Insomnia / sleeping pills
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What are sleeping pills?-Items to check for getting a comfortable sleep with rational use-
What are sleeping pills
Hypnotics, also known as sleep-inducing agents, sleeping pills, and hypnotics, are drugs that treat insomnia and sleep disorders.
It has the effect of removing anxiety and tension during sleep and improving sleep.
Taking it for a short period of time can improve symptoms such as poor sleep, waking up many times during sleep, not being able to sleep after waking up in the middle of the night, and waking up early in the morning.
However, long-term administration raises concerns about the development of tolerance and addiction, so it is a drug that should be used efficiently in the short term, and adherence to the correct dosing regimen is extremely important.
It is generally applied to people with insomnia and sleep disorders who cannot be treated without relying on medicines.
Things to know before using sleeping pills
Sleeping pills are recommended to be taken for a short period of time because long-term use can lead to tolerance and high dependence.
Sudden dose reduction or discontinuation of sleeping pills may have a rebound withdrawal effect that causes insomnia, which is worse than the insomnia before starting to take sleeping pills.
In addition, if you take an overdose of sleeping pills without observing the dosage, you may have memory problems, or you may have difficulty exerting force on your body due to muscle relaxation, which increases the risk of light-headedness and falls. There is concern about the occurrence of strong side effects such as a state of excitement or a state of high aggression.
It is important to adhere to the prescribed dosage and administration and to limit the use to short-term use so as not to develop dependence .
strong side effects
Barbiturates, benzodiazepines, and non-benzodiazepine sleeping pills, which are effective against insomnia by promoting the action of GABA, a neurotransmitter that suppresses excitement in the brain, called GABA receptor agonists, have strong side effects.
It is known that Barbiturate-type sleeping pills were widely used before benzodiazepine-type sleeping pills came into the world, but they have serious side effects such as the action dose and the lethal dose are close to each other, and at high doses there is a high risk of death. , has been replaced by benzodiazepine sleeping pills.
Benzodiazepines are safe and effective for short-term use, but their sedative and muscle relaxant effects have been associated with side effects such as drowsiness, lightheadedness, dizziness, lack of concentration, and postural control resulting in falls and injuries. is concerned.
In addition , overdose may cause memory impairment (temporary memory deficiency) and paradoxical reactions such as aggression, violence, and irritability.
Non-benzodiazepine hypnotics have fewer side effects than benzodiazepines, but side effects such as hallucinations and amnesia rarely occur at high doses, and statistically they may increase the risk of depression.
drug dependence
Barbiturates, benzodiazepines, and non-benzodiazepines that are GABA receptor agonists that have a hypnotic effect by enhancing the action of GABA, a neurotransmitter that suppresses excitation of the brain. Sleeping pills are known to form drug dependence.
Barbiturates have a faster tolerance formation rate and are more addictive.
Therefore, withdrawal symptoms are likely to occur, and the rate of delirium tremens tends to be particularly high .
Benzodiazepines have also been shown to develop resistance to muscle relaxant, hypnotic, sedative, and antiepileptic effects relatively rapidly.
It is said that tolerance to anxiolytic effects develops slowly and tolerance to amnestic effects does not develop.
Withdrawal symptoms such as insomnia, tremors, fear, and muscle cramps are often seen when tolerance is formed.
Tolerance development to non-benzodiazepines is generally slower than that of benzodiazepines, but long-term use is known to lead to tolerance and dependence.
Tolerance to the body’s sense of balance and standing safety can lead to dysfunction.
In addition, there are concerns about the onset of withdrawal symptoms after taking the drug for several weeks or longer.
History of sleeping pills
The introduction of sleeping pills began in 1869 with chloral hydrate.
Barbituric acid hypnotics appeared around 1990, but they have serious fatal side effects, and after non-barbituric acid hypnotics, benzodiazepine hypnotics appeared around 1960.
However, there are still problems with tolerance and dependence, and non-benzodiazepine sleeping pills appeared around 1980.
Barbiturates, benzodiazepines, and non-benzodiazepines are GABA receptor agonists that promote the action of GABA, which suppresses the excitability of the brain, and calms the entire brain and induces sleep. Non-benzodiazepines improved tolerance and dependence more than benzodiazepines, but the difference was not significant.
Therefore, in 2010, a melatonin receptor agonist was developed in search of further improvement. Melatonin is a hormone that regulates the circadian rhythm, and promotes sleep by adjusting the body rhythm of sleep and awakening through the body clock. It is characterized by high tolerability and low tolerance .
In 2014, an orexin receptor antagonist appeared. It promotes sleep by weakening the action of orexin, a brain substance that maintains wakefulness. It is attracting attention as a drug that can be taken for a long period of time.
Types of sleeping pills
There are four main types of sleeping pills currently in use:
- Benzodiazepines
- non-benzodiazepine
- Melatonin receptor agonist
- Orexin receptor antagonist
In the past, chloral hydrate and barbiturate-type sleeping pills were also used, but they are rarely used today due to the emergence of fatal side effects and problems of tolerance and dependence.
Long-term use of benzodiazepines and non-benzodiazepines may lead to tolerance and dependence, so use should be limited to short-term use.
In addition, antihistamines, antidepressants, and anxiolytics are also effective in treating insomnia.
Benzodiazepines
Benzodiazepine hypnotics have been popular since the 1960s.
This medicine is a GABA receptor agonist, and by promoting the action of GABA, a neurotransmitter that suppresses excitement in the brain, it suppresses the activity of the entire brain and promotes sleep.
It is safe and effective for short-term use, but long-term use tends to cause tolerance and dependence, and there is a strong tendency for withdrawal symptoms to occur if the drug is discontinued after long -term use .
As the effects of sleeping pills continue into the next morning and beyond, attention should be paid to side effects such as carry-over effects such as dizziness, muscle relaxation effects that loosen muscle tension and increase the risk of dizziness and falls, and mild memory impairment. Is required.
However, it is easy to use because there are many variations from those with a very short duration of action to those with a long duration of action, and as of 2016, about 65% of the sleeping pills in USA are issued on a prescription basis. Occupy.
As a typical drug,
- Triazolam (product name: Halcion, etc.)
- Brotizolam (brand name: Lendormin, etc.)
- Lil mother phone (Product name: Rhythmie, etc.)
- Flunitrazepam (trade name: Cyrace, Rohypnol, etc.)
- Quazepam (product name: Doral, etc.)
non-benzodiazepine
Non-benzodiazepine hypnotics are hypnotics that appeared in the 1980s and, like benzodiazepines, are GABA receptor agonists. Although their chemical structures are dissimilar to those of benzodiazepines, their pharmacological actions are similar, hence the name non-benzodiazepines.
By acting on GABA receptors and promoting the activity of GABA, a neurotransmitter that suppresses brain excitability, this medicine exerts a sedative and hypnotic effect on the entire brain.
Compared to benzodiazepines, it acts selectively by GABA receptor subtypes, making it a drug that improves dependence and withdrawal symptoms.
However, long-term use is not recommended because the reduction is not zero.
It has become popular as an alternative to benzodiazepines, but when checking the prescription issuance base for hypnotics in USA as of 2016, non-benzodiazepine hypnotics accounted for about 30% of all hypnotics.
In USA, benzodiazepines (about 60%) are still used more often.
This is related to the fact that there are only types with very short duration of action, that they are less effective for moderate and higher insomnia , and that benzodiazepines are more resistant and tend to be prescribed in higher doses. It seems to be.
Melatonin receptor agonist
Melatonin receptor agonists are drugs that are effective against insomnia by promoting the action of the sleep hormone melatonin.
Melatonin is a hormone deeply involved in the body clock and circadian rhythm, and almost all living things have it in their bodies. It is normally secreted at night and has the effect of regulating the rhythm of sleep and wakefulness by adjusting the body clock and lowering the body temperature.
It can induce a more natural, physiological sleep, and is especially recommended for insomniacs who have trouble falling asleep.
It is attracting attention because it is more tolerant and less addictive than benzodiazepine and non-benzodiazepine hypnotics.
However, the hypnotic effect is said to be weaker than that of benzodiazepines and non-benzodiazepines.
Sales began in 2010, and Rozerem (generic name: ramelteon) is the only melatonin receptor agonist sold in USA.
As of 2016, Rozerem accounts for a few percent of all sleeping pills in USA on a prescription basis.
In USA, it is designated as a prescription drug, so a doctor’s diagnosis is essential, but in the United Kingdom and the United States, it is sold as a mere supplement that does not require a prescription.
Orexin receptor antagonist
Orexin receptor antagonists act on orexin receptors to competitively block the binding of orexin, a neurotransmitter with wakefulness, to the receptors, thereby shifting the brain from the wakeful state to the sleep state. It is a drug that shifts to and has a sleeping effect .
Orexin is produced by neurons in the hypothalamus and densely projected to the nuclei that play an important role in arousal in the brain, activating these nuclei and maintaining arousal.
Orexin receptor antagonists have a sleep effect by acting on the nerve nucleus, which has the function of promoting arousal under the innervation of orexin neurons, and suppressing the function.
It is mainly effective for insomnia who has trouble falling asleep or wakes up in the middle of the night.
Orexin receptor antagonists are a new type of hypnotic that does not act on the sleep system but acts on the wakefulness system, which is a completely different mechanism of action from conventional hypnotics.
Because it acts on the arousal system, it is thought to induce natural sleep, and is less addictive and addictive than benzodiazepines, and can be used over the long term.
Launched in 2014, the only orexin receptor antagonist currently on the market in USA is Versomura (generic name: suvorexant).
drugs used in the past
Hypnotics that have been used in the past but are rarely used today include chloral hydrate and barbituric acid hypnotics.
Chloral hydrate was originally used as a sleeping pill, and its effectiveness as an insomnia treatment was recognized in 1869. Drug dependence due to long-term use and strong withdrawal effects due to sudden dose reduction or discontinuation of the drug are observed.
In addition, the amount of drug used for treatment (therapeutic range) and the amount of drug that develops toxicity (toxic range) are narrow, and there is a great concern about safety. When it was released, it was almost obsolete.
Barbituric acid-based hypnotics, like benzodiazepines and non-benzodiazepines, show sleep effects by promoting the action of GABA, which suppresses excitement in the brain.
From the 1920s to the 1950s, it was virtually the only sleeping pill and was widely used around the world. However, due to the narrow therapeutic range, side effects of death due to overdose have occurred, and it has also been used as a method of suicide attempt, which has become a public problem.
In the 1950s, non-barbiturate hypnotics with a wide safety margin were released, which were later replaced by benzodiazepine hypnotics, which were introduced in the 1960s.
Other effective medicines for insomnia treatment
Other effective medicines for insomnia include antihistamines, antidepressants, and anxiolytics.
Antihistamines are neurotransmitters in the brain that act as hypnotic analgesics by blocking the binding of histamine, which is a neurotransmitter in the brain that promotes wakefulness, to histamine receptors, thereby temporarily relieving symptoms of insomnia. .
It is designated as an over-the-counter drug and can be purchased at general pharmacies and drug stores.
Antidepressants are drugs used to treat depression.
It increases the amount of serotonin, which is a neurotransmitter in the brain, and has the effect of removing anxiety and tension and raising mood .
Serotonin is a hormone that is a source of melatonin, a sleep hormone. When a lot of serotonin is secreted during the day, melatonin is secreted well at night, and you can get a good night’s sleep.
The virtuous cycle of serotonin and melatonin is a very important factor for sleep, and antidepressants that increase the secretion of serotonin can be expected to be highly effective for insomnia patients who also have depression.
Anxiolytics are treatments for mental illness and act on the neurotransmitter dopamine in the brain .
It has been found that abnormal dopamine activity occurs during insomnia, and it has been recognized that it actually reduces the time required to fall asleep and wakefulness.
Classification of sleeping pills and representative therapeutic drugs
Hypnotics that are GABA receptor agonists (benzodiazepines, etc.) depend on their half-life (the time it takes for the blood concentration of the drug component to halve).
- Ultra-short-acting type (half-life: about 2-4 hours)
- Short-acting type (half-life: about 2-4 hours)
- Medium-time action type (half-life: about 12 to 24 hours)
- Long-acting type (half-life: 24 hours or more)
are classified into four categories.
Half-life represents the duration of action of a drug’s effect.
The ultra-short-acting type and the short-acting type are characterized by having a short half-life and do not carry over the effect the next morning, and are often prescribed to people with sleep disorders, and are typical. Zolpidem is one of the most popular medicines.
Intermediate-acting and long-acting drugs tend to be prescribed for those who wake up in the middle of the night or wake up early, and representative drugs include nimetazepam.
ultra-short-acting
Ultra-short-acting hypnotics are drugs with a half-life (the time when the blood concentration of the drug component is halved, which indicates the duration of action of the drug) is about 2 to 4 hours.
Since the half-life is very short, the duration of the effect is short, and the characteristic is that there is little carry-over effect such as wobbling or falling due to the remaining medicinal effect the next morning. It is often prescribed for people suffering from sleep disorders.
It is also often prescribed to those who lead a day-night reversal of life, such as shift work and shift work. It is a drug prescribed for transient insomnia rather than chronic insomnia, especially for mild to moderate insomnia, which is characterized by poor sleep.
The medicinal effect is relieved in about 2 to 4 hours, so it is expected to have the effect of improving awakening.
Typical drugs
- Triazolam, a benzodiazepine hypnotic (trade name: Halcyon)
- Zopiclone (trade name: Amoban), a non-benzodiazepine hypnotic
- Zolpidem tartrate (trade name: Mysley)
- Eszopiclone (Product name: Lunesta ) etc.
Elderly people tend to have a strong carry-over effect and have a high risk of falling, so it seems that there are many cases where the ultra-short-acting type is the first-line drug.
Short-acting type
Short-acting hypnotics are drugs that have a half-life of about 6 to 12 hours, which is the time it takes for the blood concentration of the drug’s components to halve, and their efficacy lasts for about 6 to 12 hours or more.
Representative drugs include benzodiazepines
- Brotizolam (brand name: Lendormin, etc.)
- Lormetazepam (trade name: Evamir, Loramet)
- Lil mother phone (Product name: Rhythmie, etc.)
In addition, bromvalerylurea (trade name: bromvalin), which is a non-barbituric acid, and etizolam (trade name: depas, eticarum, etc.), which are originally anxiolytics, are also short-acting drugs.
Basically, the diseases to which it is applied are the same as those of the ultra-short-acting type, and it tends to be often prescribed to people with insomnia who have difficulty falling asleep , and people who work night shifts and have a reversal of day and night .
It is also known to have a reducing effect on awakening time, and is also prescribed for people with mild awakening.
Some drugs have also been shown to prolong total sleep time.
It is widely applicable to the symptoms of insomnia, and the carry-over effect that the effect of sleeping pills lasts even after the next morning and the muscle relaxant effect are relatively mild, so it is the first-choice drug for general insomnia. It is said that there are many cases where
Intermediate-acting
Intermediate-acting sleeping pills are drugs that take about 12 to 24 hours for the concentration of active ingredients in the body to decrease by half (half-life), and the drug’s effect is about 12 to 24 hours. Lasts longer than.
It tends to be often prescribed to patients who wake up in the middle of the day and cannot sleep or wake up repeatedly, or who have early awakening, which is several hours earlier than the scheduled wake-up time . I have.
Representative drugs include benzodiazepines
- Flunitrazepam (brand name: Silase, Rohypnol, etc.)
- Nitrazepam (brand name: Benzarine, Nervone, etc.)
- Estazolam (Product name: Eurodin and others)
- Nimetazepam (trade name: Elimin) And so on.
Flunitrazepam is prohibited in the United States and other countries.
Nitrazepam may also be used as a treatment for epilepsy or as a pre-anesthesia medication.
In addition, although it is rarely used at present, amobarbital (trade name: Isomitar), which is a barbituric acid type, and chloral hydrate (trade name: Escre), which is a chloral hydrate type, are also medium-time action types. It is classified into.
Those who cannot sustain sleep until the morning with the ultra-short-acting type or short-acting type are the first drugs to consider as a switching of sleeping pills.
Long-acting type
Long-acting sleeping pills are sleeping pills with a long-lasting effect, with a half-life of about 24 hours or more, which is the time it takes for the concentration of the active ingredient in the blood to decrease by half.
A typical drug is a benzodiazepine hypnotic.
- Quazepam (trade name: Doral)
- Flurazepam (brand name: Dalmate, Benozil, etc.)
- Haloxazolam (trade name: Somerin) etc.
Phenobarbital (trade name: phenobar), a barbiturate-type sleeping pill, is also classified as a long-acting sleeping pill, although it is rarely used today.
It tends to be prescribed for people with symptoms of mid-career or early awakening, such as waking up many times in the middle of the night, unable to sleep after awakening, or waking up more than 2 hours earlier than the scheduled wake -up time.
Since the effect lasts for a long time, it is easier to have a carryover effect, which is a phenomenon in which the action of sleeping pills continues even the next morning. Therefore , it is not recommended for elderly people who tend to have a strong carryover effect.
This is because there is concern that the carry-over effect will cause dizziness and weakness, and the risk of falling will increase in the elderly.
Things to watch out for when taking sleeping pills
Sleeping pills are drugs that can be expected to be effective if you follow the dosage and take them correctly. , tolerance and dependence may be formed.
Sudden discontinuation of the drug is called withdrawal, and you may fall into an insomnia that is worse than the insomnia before taking the drug.
Despite the fact that sleeping pills and alcohol are strictly prohibited, many people with insomnia cannot cut off alcohol, and the effects of sleeping pills may appear strongly.
It is important to always adhere to the prescribed dosage, do not use alcohol in combination, and do not suddenly reduce or discontinue the drug without permission.
Strictly adhere to usage and dosage
Please be sure to strictly observe the usage and usage of sleeping pills .
There are many cases of overdose because it is ineffective, but it is extremely dangerous.
All drugs have side effects, but in the case of sleeping pills, if overdose, the effect of sleeping pills, which is the carry-over effect, tends to continue even after the next morning, and it is accompanied by symptoms such as drowsiness, light-headedness, and headache. In the case of elderly people, there is a concern that the risk of falling may increase.
Overdose increases the risk of developing memory impairment, in which one does not remember one’s actions for a certain period of time.
It is known that the muscle relaxant effect of sleeping pills is enhanced, and especially in the elderly, the risk of falling due to loss of strength when standing up, and the risk of manifesting a paradoxical reaction that is in a good mood and lacks control is also known to increase.
Basically, sleeping pills are supposed to be taken for a short period of time, and as the symptoms improve, the dose is gradually reduced with the aim of abstinence.
Long-term use can lead to tolerance and dependence.
When resistance is formed, the drug becomes less effective, leading to over-prescription. Dependence can make it difficult to stop taking the drug, and you are more likely to experience withdrawal symptoms when the dose is reduced or stopped.
Do not drink with alcohol
Do not take sleeping pills and alcohol together.
Since alcohol contained in alcohol is metabolized in the liver, it is suggested that the effect of sleeping pills may be enhanced by competing with the metabolism of sleeping pills and inhibiting the metabolism of sleeping pills.
Since both alcohol and sleeping pills have a central nervous system depressant effect, there is concern that the effect may be enhanced, and symptoms include decreased mental function, decreased sensory function (memory), and decreased motor function (stagger, fall). It is supposed to happen.
Alcohol acts on GABA receptors in the brain, so more cautious measures should be taken when using alcohol with barbituric acid / benzodiazepine and non-benzodiazepine hypnotics, which are GABA receptor agonists. You will be asked.
In severe cases, death can occur, and there have been cases of death due to alcohol and benzodiazepine sleeping pills in the past.
In addition, it has been confirmed that the combination of alcohol and sleeping pills increases side effects such as the appearance of anxiety and irritation, the appearance of fear-like reactions, and the aggression.
Alcohol is thought to have a sleep-onset effect, and there are many people who use it in combination, but alcohol on the contrary exacerbates insomnia, so do not take it together .
Main side effects of sleeping pills
Just as any drug has side effects, sleeping pills have side effects.
The side effects of sleeping pills are attracting public attention, probably because sleeping pills tend to be overdose compared to other drugs.
Benzodiazepine and non-benzodiazepine sleeping pills act on a neurotransmitter called GABA in the brain, suppressing the activity of the entire brain and changing the sleep rhythm from the natural state, resulting in side effects. It was an easy drug.
Common side effects include memory impairment, muscle relaxant effects, paradoxical reactions, harm to others, dependence and withdrawal symptoms .
Recently, development has progressed, and it has become possible to adjust the sleep rhythm closer to nature with sleeping pills, so if you take it at the correct dosage, you do not need to worry about side effects so much.
memory impairment
One of the main side effects of sleeping pills is memory loss.
You may experience temporary memory loss or forget what you have done.
It is often seen in the middle of the night after taking it, and I do not remember what I did in the middle of the night the next morning.
Memory problems tend to occur when overdosing on short-acting sleeping pills or when sleeping pills and alcohol are taken together.
However, once the ingredients of the sleeping pills are metabolized and excreted from the body, the memory returns to normal, so it is only temporary, but it is one of the side effects that people around them are very worried about.
As a countermeasure, if you lie down immediately after taking sleeping pills, it seems that the onset can be suppressed to some extent.
Muscle relaxant action
One of the main side effects of sleeping pills is muscle relaxant action. The muscle relaxant action is originally one of the actions of sleeping pills. It relaxes the body by relaxing the muscles and promotes sleep.
As a side effect, the muscle relaxant effect comes out strongly, making it difficult to apply strength to the body, which can cause dizziness and falls. There are also reports that when it gets worse, it becomes impossible to stand up.
Please note that there is a risk of fracture.
It is more likely to occur when taking long-acting sleeping pills, and tends to occur more often in elderly people with impaired metabolic function in the body .
paradoxical reaction
Paradoxical reactions are one of the major side effects of sleeping pills.
Strange reactions are expected to occur, such as suddenly becoming in a good mood, becoming agitated by trivial things, acting without restraint such as frolicking, or taking aggressive behavior that is different from usual. It refers to a state in which a reaction opposite to the action of is expressed.
In serious cases, suicide attempts such as jumping and tying a string around the neck have also been reported.
It tends to be prominent with barbituric acid and benzodiazepine hypnotics, and has been reported to include increased anxiety, increased aggression, delayed gratification, confusion, violence, and convulsions.
It seems that the higher the dose, the better the expression .
Other harmful acts
One of the main side effects of sleeping pills is harmful behavior (acts that harm others) .
The US Food and Drug Administration (FDA) announced in 2010 the results of analyzing data from ARES, an adverse event reporting system, and found that short-acting sleeping pills tended to have a high incidence of other harmful behaviors. I did.
The risk of other harmful acts such as injury and murder is 8.7 times for triazolam (trade name: Halcyon), which is a benzodiazepine, 6.7 times for zolpidem (trade name: Mysley), which is a non-benzodiazepine, and eszopiclone (trade name: Lunesta). ) Was shown to increase 4.9 times.
In addition, benzodiazepine-based diazepam (trade name: Sercin) has a 3.1-fold increase in risk, alprazolam (trade name: Solanax) has a 3.0-fold increase, and clonazepam (trade name: Ribotril) has a 2.8-fold increase in risk.
Dependence
Addiction is one of the main side effects of sleeping pills.
Dependence is defined as a state in which long-term use of sleeping pills leads to the formation of tolerance, the same amount of intake is no longer expected to be effective, and a higher dose is demanded both mentally and physically. increase.
Barbiturates and benzodiazepines tend to be more common in sleeping pills.
Barbiturate addiction quickly develops psychological dependence, followed by physical dependence. The drug itself has a high potential for abuse.
Benzodiazepine dependence develops by prolonging the use of benzodiazepines in order to avoid discomfort, as conventional doses are no longer effective once tolerance develops. Even if you take the correct dose, long-term use can lead to dependence, so be careful.
withdrawal symptoms
One of the major side effects of sleeping pills is withdrawal symptoms.
A condition in which a rapid reduction or discontinuation of a drug dose causes insomnia, which is worse than the insomnia before taking the drug, or causes unpleasant symptoms such as anxiety, agitation, and depression. is.
It is found in barbiturates, benzodiazepines, and non-benzodiazepine hypnotics.
Anxiety is the most common withdrawal symptom of benzodiazepine and non-benzodiazepine hypnotics, with disturbed sleep, irritability, panic attacks, sweating, hand tremors, memory impairment, and palpitations. increase.
Symptoms that develop are often relatively severe and usually take several weeks to improve.
Drug regulation of sleeping pills
Many sleeping pills are internationally regulated .
The Convention on Psychotropic Drugs, promulgated in 1971, restricts the distribution of many barbituric acid and benzodiazepine hypnotics internationally as a risk of abuse.
Hypnotics are regulated in USA by the “Narcotics and Psychotropics Control Law”.
However, in USA, the burden on patients is kept to 30% due to universal health insurance, and the price of sleeping pills is set lower than in other countries. In 2010, it was pointed out by the International Narcotics Control Board that the amount prescribed is large and inappropriate use by doctors is possible.
In response, various academic societies and the Ministry of Health, Labor and Welfare have issued warnings regarding the proper use of benzodiazepine hypnotics.
In the United States, it is regulated by the Controlled Substances Act, a law that regulates the manufacture, import, possession, and distribution of drugs, and flunitrazepam is not allowed to be brought in even with a doctor’s certificate, depending on the state.
Benzodiazepines, the non-benzodiazepine zolpidem tartrate, and the long-acting berbiturate sleeping pills are under scrutiny, with limited prescriptions, for their potential for abuse and dependence.
Prescriptions of more than 4 weeks are generally not permitted in European countries.
How to buy sleeping pills
The method depends on whether you want to buy sleeping pills or the type of medicine.
Sleeping pills are highly effective and are covered by insurance, but in order to purchase them, a doctor’s diagnosis, a doctor’s prescription, and a pharmacist’s dispensing are essential.
On the other hand, sleep-improving drugs have milder effects than sleeping pills, are used to temporarily improve insomnia , and can be purchased at general pharmacies and drug stores.
In addition, overseas medicines are used for personal purposes, the quantity is limited to a certain quantity, and the use is the responsibility of the individual, but it can be imported individually via the Internet.
get a prescription at a hospital
If you wish to take sleeping pills prescribed by a doctor to treat insomnia, please first consult a medical institution and receive a diagnosis of insomnia.
If a doctor checks your physical condition and determines that you have insomnia and that treatment with sleeping pills is appropriate, a prescription will be issued. By submitting the prescription to the dispensing pharmacy, the pharmacist will dispense based on the doctor’s prescription, and after listening to the explanation of sleeping pills by the pharmacist, you will be able to obtain it.
There are many processes that go through until it is obtained, but this is a drug that requires caution when using it because sleeping pills are prescription drugs (also known as prescription drugs), which are extremely effective and may cause side effects. This is because it has been designated by the Ministry of Health, Labor and Welfare.
Since it is said that a doctor’s diagnosis and a pharmacist’s explanation are essential for general consumers to use it, general pharmacies, drug stores, and general mail-order sites such as Amazon and Rakuten do not handle it.
Hypnotics are very effective for insomnia when taken for a short period of time, but when taken for a long period of time, they cause tolerance and dependence problems. Withdrawal symptoms may also be a concern if the drug dose is suddenly reduced or discontinued.
Therefore, it is necessary for the doctor to check the physical condition and adjust the drug each time, so be sure to take the medicine according to the doctor’s instructions.
buy over the counter medicine
As a treatment for insomnia symptoms, a drug called sleep improvement drug is sold in USA as an over-the-counter drug.
Unlike sleeping pills, it is different from the active ingredient of the drug, and mainly contains diphenhydramine hydrochloride, which is an antihistamine.
Over-the-counter sleep-improving drugs are not for “insomnia”, but for “temporary insomnia” such as light sleep and poor sleep. Compared to sleeping pills prescribed by a doctor, the effect is weaker and induces you to fall asleep slowly.
It is not enough to go to the hospital, and it is a drug that is used only for temporary improvement of symptoms rather than chronic symptoms.
Medicines handled at general pharmacies are called OTC medicines, and are classified into guidance-required medicines and over-the-counter medicines.
Most of the sleep-improving drugs are second-class OTC drugs, and although it is necessary to pay attention to safety such as drug combinations and side effects, explanations to patients are suppressed to an obligation to make efforts, and pharmacists and others Since it is a drug that can be sold by registered sellers, it is relatively easy to obtain.
Online sales are also permitted.
buy online
If you are suffering from chronic insomnia but hesitate to visit a medical institution, or if you want to improve your temporary insomnia but don’t want to buy it at the store, you can use mail order. It would be nice.
For those who wish to purchase drugs for insomnia by mail order, there is a method of importing drugs that are sold in overseas markets instead of drugs that have been approved in USA.
In USA, insomnia treatment drugs are designated as prescription drugs, and can be obtained only by submitting a prescription issued based on a doctor’s diagnosis to a dispensing pharmacy.
Therefore, it is not available on Amazon and Rakuten, which are typical mail-order sites in USA.
On the other hand, the Pharmaceutical Machinery Law indicates that insomnia treatment drugs sold in overseas markets can be imported from overseas for personal use and up to a certain quantity without prior notice to the Ministry of Health, Labor and Welfare. It has been.
No doctor’s consultation or prescription is required. Please purchase from the mail order site provided by the agency through a private import agency.
In addition, sleep-improving drugs, which are treatments for temporary insomnia, can also be imported individually from overseas, and can also be purchased online in USA.
Guidelines for Correct Use of Sleeping Pills
In USA, in 2013, a research group of the Ministry of Health, Labor and Welfare and the USA Society of Sleep Research jointly established the “Clinical Guidelines for Appropriate Use and Discontinuation of Sleeping Pills” as clinical guidelines for safe and effective drug therapy for insomnia . ” was announced.
Insomnia affects about 10% of the general USA adult. Due to the aging of the population and the modern society that operates 24 hours a day, there are a certain number of people engaged in shift work and night shifts, and more people are living night shifts.
The rate of exposure to stress is also on the rise, and there is concern that the number of patients suffering from insomnia will increase in the future due to the increase in patients with lifestyle-related diseases and depression, which are the risks of developing insomnia.
In fact, the amount of sleeping pills prescribed is on the rise, and the percentage of patients taking high doses or multiple sleeping pills is also on the rise. Some patients are unable to stop taking the drug despite taking the regular dose, and there have been reports of abuse and overdose.
Hypnotics can be tolerated by long-term use, there are concerns about physical and psychological dependence, and there are withdrawal symptoms.
Good management is required for use.
This guideline provides guidelines for both doctors and patients on how to safely and effectively treat insomnia as well as drug treatment.
Please refer to it once as it can solve your questions about insomnia.
Effectiveness of sleeping pills (summary)
Sleeping pills are very effective in treating insomnia when taken for a short period of time. However, it has been pointed out that long-term use may lead to the formation of tolerance and physical and mental dependence.
Abruptly reducing the dose or stopping the drug may cause withdrawal symptoms. Therefore, it is premised on efficient treatment by short-term administration for patients who have not obtained the expected effect with non-drug therapy.
If you follow the correct dosing regimen, the risk is not so high, so understand the characteristics of sleeping pills and follow the guidelines to use them safely and effectively.