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A hypnotic (from Hypnos, sleep), also known as a somnifacient or soporific, and commonly known as sleeping pills, are a class of psychoactive drugs whose primary function is to and to treat (sleeplessness).

This group of drugs is related to . Whereas the term sedative describes drugs that serve to calm or , 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 to loss of consciousness), they are often referred to collectively as sedative–hypnotic drugs.

(2025). 9780071468046, The McGraw-Hill Companies, Inc..

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 the human sleep pattern—a physician may instead recommend changes in the environment before and during sleep, better , 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 (Z-drugs), while 10.8% are taking , as of 2010, in the USA. Early classes of drugs, such as , have fallen out of use in most practices but are still prescribed for some patients. In children, prescribing hypnotics is not currently acceptable—unless used to treat or . Elderly people are more sensitive to potential side effects of daytime fatigue and cognitive impairment, and a found that the risks generally outweigh any marginal benefits of hypnotics in the elderly. A review of the literature regarding benzodiazepine hypnotics and Z-drugs concluded that these drugs have adverse effects, such as dependence and accidents, and that optimal treatment uses the lowest effective dose for the shortest therapeutic time, with gradual discontinuation to improve health without worsening of sleep.

Falling outside the above-mentioned categories, the neurohormone melatonin and its analogues (e.g., ) serve a hypnotic function.


Types

Barbiturates
are drugs that act as central nervous system , and can therefore produce a broad spectrum of effects, from mild to total . They are also effective as , hypnotics, and effects; however, these effects are somewhat weak, preventing barbiturates from being used in in the absence of other analgesics. They have dependence liability, both physical and psychological. Barbiturates have now largely been replaced by in routine medical practice – such as in the treatment of anxiety and insomnia – mainly because benzodiazepines are significantly less dangerous in . However, barbiturates are still used in general anesthesia, for , and for . Barbiturates are derivatives of .

The principal mechanism of action of barbiturates is believed to be positive allosteric modulation of receptors.

Examples include , , , , and sodium thiopental.


Quinazolinones
are also a class of drugs that function as hypnotics/sedatives that contain a 4-quinazolinone core. Their use has also been proposed in the treatment of .

Examples of quinazolinones include , , (Aolan, Athinazone, Ethinazone), , (Arofuto), (Nubarene, Casfen), and (Quaalude).


Benzodiazepines
can be useful for short-term treatment of insomnia. Their use beyond 2 to 4 weeks 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 sleep time, and reducing wakefulness. Like alcohol, benzodiazepines are commonly used to treat insomnia in the short-term (both prescribed and self-medicated), but worsen sleep in 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 (the most restorative part of sleep for both energy and mood).

Other drawbacks of hypnotics, including benzodiazepines, are possible to their effects, , and reduced slow-wave sleep and a withdrawal period typified by rebound insomnia and a prolonged period of anxiety and agitation.

(2009). 9780826110947, Springer Publishing Company. .
The list of benzodiazepines approved for the treatment of insomnia is 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 and , have residual effects that may persist into the next day and are, in general, not recommended.

It is not clear whether the newer nonbenzodiazepine (Z-drug) hypnotics 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 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 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., which cites

  • 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 is primarily at .

(2025). 9780120883974, Elsevier.


Nonbenzodiazepines
Nonbenzodiazepines (Z-drugs) are a class of psychoactive drugs that are "benzodiazepine-like" in nature. Nonbenzodiazepine are almost entirely the same as benzodiazepine drugs, and therefore entail similar benefits, side effects, and risks. Nonbenzodiazepines, however, have dissimilar or different chemical structures, and are unrelated to benzodiazepines on a molecular level.

Examples include (Imovane), (Lunesta), (Sonata), and (Ambien). Since the generic names of all drugs of this type start with Z, they are often referred to as Z-drugs.Ryba, N.; Rainess, R. Z-drugs and Falls: A Focused Review of the Literature. The Senior Care Pharmacist 2020, 35 (12), 549-554. DOI: 10.4140/tcp.n.2020.549.

Research on nonbenzodiazepines is new and conflicting. A review by a team of researchers suggests the use of these drugs for people who have trouble falling asleep (but not staying asleep),Because the drugs have a shorter elimination half life they are metabolized more quickly: nonbenzodiazepines zaleplon and zolpidem have a half-life of 1 and 2 hours (respectively); for comparison, the benzodiazepine clonazepam has a half-life of about 30 hours. This makes the drug suitable for sleep-onset difficulty, but the team noted sustained sleep efficacy was unclear. as next-day impairments were minimal. The team noted that 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 to nonbenzodiazepines may be slower to develop than with benzodiazepines. A different team was more skeptical, finding little benefit over benzodiazepines.


Melatonin/melatonin receptor agonists
Melatonin, the hormone produced in the in the brain and secreted in dim light and darkness, among its other functions, promotes sleep in mammals. It activates both melatonin receptors MT1 and MT2 to produce beneficial effects on sleep, therefore being used exogenously for mild insomnia. A small improvement in sleep onset and total sleep time by using melatonin has been shown in recent systematic reviews.

Synthetic analogues of melatonin, or melatonin receptor agonists, have also been made. Among these, and are used for sleep disorders. is an antidepressant of this class, with some studies also reporting an effect on sleep.


Antihistamines
, also known as H1 antagonists, are a class of drugs that inhibit action at H1 receptors. They are clinically used to alleviate allergic reactions including allergic rhinitis, allergic conjunctivitis, and , which are mediated by . First-generation antihistamines, such as and , often cause sedation as a side effect, which can be utilized to treat insomnia. Some antihistamines, such as doxylamine, are available for purchase (OTC) in some countries and can be used for the occasional relief of insomnia. Low-dose is approved by the FDA for the treatment of insomnia. Second generation of antihistamines such as and have a much less sedating effect than the first ones with a much lower degree of crossing the blood–brain barrier.

In common use, the term antihistamine refers only to compounds that inhibit action at the H1 receptor.

Clinically, H1 antagonists are used to treat certain . Sedation is a common side effect, and some H1 antagonists, such as and doxylamine, are also used to treat insomnia.


Orexin antagonists
Dual orexin receptor antagonists are drugs that block the orexin receptors OX1 and OX2, hence reducing the wakeful effect of the and inducing sleep. Orexin antagonists , , and have been shown in studies to improve sleep onset and sleep quality.


Others

Antidepressants
Some have sedating effects.

Examples include:

Serotonin antagonist and reuptake inhibitors
Tricyclic antidepressants
(2025). 9780857110848, Pharmaceutical Press. .
Tetracyclic antidepressants


Antipsychotics
While some of these drugs are frequently prescribed for insomnia, such use is not recommended unless the insomnia is due to an underlying mental health condition treatable by 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 and , 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 with sedation as a side effect that are occasionally used for insomnia:

First-generation
Second-generation


Miscellaneous drugs
Alpha-adrenergic agonist


History
Hypnotica was a class of somniferous drugs and substances tested in medicine of the 1890s and later. These include , acetal, , , , amylenhydrate, , chloralurethan, ohloralamid, or chloralimid.Pacific Record of Medicine and Surgery - Volume 5 - Page 36 1890

Research about using medications to treat insomnia evolved throughout the last half of the 20th century. Treatment for insomnia in psychiatry dates back to 1869, when was first used as a soporific.

(2025). 9780195176681, Oxford University Press.
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 and tended to cause physical and psychological dependence.

During the 1970s, and 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 or other . Questions have been raised as to whether they disturb sleep architecture.

Nonbenzodiazepines are the most recent development (1990s–present). Although it is clear that they are less toxic than barbiturates, their predecessors, comparative efficacy over benzodiazepines has 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 if they have sedating effects. Examples of these include (an antidepressant), (an medication), (an antipsychotic), and allergy and medications and . Off-label sleep remedies are particularly useful when first-line treatment is unsuccessful or deemed unsafe (as in patients with a history of substance use disorders).


Effectiveness
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 (standardized mean difference (SMD)) in terms of efficacy for insomnia. The assessed medications included (e.g., , , many others) (SMDs 0.58 to 0.83), (, , , ) (SMDs 0.03 to 0.63), sedative and (, , , ) (SMDs 0.30 to 0.55), the (SMD 0.07), orexin receptor antagonists (, , , ) (SMDs 0.23 to 0.44), and melatonin receptor agonists (melatonin, ) (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 , , and and the antidepressants and , were not included in analyses due to insufficient data.


Risks
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 the Medication Appropriateness Tool for Comorbid Health Conditions in Dementia (MATCH-D).Citation error. See the inline comment on how to fix it. The use of these medications can further impede cognitive function for people with dementia, who are also more sensitive to side effects of medications.


See also
  • Sleep induction § Alcohol


Notes


Further reading
  • discusses Barbs vs. benzos


External links

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