Sleep Medications

Sedative-Hypnotics Overview

• Definition:

  • Sedative-hypnotics are drugs that depress or slow down the body's functions.

  • Often referred to as tranquilizers, sleeping pills, or simply sedatives.

  • Used for calming anxiety and promoting sleep.

  • Intended for short-term use; can lead to withdrawal symptoms.

Types of Sedative-Hypnotics

• Barbiturates:

  • Pentobarbital (Nembutal)

  • Secobarbital (Seconal)

  • Phenobarbital (Luminal)

• Benzodiazepines:

  • Flurazepam (Dalmane)

  • Temezepam (Restoril)

  • Triazolam (Halcion)

  • Lorazepam (Ativan)

  • Diazepam (Valium)

• Non-Benzodiazepines:

  • Eszopiclone (Lunesta)

  • Indicated for chronic insomnia; peak action in 1 hour.

  • Common side effects: next-day drowsiness, unpleasant taste, dry mouth, headache, dizziness.

  • Zaleplon (Sonata)

  • Effective for sleep initiation due to short half-life; less likely to cause daytime drowsiness.

  • Side effects: headache, malaise, bloody nose, altered color perception.

  • Zolpidem (Ambien and Ambien CR)

  • Ambien: helps with sleep onset.

  • Ambien CR: helps with both onset and maintenance; associated with sleepwalking and nocturnal activities without memory.

  • Less tolerance noted with Ambien CR.

Melatonin Receptor Agonists

• Ramelteon (Rozerem):

  • Unique mechanism; not associated with dependence.

  • Absorption decreased after high-fat meals.

  • Not recommended for individuals with obstructive sleep apnea or severe chronic obstructive pulmonary disease (COPD).

  • Common side effects: fatigue, headache, nausea, dizziness.

  • Considered one of the safest drugs for long-term use.

Orexin Receptor Antagonists

• Suvorexant (Belsomra):

  • Works by blocking orexin receptors, aiding sleep induction.

  • Approved for adults with sleep onset and maintenance issues.

  • Potential serious side effects; effects may go unnoticed due to confusion.

Complementary Health Approaches

• Herbal Therapies:

  • Examples: Kava kava, Valerian.

• Mindfulness Techniques:

  • Meditation, Yoga, Acupressure, Acupuncture.

• Aromatherapy:

  • Use of essential oils for relaxation.

• Antihistamines:

  • Diphenhydramine (Benadryl)

  • Hydroxyzine (Atarax, Vistaril)

Sleep Environment Considerations

• Noise Reduction:

  • Identify and minimize disruptive noises in hospital settings.

• Creating Restful Environment:

  • Implement bedtime rituals, offer relaxation methods, ensure comfort.

  • Provide appropriate snacks and beverages.

  • Respect normal sleep-wake patterns.

  • Cluster nursing care to minimize disturbances (e.g., avoid bright lights).

  • Employ medications, provide education on sleep hygiene, use music for relaxation, and focus on noise reduction.