Sleeping pills: the rules for choosing which one is better to use and a list of effective safe remedies

Like any other neurological disorder, sleep disorders require an attentive approach and complex therapy. First of all, the doctor needs to understand the reasons for this condition, to exclude pathologies that could cause such violations.

Sleeping pills are a quick and relatively safe way to normalize the patient's well-being. But the principle of action of most drugs of this class is closely related to the effect on the central nervous system (CNS), therefore uncontrolled reception, especially for a long time, is fraught with serious complications, the development of addiction and other side effects effects.

Main pharmacological groups

The widespread prevalence of sleep disorders prompted physicians to study in more detail the physiology of this process and the reasons that contribute to such disorders. Sleep consists of several stages:

• the first and second phases of REM sleep (takes 2 - 5% and 45 - 55% of the total duration of night rest, respectively);
• the deepest delta is sleep (13 - 23%);
• REM sleep (20 - 25%).

The normal duration of healthy sleep ranges from 6.5 to 8.5 hours. This time is enough for good rest and recuperation. In this case, wakefulness (the process of falling asleep) should take no more than 5%. Insomnia is accompanied by a violation of the duration of all sleep phases, their frequent change.

The main cause of persistent insomnia is mental illness (detected in 40% of patients) and various chronic pathologies (diagnosed in 35% of patients). However, in 15% of cases, it is not possible to reliably establish the cause of sleep disorders, and then symptomatic therapy is prescribed.

The use of hypnotics allows you to normalize sleep and eliminate the main signs of insomnia:

• general weakness and malaise;
• decreased mood;
• depressive state;
• lack of motivation, energy and initiative;
• decreased concentration of attention, which affects the quality of the work performed, the ability to drive vehicles, etc.;
• heart rhythm disturbances, nausea, appetite disorders.

But in addition to drugs, there are other methods for treating insomnia (psychotherapy, phototherapy, encephalophony, hypnotherapy). Taking into account the rather high probability of undesirable reactions, medications are used only in the absence of results from other methods of combating insomnia.

For insomnia treatment drugs from the following pharmacological groups are used:

• herbal preparations, collections of medicinal herbs with a sedative effect;
• drugs that mimic the effect of the hormone melatonin;
• blockers of H-histamine receptors (antihistamine drugs);
• benzodiazepines;
• barbiturates;
• antipsychotics and antidepressants with a predominant hypnotic effect.

Relatively recently, non-benzodiazepine so-called Z - drugs (the name of this group originated from three active ingredients - cyclopyrrolone derivative zopiclon, imidazopyridine zolpidem and pyrozolopyrimidine zaleplon). It is these hypnotics and sedatives that are considered the safest for the treatment of insomnia.

Non-prescription

Due to the effect on the central nervous system and brain activity, most sleeping pills are legally sold only with a doctor's prescription. Melatonin preparations lead the rating of relatively harmless sedatives. In humans, most of this hormone is produced by the pineal gland (the structure of the brain), and its secretion synchronized with the day-night cycle (at night, the concentration of melatonin is 200 pg / ml, and in the daytime - 10 pg / ml).

According to the data of clinical studies, the role of melatonin in the regulation of sleep and biorhythms is beyond doubt. Therefore, the use of this hormone in the composition of drugs allows you to cope with insomnia with minimal risk of side effects.

Melatonin is found in the following drugs:

• Kaksapal Neo (Russia);
• Melaxen (USA);
• Melarena (Russia);
• Melarithm (Russia);
• Sonnovan (Russia);
• Circadin (UK).

The cost of these drugs ranges from 300 to 730 rubles. All of them are available in the form of tablets, coated with a membrane that is soluble in the intestinal cavity. The recommended dosage is 3 mg of melatonin (which corresponds to one tablet). The drug is taken 30-40 minutes before bedtime. For the prevention of insomnia, which occurs against the background of a change in time zones, the medication is started 1 to 2 days before the trip and continues for 3 to 4 days.

Homeopathic remedies are also included in the over-the-counter list of mild sleeping pills. These preparations contain natural ingredients, so they practically have no contraindications, with the exception of individual intolerance.

For the treatment of insomnia, doctors recommend the following homeopathic medicines:

• Rescue Remedy Bach, 1 - 2 drops are applied under the tongue or dissolved in a small amount of water and rubbed the skin behind the ears, applied immediately before bedtime or after exposure to a stress factor;
• Edas - 306, take 7 ml (for children, the dosage is halved) three times a day after meals;
• Homeostress, drink 1 - 2 tablets three times a day (but the course of therapy should not exceed 7 - 10 days);
• Nott, take 5-10 drops, diluted in a small volume of water three times a day, before swallowing the solution should be kept in the mouth for a short time.

Melatonin-based preparations can be taken no longer than a week, homeopathic remedies are intended for long-term use (for 1 - 1.5 months), if the instructions are not specified reverse. But if, against the background of taking these medications, the patient's condition does not change or, on the contrary, worsens, it is necessary to consult a doctor.

Non-drug therapy methods

Sometimes insomnia can be managed without medication. First of all, you need to pay attention to the condition of the bed (mattress, pillow, blanket), the temperature in the bedroom. The patient's lifestyle also plays an important role. So, insomnia can be provoked by smoking, alcohol consumption and other substances stimulating the nervous system (caffeine, drugs, etc.).

Regular physical activity (but not immediately before bedtime), auto-training and relaxation techniques have a good result. In the conditions of medical institutions (day hospital), psychotherapy and physiotherapy sessions are offered. So, patients suffering from insomnia are shown phototherapy (exposure to light pulses to restore biorhythms).

A modern method of treating insomnia is the so-called encephalophony, which is also called the music of the brain. The essence of this method consists in recording data obtained during the EEG procedure. Then, with the help of special programs and algorithms, they are transformed into music, which differs in cycles of sleep, wakefulness, emotional stress and vice versa, relaxation.

Modern medicines

It is Z-drugs that belong to the latest generation of drugs for the treatment of insomnia. They are distinguished by a high safety profile, a fast developing effect and a lack of addiction. The Z-drugs list includes:

• Zolpidem (Ivadal, Nitrest, Oniria, Sanval, Snovitel, Hypnogen). It is produced in tablets with a mass fraction of the active substance of 10 mg. The daily dosage is 10 mg, if necessary, it is doubled. Take the medicine once a day, one hour before bedtime.
• Zopiclone (Imovan, Relaxon, Somnol, Thorson). Assign 7.5 mg (which corresponds to one tablet) once a day, also immediately before bedtime. In rare cases, this amount is increased to 15 mg, or vice versa, reduced to 3.75 mg.
• Zaleplon (Andante). The recommended dosage is 10 mg per day, drink before bedtime.

Natural sedatives

Medicines containing herbal ingredients do not have a strong hypnotic effect and instant action. Such drugs also normalize a person's sleep and emotional state. These funds are safe, recommended for various categories of patients (some can be used during pregnancy and lactation, old age) without the risk of serious complications.

Herbal sedatives include:

• Persen Night. Contains a composition of lemon balm, valerian and peppermint. Take 1 - 2 capsules one hour before bedtime.
• Corvalol. The drops contain phenobarbital, mint extract and other components. The recommended dosage is 15-30 drops three times a day on a piece of sugar or dissolving in a little water.
• Valerian. A mild and “versatile” sedative. Take 1 - 2 tablets up to three times a day.
• Sleep formula. The drug contains a combination of herbal ingredients that mimic the effect of melatonin and additionally have a sedative effect. Take 2 capsules with dinner.

Despite their natural composition, herbal preparations can cause mild daytime sleepiness. This should be taken into account by people whose daily and professional activities require constant concentration of attention.

Combined composition

As a rule, synthetic drugs containing several biologically active substances are not used for the treatment of insomnia due to their too strong effect on the central nervous system (CNS). Therefore, for insomnia, combined medicines are prescribed in liquid and tablet form, containing herbal ingredients. These include:

• Novo-Passit (2 tablets up to 3 times a day);
• plant fees of the Fitosedan series (brewed in accordance with the instructions);
• Lotusonik (2 tablets three times a day);
• Evening pills (drink 1 - 2 pills before bedtime, and with increased emotional excitability - up to three times a day);
• Elixir Melisan Klosterfrau (1 - 3 teaspoons, diluted with warm water in a 1: 1 ratio 15 - 20 minutes before bedtime).

However, these drugs are suitable for treating mild forms of insomnia. To combat chronic sleep disorders, professional advice and individual selection of the medication are required.

Which sleeping pill is better: principles for choosing a drug, what is prescribed for adult patients, general rules for use

The use of herbal preparations and products based on melatonin requires compliance with certain rules regarding sleep hygiene, normalization of the emotional state, lifestyle correction (refusal from strong coffee, tea, alcohol and etc.). However, some drugs dispensed from pharmacies strictly according to a doctor's prescription have an almost instant effect. Sleep comes on quickly and depends little on environmental factors.

These medicines include benzodiazepine derivatives. The hypnotic effect is noticeable from the first dose (for most patients, the minimum is sufficient).

However, taking such drugs also has its drawbacks:

• danger when combined with other drugs, alcohol;
• high risk of adverse reactions, especially in case of overdose;
• the likelihood of developing addiction;
• withdrawal syndrome in case of improper discontinuation of the drug.

Given these factors, the appointment of benzodiazepines and the calculation of their dosage should be dealt with only by a doctor after a complete examination of patients.

The medicines of this group include:

• Gidazepam (0.03-0.05 g three times a day);
• Diazepam (5 to 30 mg per day);
• Rudotel (0.01 - 0.03 g per day, divided into three doses or taken once before bedtime);
• Helex (0.25 - 0.5 mg up to three times a day).

Selection principles

If a person suffers from insomnia and related disorders, sooner or later the question still arises as to which sleeping pill is better.

For a doctor, the main criteria for choosing a medication are:

• age;
• concomitant conditions (pregnancy, lactation and the possibility of its termination if necessary);
• pathology of internal organs, especially the brain, liver and kidneys;
• duration of insomnia, other neurological disorders;
• lifestyle and the ability to comply with all the rules of admission and self-control of dosage.

Financial condition also plays an important role, since original drugs are much more expensive (although they are better tolerated and have a more pronounced effect).

But from doctors, the patient expects a specific answer to the question, which sleeping pill is still better. In the treatment of acute insomnia, drugs based on melatonin come to the fore. Herbal sedatives may work if the insomnia is caused by mild emotional distress. For more serious sleep disorders, drugs from the Z-drug list are increasingly being prescribed.

The list of sleeping pills that are prescribed for adults includes barbiturates:

• Phenobarbital (10 to 200 mcg up to three times a day);
• Reladorm (1 tablet at bedtime).

Such drugs can cause serious side reactions, addiction, and an overdose is dangerous with severe complications, up to and including death. Therefore, medications from the group of barbiturates are prescribed as a last resort, if there is no result from the use of other drugs.

Basic principles of drug treatment

In order to avoid side reactions and the speedy normalization of the condition of a sick person, when taking and prescribing sleeping pills, they are guided by certain rules:

• the effectiveness of therapy is assessed on the 2nd - 3rd day of using the drug, if necessary, you should consult a doctor again to adjust the dosage or change the medication;
• when waking up in the middle of the night, additional medication is allowed, but no later than 5 hours before the expected awakening, in order to avoid daytime sleepiness;
• if disturbing symptoms appear (including severe daytime sleepiness), it is also recommended to see a doctor;
• when treatment is canceled, the dosage of prescription drugs is reduced gradually (at least within a week);
• after taking medications that affect the central nervous system, the effect of therapy can be strengthened by the use of herbal sedatives or drugs containing melatonin.

However, in treating insomnia, drug use alone is not enough. The best result can be achieved when combined with non-drug therapies. You should also pay attention and exclude factors that negatively affect the quality of sleep.

Safe sleeping pills: drugs suitable for children, elderly patients and pregnant women

Medications are rarely used to correct childhood insomnia. In most cases, compliance with the daily regimen, relaxing massage, herbal baths is sufficient.

But if it is necessary to take drugs, prescribe natural herbal remedies or homeopathy, mild sedative drugs:

• Glycine (prescribed for children over 3 years old, 1 tablet three times a day);
• Bayu-Bay (intended for children over 3 years old, 10 - 15 drops one hour before bedtime);
• Tenoten for children (children under 3 years old are given half a tablet, over 3 years old - 1 tablet three times a day).

Due to age-related changes, a slowdown in the functioning of the liver and kidneys, an elderly patient is prescribed sleeping pills with caution. The dosage of potent drugs is halved. But preference is given to herbal or homeopathic medicines.

The treatment of insomnia during pregnancy requires special attention, because during the period of bearing a child, a truly safe, but effective sleeping pill is required. Doctors recommend turning to traditional medicine recipes and taking decoctions based on medicinal herbs.

Each hypnotic drug has its own contraindications for admission.

But common to all are:

• individual intolerance;
• severe pathologies of the liver and kidneys;
• taking other medications, alcohol and drugs that depress the activity of the central nervous system.

Insomnia medications often cause unwanted reactions. More often, patients complain of daytime sleepiness and impaired concentration, lethargy. To eliminate such symptoms, a dosage adjustment is sufficient.

If you cannot find a safe sleeping pill without side effects, potent drugs must be taken correctly to avoid addiction. The prescribed dosage should be observed, and the duration of treatment should not exceed 2 weeks without further consultation with a doctor. The drugs are also canceled gradually, with a phased dose reduction.