include amobarbital , pentobarbital , phenobarbital , secobarbital , and sodium thiopental . Quinazolinones are also a class of drugs which function as hypnotic/sedatives that contain a 4-quinazolinone core. Their use has also been proposed in the treatment of cancer . Examples of quinazolinones include cloroqualone , diproqualone , etaqualone (Aolan, Athinazone, Ethinazone), mebroqualone , Afloqualone (Arofuto), mecloqualone (Nubarene, Casfen), and methaqualone (Quaalude). Benzodiazepines can be useful for short-term treatment of insomnia. Their use beyond 2 to 4 weeks

832-451: Is not recommended due to the risk of dependence. It is preferred that benzodiazepines be taken intermittently—and at the lowest effective dose. They improve sleep-related problems by shortening the time spent in bed before falling asleep, prolonging the sleep time, and, in general, reducing wakefulness. Like alcohol , benzodiazepines are commonly used to treat insomnia in the short-term (both prescribed and self-medicated), but worsen sleep in

884-436: Is primarily at GABA A receptors . Nonbenzodiazepines are a class of psychoactive drugs that are very "benzodiazepine-like" in nature. Nonbenzodiazepine pharmacodynamics are almost entirely the same as benzodiazepine drugs, and therefore entail similar benefits, side-effects and risks. Nonbenzodiazepines, however, have dissimilar or entirely different chemical structures, and therefore are unrelated to benzodiazepines on

936-521: Is used by both researchers and policymakers to better understand how Australians are aging and using health services to prevent and manage ill-health and disability and guide health system decisions. 45 and Up is the largest ongoing study of healthy aging in the Southern Hemisphere. GUiNZ is New Zealand's largest ongoing longitudinal study. It follows approximately 11% of all NZ children born between 2009 and 2010. The study aims to look in depth at

988-656: The Medication Appropriateness Tool for Comorbid Health Conditions in Dementia (MATCH-D) . The use of these medications can further impede cognitive function for people with dementia, who are also more sensitive to side effects of medications. Sedative A sedative or tranquilliser is a substance that induces sedation by reducing irritability or excitement . They are CNS depressants and interact with brain activity causing its deceleration. Various kinds of sedatives can be distinguished, but

1040-466: The antipsychotic quetiapine (SMD 0.07), orexin receptor antagonists ( daridorexant , lemborexant , seltorexant , suvorexant ) (SMDs 0.23 to 0.44), and melatonin receptor agonists ( melatonin , ramelteon ) (SMDs 0.00 to 0.13). The certainty of evidence varied and ranged from high to very low depending on the medication. Certain medications often used as hypnotics, including the antihistamines diphenhydramine , hydroxyzine , and promethazine and

1092-580: The medication appropriateness tool for co‐morbid health conditions in dementia criteria . The use of these medications can further impede cognitive function for people with dementia, who are also more sensitive to side effects of medications. Sedatives can sometimes leave the patient with long-term or short-term amnesia . Lorazepam is one such pharmacological agent that can cause anterograde amnesia . Intensive care unit patients who receive higher doses over longer periods, typically via IV drip , are more likely to experience such side effects. Additionally,

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1144-617: The over-the-counter allergy and antiemetic medications doxylamine and diphenhydramine . Off-label sleep remedies are particularly useful when first-line treatment is unsuccessful or deemed unsafe (as in patients with a history of substance abuse ). Barbiturates are drugs that act as central nervous system depressants , and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia . They are also effective as anxiolytics , hypnotics, and anticonvulsalgesic effects; however, these effects are somewhat weak, preventing barbiturates from being used in surgery in

1196-474: The 1970s, quinazolinones and benzodiazepines were introduced as safer alternatives to replace barbiturates; by the late 1970s, benzodiazepines emerged as the safer drug. Benzodiazepines are not without their drawbacks; substance dependence is possible, and deaths from overdoses sometimes occur, especially in combination with alcohol and/or other depressants . Questions have been raised as to whether they disturb sleep architecture. Nonbenzodiazepines are

1248-508: The USA. Early classes of drugs, such as barbiturates , have fallen out of use in most practices but are still prescribed for some patients. In children, prescribing hypnotics is not yet acceptable—unless used to treat night terrors or sleepwalking . Elderly people are more sensitive to potential side effects of daytime fatigue and cognitive impairments , and a meta-analysis found that the risks generally outweigh any marginal benefits of hypnotics in

1300-545: The absence of other analgesics. They have dependence liability, both physical and psychological . Barbiturates have now largely been replaced by benzodiazepines in routine medical practice – such as in the treatment of anxiety and insomnia – mainly because benzodiazepines are significantly less dangerous in overdose . However, barbiturates are still used in general anesthesia, for epilepsy , and for assisted suicide . Barbiturates are derivatives of barbituric acid . The principal mechanism of action of barbiturates

1352-428: The antidepressants amitriptyline and mirtazapine , were not included in analyses due to insufficient data. The use of sedative medications in older people generally should be avoided. These medications are associated with poorer health outcomes, including cognitive decline , and bone fractures. Therefore, sedatives and hypnotics should be avoided in people with dementia, according to the clinical guidelines known as

1404-428: The collection of new data). Cohort studies are one type of longitudinal study which sample a cohort (a group of people who share a defining characteristic, typically who experienced a common event in a selected period, such as birth or graduation) and perform cross-section observations at intervals through time. Not all longitudinal studies are cohort studies; some instead include a group of people who do not share

1456-411: The elderly. A review of the literature regarding benzodiazepine hypnotics and Z-drugs concluded that these drugs can have adverse effects, such as dependence and accidents, and that optimal treatment uses the lowest effective dose for the shortest therapeutic time period, with gradual discontinuation in order to improve health without worsening of sleep. Falling outside the above-mentioned categories,

1508-650: The focus in life. Both physical and psychological dependence can be treated with therapy. Many sedatives can be misused, but barbiturates and benzodiazepines are responsible for most of the problems with sedative use due to their widespread recreational or non-medical use. People who have difficulty dealing with stress, anxiety or sleeplessness may overuse or become dependent on sedatives. Some heroin users may take them either to supplement their drug or to substitute for it. Stimulant users may take sedatives to calm excessive jitteriness. Others take sedatives recreationally to relax and forget their worries. Barbiturate overdose

1560-583: The human sleep pattern—a physician may instead recommend changes in the environment before and during sleep, better sleep hygiene , the avoidance of caffeine and alcohol or other stimulating substances, or behavioral interventions such as cognitive behavioral therapy for insomnia (CBT-I), before prescribing medication for sleep. When prescribed, hypnotic medication should be used for the shortest period of time necessary. Among individuals with sleep disorders, 13.7% are taking or prescribed nonbenzodiazepines , while 10.8% are taking benzodiazepines , as of 2010, in

1612-482: The hypnotic based on cost and the patient's preference. Older adults should not use benzodiazepines to treat insomnia—unless other treatments have failed to be effective. When benzodiazepines are used, patients, their caretakers, and their physician should discuss the increased risk of harms, including evidence which shows twice the incidence of traffic collisions among driving patients, as well as falls and hip fracture for all older patients. Their mechanism of action

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1664-456: The incidence of these adverse reactions at about 5%, even in short-term use of the drugs. The paradoxical reactions may consist of depression , with or without suicidal tendencies , phobias , aggressiveness, violent behavior and symptoms sometimes misdiagnosed as psychosis . Sedatives and alcohol are sometimes combined recreationally or carelessly. Since alcohol is a strong depressant that slows brain function and depresses respiration ,

1716-657: The individual level, they have more power than cross-sectional observational studies, by virtue of being able to exclude time-invariant unobserved individual differences and also of observing the temporal order of events. Longitudinal studies do not require large numbers of participants (as in the examples below). Qualitative longitudinal studies may include only a handful of participants, and longitudinal pilot or feasibility studies often have fewer than 100 participants. Longitudinal studies are time-consuming and expensive. Longitudinal studies cannot avoid an attrition effect: that is, some subjects cannot continue to participate in

1768-570: The insomnia is due to an underlying mental health condition treatable by antipsychotics as the risks frequently outweigh the benefits. Some of the more serious adverse effects have been observed to occur at the low doses used for this off-label prescribing, such as dyslipidemia and neutropenia , and a recent network meta-analysis of 154 double-blind, randomized controlled trials of drug therapies vs. placebo for insomnia in adults found that quetiapine had not demonstrated any short-term benefits in sleep quality. Examples of antipsychotics with sedation as

1820-479: The last half of the 20th century. Treatment for insomnia in psychiatry dates back to 1869, when chloral hydrate was first used as a soporific. Barbiturates emerged as the first class of drugs in the early 1900s, after which chemical substitution allowed derivative compounds. Although they were the best drug family at the time (with less toxicity and fewer side effects), they were dangerous in overdose and tended to cause physical and psychological dependence. During

1872-422: The life span; and in sociology , to study life events throughout lifetimes or generations; and in consumer research and political polling to study consumer trends. The reason for this is that, unlike cross-sectional studies , in which different individuals with the same characteristics are compared, longitudinal studies track the same people, and so the differences observed in those people are less likely to be

1924-462: The long-term. While benzodiazepines can put people to sleep (i.e., inhibit NREM stage 1 and 2 sleep), while asleep, the drugs disrupt sleep architecture by decreasing sleep time, delaying time to REM sleep, and decreasing deep slow-wave sleep (the most restorative part of sleep for both energy and mood). Other drawbacks of hypnotics, including benzodiazepines, are possible tolerance to their effects, rebound insomnia , and reduced slow-wave sleep and

1976-751: The majority of them affect the neurotransmitter gamma-aminobutyric acid (GABA). In spite of the fact that each sedative acts in its own way, most produce relaxing effects by increasing GABA activity. This group is related to hypnotics . The term sedative describes drugs that serve to calm or relieve anxiety , whereas the term hypnotic describes drugs whose main purpose is to initiate, sustain, or lengthen sleep. Because these two functions frequently overlap, and because drugs in this class generally produce dose-dependent effects (ranging from anxiolysis to loss of consciousness) they are often referred to collectively as sedative-hypnotic drugs. Sedatives can be used to produce an overly-calming effect ( alcohol being

2028-508: The medications are stopped). As with alcohol, the effects of benzodiazepine on neurochemistry, such as decreased levels of serotonin and norepinephrine , are believed to be responsible for their effects on mood and anxiety. Additionally, benzodiazepines can indirectly cause or worsen other psychiatric symptoms (e.g., mood, anxiety, psychosis, irritability) by worsening sleep (i.e., benzodiazepine-induced sleep disorder). Like alcohol , benzodiazepines are commonly used to treat insomnia in

2080-467: The most common sedating drug). In the event of an overdose or if combined with another sedative, many of these drugs can cause sleep and even death . There is some overlap between the terms "sedative" and " hypnotic ". Advances in pharmacology have permitted more specific targeting of receptors, and greater selectivity of agents, which necessitates greater precision when describing these agents and their effects: The term "chemical cosh " ( cosh being

2132-710: The most recent development (1990s–present). Although it is clear that they are less toxic than barbiturates, their predecessors, comparative efficacy over benzodiazepines have not been established. Such efficacy is hard to determine without longitudinal studies . However, some psychiatrists recommend these drugs, citing research suggesting they are equally potent with less potential for abuse. Other sleep remedies that may be considered "sedative–hypnotics" exist; psychiatrists will sometimes prescribe medicines off-label if they have sedating effects. Examples of these include mirtazapine (an antidepressant), clonidine (an older antihypertensive drug ), quetiapine (an antipsychotic), and

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2184-426: The neurohormone melatonin and its analogues (such as ramelteon ) serve a hypnotic function. Hypnotica was a class of somniferous drugs and substances tested in medicine of the 1890s and later. These include Urethan , Acetal , Methylal , Sulfonal , Paraldehyde , Amylenhydrate , Hypnon , Chloralurethan and Ohloralamid or Chloralimid . Research about using medications to treat insomnia evolved throughout

2236-550: The next day and are, in general, not recommended. It is not clear as to whether the new nonbenzodiazepine hypnotics (Z-drugs) are better than the short-acting benzodiazepines. The efficacy of these two groups of medications is similar. According to the US Agency for Healthcare Research and Quality , indirect comparison indicates that side-effects from benzodiazepines may be about twice as frequent as from nonbenzodiazepines. Some experts suggest using nonbenzodiazepines preferentially as

2288-540: The people admitted to emergency rooms in the U.S. as a result of nonmedical use of sedatives have a legitimate prescription for the drug, but have taken an excessive dose or combined it with alcohol or other drugs. There are also serious paradoxical reactions that may occur in conjunction with the use of sedatives that lead to unexpected results in some individuals. Malcolm Lader at the Institute of Psychiatry in London estimates

2340-487: The prolonged use of tranquilizers increases the risk of obsessive and compulsive disorder, where the person becomes unaware whether he has performed a scheduled activity or not, he may also repetitively perform tasks and still re-performs the same task trying to make-up for continuous doubts. Remembering names that were earlier known becomes an issue such that the memory loss becomes apparent. Sedatives — most commonly alcohol but also GHB , Flunitrazepam (Rohypnol), and to

2392-399: The result of cultural differences across generations, that is, the cohort effect . Longitudinal studies thus make observing changes more accurate and are applied in various other fields. In medicine, the design is used to uncover predictors of certain diseases. In advertising, the design is used to identify the changes that advertising has produced in the attitudes and behaviors of those within

2444-646: The safety of these drugs had been established, but called for more research into their long-term effectiveness in treating insomnia. Other evidence suggests that tolerance to nonbenzodiazepines may be slower to develop than with benzodiazepines . A different team was more skeptical, finding little benefit over benzodiazepines. Melatonin , the hormone produced in the pineal gland in the brain and secreted in dim light and darkness, among its other functions, promotes sleep in diurnal mammals. Ramelteon and tasimelteon are synthetic analogues of melatonin which are also used for sleep-related indications. In common use,

2496-409: The short-term (both prescribed and self-medicated), but worsen sleep in the long-term. While benzodiazepines can put people to sleep, they disrupt sleep architecture : decreasing sleep time, delaying time to REM sleep , and decreasing deep slow-wave sleep (the most restorative part of sleep for both energy and mood). Sedatives and hypnotics should be avoided in people with dementia, according to

2548-411: The study for various reasons. Under longitudinal research methods, the reduction in the research sample will bias the remaining smaller sample. Practice effect is also one of the problems: longitudinal studies tend to be influenced because subjects repeat the same procedure many times (potentially introducing autocorrelation ), and this may cause their performance to improve or deteriorate. The Study

2600-512: The target audience who have seen the advertising campaign. Longitudinal studies allow social scientists to distinguish short from long-term phenomena, such as poverty . If the poverty rate is 10% at a point in time, this may mean that 10% of the population are always poor or that the whole population experiences poverty for 10% of the time. Longitudinal studies can be retrospective (looking back in time, thus using existing data such as medical records or claims database) or prospective (requiring

2652-411: The term antihistamine refers only to compounds that inhibit action at the H 1 receptor (and not H 2 , etc.). Clinically, H 1 antagonists are used to treat certain allergies . Sedation is a common side-effect, and some H 1 antagonists, such as diphenhydramine (Benadryl) and doxylamine , are also used to treat insomnia. Second-generation antihistamines cross the blood–brain barrier to

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2704-456: The two substances compound each other's actions and this combination can prove fatal. The long-term use of benzodiazepines may have a similar effect on the brain as alcohol , and are also implicated in depression , anxiety , posttraumatic stress disorder (PTSD), mania , psychosis , sleep disorders , sexual dysfunction , delirium , and neurocognitive disorders (including benzodiazepine-induced persisting dementia which persists even after

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