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If you have insomnia, it is ideal to first try to improve your sleep condition by improving your lifestyle and sleep environment, rather than relying on medication.
On the other hand, some people may find their symptoms so distressing that they need to rely on sleeping pills. However, while we use the general term "sleeping pills," the contents of these medications vary greatly, as do their effects on the body.
This article will introduce the different types of sleeping pills available, as well as how to choose them and use them effectively.
Types of Sleeping Pills
When using sleeping pills, it's important to understand the effects and impact of the medication yourself, rather than simply assuming it's safe because a doctor prescribed it. Here, we'll introduce the types of sleeping pills available.
Sleeping pills can be broadly divided into two main groups, and each group contains several types.
| Sedative Sleeping Pills | Sleeping Pills that Enhance Natural Sleepiness |
|---|---|
| Barbiturates, Benzodiazepines, Non-benzodiazepines | Melatonin receptor agonists, Orexin receptor antagonists |
① Sedative Sleeping Pills
Sedative sleeping pills have traditionally been used as sleep aids and still constitute the majority of sleeping pills prescribed by medical institutions today. These drugs generally suppress and sedate brain activity.
Barbiturates
Barbiturates were originally developed as anesthetics and were used as sleeping pills. However, due to their strong side effects, they are now rarely used as sleeping pills and are instead used as anesthetics and anticonvulsants.
Benzodiazepines
The next prevalent type of medication was benzodiazepines, which are still prescribed in Japan today. Benzodiazepines were originally developed as anxiolytics and, while they have sleep-inducing and anxiolytic effects, they also have side effects such as memory and consciousness impairment due to their sedative action, and unsteadiness due to their muscle relaxant action. Their use is declining overseas.
Furthermore, barbiturates and benzodiazepines have a characteristic of being addictive, making dosage reduction or discontinuation difficult.
Non-benzodiazepines were developed to reduce the side effects of benzodiazepines, and include those that are less likely to cause memory impairment and those that reduce muscle relaxant effects. However, it is important to note that the mechanism of action of these drugs is almost identical to that of benzodiazepines.
So far, we have discussed sedative drugs. A common point among them is that while they have strong sleep-inducing effects, they are ultimately drugs that reduce brain activity and do not address the fundamental cause of insomnia.
② Sleeping Pills that Enhance Natural Sleepiness
In contrast to ①, sleeping pills that address abnormalities in the body's systems that cause insomnia, known as ② natural sleepiness-enhancing sleeping pills, have emerged.
Melatonin Receptor Agonists
One of these is melatonin receptor agonists. Melatonin is a hormone produced in the pineal gland of the brain, involved in the body's internal clock and sleep induction. Therefore, if melatonin production becomes abnormal, insomnia symptoms appear. Melatonin receptor agonists work similarly to melatonin, compensating for melatonin deficiency and improving insomnia symptoms.
Orexin Receptor Antagonists
Another drug is the orexin receptor antagonist. Orexin is a neurotransmitter produced in the hypothalamus of the brain that maintains wakefulness, and a decrease in orexin activity causes drowsiness. Conversely, excessive orexin activity maintains wakefulness and leads to insomnia symptoms. Orexin receptor antagonists induce drowsiness by blocking the action of orexin.
We've introduced two types of sleeping pills that enhance natural sleepiness. These medications resolve insomnia by supplementing the action of what is deficient or blocking the action of what is excessive within the body's sleep-wake system. They are characterized by fewer side effects and less risk of dependence.
As mentioned above, sleeping pills are broadly divided into two groups based on their ingredients. However, ① sedative sleeping pills are further classified into "ultrashort-acting," "short-acting," "intermediate-acting," and "long-acting" based on their duration of action. When these sleeping pills are prescribed, it is important to pay attention to their duration of action.
Choosing and Effectively Using Sleeping Pills
Traditionally, the prevailing method involved using sedative sleeping pills to forcibly sedate the brain and induce sleep. However, advances in understanding the mechanisms of sleep in recent years have led to a shift towards identifying the cause of insomnia and treating the specific physical abnormalities found.
Therefore, instead of immediately using sedative sleeping pills, it is preferable to first use sleeping pills that enhance natural sleepiness. If these are ineffective, it indicates that melatonin deficiency or orexin excess is not the cause of insomnia, and there may be other underlying reasons. Only if absolutely necessary, should sedative sleeping pills be considered as a last resort.
To manage sleeping pills effectively, there are things you, as a patient with insomnia, can do. Instead of thinking, "I need sleeping pills because I can't sleep," it's crucial to consult a sleep specialist in detail about how your sleep is poor and how it's bothering you.
Furthermore, even if sleeping pills are prescribed after consultation, it is important to understand what kind of medication it is. If you have any questions, ask your pharmacist. Understanding the nature of the sleeping pill before using it will lead to appropriate effects and reduce problems.
If you experience any unusual symptoms during use or feel that the medication is not right for you, do not hesitate to consult your doctor. By taking an active role in managing your sleep, you can effectively work with sleeping pills.
