How to choose sleeping pills: without prescriptions for sound sleep, potent, for children, pregnant women

Sleeping pills are medications that are part of the group of psychoactive drugs that promote falling asleep, long and deep sound sleep, if its disturbance is not associated with pathology of internal organs.

The second name for sleeping pills is hypnotics. The name comes from the Latin word hypnosis. These include drugs of various chemical structures that suppress the function of the central nervous system and induce sleep that is close to physiological.

Sleep disorders

In order to choose the right sleeping pill, the doctor must determine the nature of the patient’s sleep disorder. Most hypnotics can only affect a specific disorder, and not all disorders at once.

The following sleep disorders are distinguished:

• if disturbances occur only during falling asleep - presomnia
  disorder;
• with intrasomnic
  disorder, light sleep and frequent waking up are observed;
• post-somnia
  disorders require adjustment if you are concerned about the problem of early rise and daytime sleepiness.

All of the above violations indicate an insufficient amount of sleep, since it does not restore strength and does not provide rest. In addition, a number of other disorders are associated with the human sleep process:

• insomnia
  – disruption of the process of falling asleep or sleep itself;
• hypersomnia
  – the need for prolonged sleep, which can be caused by unhealthy processes in the body;
• parasomnia
  – walking and talking in sleep, heavy dreams;
• snoring
  caused by the characteristics of the body;
• apnea
  is the sudden cessation of breathing during sleep.

All these disorders arise for various reasons: violation of the day-night routine, emotional stress, mental illness.

Indications for use

Sleep disturbance in adults is characterized by insomnia (when, even being tired, a person cannot fall asleep), hypersomnia (constant drowsiness, depression, accompanied by decreased energy), frequent awakenings during sleep (5-6 times or more often). The consequences of all these deviations are loss of strength, irritability, memory problems, impaired thinking, and headaches.

Insomnia can be caused by a stuffy room, late meals, uncomfortable bed, stress, physical inactivity

All causes that arise in old age are divided into external and internal. Internal factors:

• post-stroke condition;
• stress;
• Parkinson's disease;
• age-related dementia;
• disrupted routine;
• accompanying diseases;
• rhinorrhea;
• decreased blood sugar;
• limb spasms;
• uncontrolled use of medications.

Problematic sleep in an adult is accompanied by prolonged falling asleep, sensitivity (when any rustle can interrupt rest), and frequent awakenings. If one of the symptoms is present or the causes of insomnia are unclear, you should seek help from a doctor.

Sleeping pills: classification

According to the mechanism and spectrum of their action, as well as additional factors influencing the sleep process, hypnotics are divided into:

1. Benzodiazepines
   are used as a sedative (at a small dosage), anti-anxiety (at an average dosage) and as a powerful hypnotic (when used in high concentrations), as well as antispasmodic.
   These include: Nitrazepam, Flunitrazepam, Triazolam
   , etc.
2. Barbiturates
   are excellent for relieving anxiety and insomnia.
   Their action is based on central nervous system suppression, which begins on average 20-30 minutes after administration. Barbiturates promote the onset of deep sleep. This group includes: Barbital, Estimal, Barbital-sodium
   , etc.
3. Cyclopyrrolones
   are potent drugs that provide prolonged sleep, but cause morning and afternoon drowsiness.
   They should not be used by those who drive a car. The sleep phase usually begins half an hour after taking it and lasts 6-8 hours. Zopiclone
   represents this group .
4. Ethanolamines
   help with primary insomnia or short-term sleep disorders.
   This group is represented by the drug Donormil
   .
5. Imidazopyridines
   have a long-lasting hypnotic effect, which corresponds to the characteristics of natural immersion in sleep, promote rapid falling asleep and normalize all processes.
   In addition, patients do not develop addiction to medications in this group. Zolpidem
   is an imidazopyridine .
6. Aldehydes
   are hypnotics and anticonvulsants, relieve mental agitation.
   In addition, they are actively used for spasmophilia, tetanus, locally for seborrhea, etc. The group is represented by Chloral hydrate
   .
7. Antihistamines
   help restore sleep processes, their effect increases after taking psychotropic drugs.
   They are actively used for various types of allergies. They act quickly, but not for long, 4-8 hours. May cause psychomotor agitation. Some of them have a relatively weak, but quite noticeable hypnotic effect. Such drugs include Diphenhydramine, Tavegil, Suprastin, Pipolfen
   . 2nd generation medications of this group do not affect physical and mental activity. These include Kestin, Claritin, Zyrtec. The latest generation of drugs can be prescribed to people whose activities are associated with increased concentration, as they also do not have a hypnotic effect. These are Gismanal, Trexil, Telfax.
8. Sedative neuroleptics
   have a hypnotic and psychotropic effect, calm, relieve tension and muscle spasms, and help clarify the thought process.
   These include: Chlorpromazine, Chlorprothixene, Clozapine
   .
9. Sedative antidepressants
   have a hypnotic, anti-anxiety and sedative effect, and have a positive effect on the emotional sphere. This group includes: Azafen and Doxepin.

In accordance with the nature of the sleep disorder and its accompanying symptoms, the patient is prescribed sleeping pills of the most appropriate group. In this case, their additional effects and the duration of the main effect are taken into account.

Classification based on duration of exposure

One of the most important characteristics of any medicine is the duration of its effect, and for sleeping pills this is probably the most important property along with the safety of administration.

When choosing one or another group of hypnotics, you need to be very careful. For example, strong sleeping pills should not be taken before a trip or an important meeting, while weak ones will not help with severe sleep disorders.

Non-narcotic and narcotic hypnotics

All sleeping pills are divided into drugs with narcotic and non-narcotic effects.

Non-narcotic drugs:

• benzodiazepines: Flunitrazepam, Nitrazepam;
• aldehydes: Chloral hydrate;
• cyclopyrrolones and imidazopyridines: Imovan, Zolpidem;
• antihistamines: Donormil.

Narcotic hypnotics:

• barbiturates: Barbital, Estimal, Phenobarbital.

With the regular use of narcotic hypnotics, drug dependence occurs, both on the mental and physical level. When these drugs are discontinued, characteristic symptoms occur: anxiety, confusion, and sleep problems.

Potent sleeping pills include barbiturates: Bellataminal, Hexobarbital, Methohexital, Phenobarbital, Cyclobarbital; they are suitable for sound sleep, but are not available without a prescription and require constant dosage monitoring.

Light non-narcotic hypnotics have a weak effect, but are available without a prescription and are quite safe. These are Corvalol, Novo-Passit, Persen-Forte, which do not have a narcotic effect and are natural remedies.

Reviews

Lydia: “Insomnia overtook me after 40, when serious problems with the gastrointestinal tract began. “Novopassit” helped - a mild, fast-acting remedy that helped me fall asleep within half an hour. Now there are no such problems, but at one time the drops made my life much easier.”

Olga: “When I was divorcing my husband, I was under terrible stress and I was prescribed Amitriptyline and Eglonil (antidepressants and tranquilizers). After 2 months of taking it, I managed to overcome not only apathy, but also insomnia. But they slow down consciousness and constantly make you sleepy.”

Irina: “I often suffer from problems with sleep, but I haven’t gotten around to taking pills yet. Herbal teas help more or less. But chemistry will show itself sooner or later, so it’s better not to get carried away with such treatment for insomnia.”

The effect of sleeping pills of various groups

Different groups of hypnotics have different effects. What mechanisms allow hypnotics to influence a person?

Barbiturates

This group of hypnotics interacts with gamma-aminobutyric acid, which affects the inhibition of nerve impulses and, accordingly, promotes the excitation of neurons. Hypnotics of this group influence the receptors of this block and thereby increase the entry of chlorine ions into the cell. As a result, the degree of excitation of neurons begins to decrease, and the processes of sending impulses to the central nervous system are blocked.

Benzodiazepines

Drugs belonging to this group also act on the GABA complex. The effect of taking them directly depends on the dosage of the medicine taken. In small doses, benzodiazepines reduce anxiety, in large doses they achieve a hypnotic effect.

Z-drugs

They reliably but gently affect the GABA complex and reduce excitation in the central nervous system, but have contraindications during pregnancy and lactation, with breathing problems and childhood. They are selective. For example, Zolpidem targets a specific structural subtype.

Antihistamine sleeping pills

They block H1 histamine receptors, eliminating allergy symptoms, but some of them have a side effect of sedation, which is used for insomnia. One of the potent hypnotics in this series is Donormil.

Contraindications and side effects

Even an expensive good sleeping pill does not guarantee the absence of side effects. They can be triggered by violation of contraindications, overdose, or the body’s individual reaction to active substances. Therefore, even after visiting a doctor, it is important to study the instructions.

There can be a lot of contraindications, they depend on the active ingredients, but this does not prevent us from highlighting a few of the most common ones:

• pregnancy, lactation;
• children under 18 years of age;
• disruption of the kidneys and urinary system;
• apnea and other breathing pathologies;
• alcoholism;
• autoimmune diseases;
• glaucoma;
• brain diseases.

Side effects include dizziness, nausea and vomiting, addiction, lethargy, impaired memory and concentration. Overdose of certain drugs is fatal.

REFERENCE! More than 9 million different medicinal sleeping pills are used annually around the world. They are most in demand among the population over 60 years of age, despite the fact that this is only 15% of the world's population.

What should you consider when choosing sleeping pills?

When choosing a drug, you need to consider the type and degree of sleep disorder:

1. If the problem is only falling asleep
   , hypnotics of medium or short duration are suitable. For moderate severity of the disorder, you can use various drugs - you need to choose one for each organism. For these purposes, Clomethiazole, Zopiclone, or Propimyosin are usually prescribed. Barbiturates and benzodiazepines are not prescribed.
2. If you are worried about waking up in the middle of the night,
   a sleeping pill with an average duration of action will help you sleep soundly. These are: Chloral hydrate, Melatonin, Doxylamine. For a quick effect, products containing chloral hydrate are suitable, but with prolonged use they become addictive, and for long-term use, Doxylamine is suitable.
3. The problem of early rise
   will be solved by medications with medium or long-term effects. In particular, Diphenhydramine. However, they are contraindicated for those whose work requires attention.

Overdose of sleeping pills

Caution when taking benzodiazepines and barbiturates is mandatory, since these potent drugs contribute to addiction to them, so it is better to use drugs from other groups. For example, Doxylamine or Zopiclone. These drugs influence the process of falling asleep, ensuring rapid immersion in sleep without disturbing its structure.

The dosage of the drug must be observed, since large doses of, for example, barbiturates can cause serious consequences: changes in gait, slow speech, and in the most severe cases lead to coma or death.

Therapeutic actions for insomnia

The basis of pharmacotherapy for sleep disorders includes:

• hygienic measures with the use of herbal sedatives;
• short-acting sleeping pills Nozepam, Zopiclone;
• breaks in treatment after a course duration of 10-14 days;
• taking sleeping pills by elderly patients at half the dose;
• use of Zopiclone, Zolpidem by those suffering from apnea;
• psychotherapeutic activities for those who sleep 6 hours a day.

Patients with problems falling asleep can be successfully treated with drugs from the benzodiazepam group or new drugs. To eliminate nightmares and vegetative reactions, tranquilizers like Phenazepam and antipsychotics like Clozapine are very helpful. Painful early awakenings are eliminated with antidepressants.

If the condition is caused by cerebral atherosclerosis, then long-acting drugs such as Nitrazepam are needed along with Tanakan, intended to improve cerebral circulation. When insomnia is caused by jet lag, you can take a good remedy like Apik Melatonin.

In addition to the pineal gland hormone, it contains vitamin B pyridoxine. Potent sleeping pills are not prescribed in courses to people of certain professions: pilots, drivers, high-altitude workers, operators of high-precision equipment.

Strong sleeping pills - what is available without a prescription?

In any group there are weak and strong drugs, which must be used with particular caution.

Potent hypnotics include:

1. Benzodiazepines
   : Dormicum, Midazolam, etc.
2. Barbiturates
   : Brietal, Bellataminal, etc.
3. Z-drugs
   : Piclodorm, Relaxone, Zopiclone.

These sleeping pills are very strong and are available only with a prescription.

Melaxen, a strong sleeping pill for sound sleep, can be purchased without prescriptions at the end of 2022. The drug has a mild but effective effect and does not shorten the duration of the sleep phase. You can also buy the sleeping pill Donormil without a prescription. These are perhaps the two best over-the-counter powerful hypnotics.

It is unfortunate to note that all sleeping pills are addictive to varying degrees. But the patient becomes addicted to only some hypnotics quickly, but not to others. Usually, melatonin and diphenhydramine medications are not addictive.

Alcohol compatible list

There is almost always incompatibility between the strongest sleeping pills and ethyl alcohol. Combining alcohol with sleep medications can be dangerous to human health and life.

Alcohol+barbiturates

Ethyl alcohol increases the toxicity of barbiturates, enhances their effect, reduces the adequate response and leads to increased depression of the central nervous system.

In people with respiratory failure, the combined use of ethyl alcohol and barbiturates can lead to depression of the respiratory center.

In people with alcohol dependence, treatment with barbiturates leads to rapid drug dependence.

Alcohol+benzodiazepines

Only under the supervision of a physician are benzodiazepine drugs prescribed for alcohol withdrawal as a sedative. Medications make the detoxification process easier.

The combination of benzodiazepines and alcoholic beverages leads to severe intoxication. In humans, the functions of the central nervous system are disrupted, the respiratory center is depressed.

If you do not wake up the victim and provide first aid, he may die from respiratory arrest.

Alcohol and H1-histamine receptor antagonists

Ethyl alcohol reduces the sedative effect of antihistamines and increases the risk of side effects. In this case, a person cannot fall asleep due to increased heart rate, anxiety, and dry mouth.

In order for sleep to occur, the patient has to increase the dosage. Ultimately, this leads to drug addiction.

Alcohol + drugs based on Melaxen

Ethyl alcohol can neutralize the effect of melatonin preparations. Preparations based on this hormone are adaptogens and help you fall asleep quickly.

Alcoholic drinks do not cause poisoning when combined with melatonin. Sometimes nausea and dizziness may occur.

Alcohol+z-drugs (non-benzodiazepines)

During treatment with z-group drugs, you should not drink alcohol. The combined effect increases the risk of side effects of the drug. A person experiences rapid intoxication, dizziness, nausea and vomiting. After a combination of these substances, retrograde amnesia develops.

Natural remedies

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You can improve the process of falling asleep not only with the help of medications, but also with home remedies. Here are some of them:

• baked potatoes have a calming effect;
• Warm milk at night will help against insomnia; the tryptophan present in it has a calming effect;
• A decoction of chamomile with honey is also an excellent sleep aid.

These recipes help reduce nervous tension, relax and quickly fall asleep.

General principles for treating insomnia

Strong sleeping pills are not always required. Sometimes it is enough to adjust your sleep and rest patterns and eliminate the irritating factor. However, with long-term chronic insomnia, it is impossible to do without medications. When prescribing medications, take into account:

• symptoms;
• concomitant pathologies;
• drug interactions;
• side effects of medications;
• patient's age;
• physiological conditions (pregnancy, lactation).

Important! Sleeping pills from the group of benzodiazepines should not be taken if breathing during sleep is disrupted (night apnea). Prolonged hypnotics are contraindicated in patients who the next morning are forced to drive or engage in work that requires concentration.

Rapid-acting sleeping pills are indicated in the following cases:

• the duration of insomnia is 1–4 weeks with minor consequences for the general condition of a person;
• insomnia for more than 4 weeks, which is accompanied by negative health consequences.

If in the first case sedatives with a hypnotic effect will help, then in case of severe insomnia, potent sleeping pills are prescribed.

Our choice: TOP 15 best sleeping pills

High-quality sleeping pills provide quick fall asleep, deep immersion in a long sleep, but without consequences for the body and addiction.

Over-the-counter sleeping pills to treat insomnia and related disorders:

The choice of any remedy must be agreed with your doctor.

“Give me a good sleeping pill...without a prescription.” Overview table for drugs

Insomnia is a common disorder with many different causes. About a third of the population knows about it firsthand. Moreover, insomnia is more common in women than in men, and its frequency increases with age. During the pandemic, the number of complaints about insomnia has increased. This is partly due to increased anxiety and psychological tension during these difficult times. Sleep disturbances can also be a consequence of a coronavirus infection.

Sleep disorders (insomnia, insomnia) are conditions that recur repeatedly, when, despite sufficient conditions for sleep, its duration or quality suffers.

Insomnia can manifest itself in different forms. The person may have difficulty falling asleep, waking up frequently at night, waking up early, and being unable to fall back to sleep.

Sleep disorders negatively affect wakefulness: a person feels tired, overwhelmed, physically and mentally exhausted, memory and concentration suffer.

Pharmacy workers are constantly faced with customers asking for some good sleeping pills.

Remedies for sleep disorders.

Pharmacy drugs for sleep disorders can be divided into prescription drugs, which are prescribed by a doctor, and over-the-counter drugs. Compositions to support sleep are also included in many dietary supplements.

When can the chief captain give a pill “for sleep.”

Insomnia may be associated with an underlying disease (hypertension, thyrotoxicosis, pain syndrome, depression, bipolar disorder, restless legs syndrome, obstructive sleep apnea syndrome), medications (beta-blockers (they suppress endogenous melatonin), SSRI antidepressants, stimulants, containing caffeine), abuse of alcohol and tobacco, with withdrawal syndrome due to giving up alcohol (smoking, etc.), uncontrolled use of sedatives and sleeping pills, imbalance of sleep and wakefulness, lack of adequate conditions for sleep.

The most common case is acute situational insomnia, which occurs as a reaction to stress and lasts no more than 3 months. It is also adaptive or household. Stressful situations arise constantly (illness, death, separation, birth, preparing for an exam, searching, losing a job, and others). About 20% of the population experience this form of insomnia, which most often goes away on its own. But if this condition drags on, it becomes chronic, which is more difficult to treat. Medications help cope with acute insomnia, preventing it from becoming chronic and allowing it to recover faster. For mild acute adaptation insomnia, over-the-counter drugs are optimal, which the pharmacist can confidently offer.

NB! For elderly people who come and ask for something effective, because nothing helps them, such drugs are not suitable. They can only be advised to see a doctor.

Another reason for recommending a specific over-the-counter drug: insomnia due to jet lag.

Phytohypnotics

valerian takes precedence . It has a good sedative effect. However, the effect of its use develops slowly. With long-term use, valerian preparations can cause a withdrawal syndrome comparable to that of benzodiazepines. In high doses, valerian can cause liver damage. Valerian preparations are not recommended for pregnant and lactating women and children under 12 years of age. One more thing: in about one in four, valerian causes stimulation instead of sedation.

Motherwort is especially good for people with hypertension because it lowers blood pressure and also reduces the rate and strength of heart contractions. Multicomponent herbal remedies have a stronger calming effect due to the mutual strengthening of the components.

Herbal drugs are considered relatively safe, but it is necessary to remember the likelihood of an allergic reaction. With long-term use in large doses, lethargy and lethargy are possible, which must be taken into account when doing work that requires reaction speed.

People's favorites

The combined drugs Corvalol, Valoserdin, Valocordin contain small doses of the potent hypnotic phenobarbital . At a dose of 15-30 drops they have a sedative and antispasmodic effect, and when increased to 40-50 drops, they have a sleeping pill. It so happens that in our country these drugs have a special love among the elderly population, and many simply abuse them. Use in large doses as a sleeping pill leads to dependence and causes depression of cognitive functions.

Valemidine is inferior in popularity to drugs with phenobarbital; it consists of a mixture of herbal tinctures with a small amount of diphenhydramine, a known H1-histamine receptor antagonist with a hypnotic effect. Motherwort and hawthorn in the composition determine its use for concomitant hypertension.

Sleep hormone

Melatonin is a regulator of biological rhythms. Its main function is to transmit a biochemical signal about the beginning of the night. Therefore, first of all, it can be recommended for insomnia caused by disruption of circadian rhythms when changing time zones, when working on the night shift.

But that is not all. Melatonin levels decrease with age, so melatonin supplements will be effective for insomnia in the elderly. For gerontological patients, it is important that it not only normalizes falling asleep, but also improves the intellectual and mnestic functions of the brain. Conventional melatonin preparations may not work for nighttime and early morning awakenings, since the elimination period is 30 minutes. up to 2 hours. There is a long-acting drug on the market, Circadin, designed specifically for people over 55 years of age (available by prescription).

Studies have shown low melatonin levels in people with neurological diseases. The positive effects of use are shown in people with Alzheimer's disease, Parkinson's disease, epilepsy, and headaches.

Its use is justified for insomnia after brain injury, when the secretion of melatonin may be impaired.

The physiological effects of melatonin are extensive. Melatonin receptors are located throughout the body. It is involved in immunomodulation, regulation of endocrine functions, lipid and carbohydrate metabolism, and is able to scavenge free radicals. Currently, its role in the treatment and prevention of cancer (breast cancer, especially triple negative, prostate cancer, stomach cancer, etc.), metabolic disorders, cardiovascular pathologies, neurodegenerative diseases, gastroenterological practice, and mental disorders is being discussed .

Interesting : The action of agomelatine, which is part of the antidepressant with a sedative effect Valdoxan, is based on stimulation of melatonin receptors in the brain.

Melatonin is not addictive. Not recommended for women planning pregnancy. Not for use in persons under 18 years of age, pregnant or breastfeeding women, or persons with autoimmune diseases.

Over-the-counter anxiolytic

Afobazole is a non-benzodiazepine selective anti-anxiety drug. It is well tolerated, but the effect on improving sleep quality develops gradually: by 5-7 days after the start of treatment and reaches its maximum effect by the 4th week. After discontinuation of the drug, the effect lasts for another 1-2 weeks. Does not cause drowsiness, does not affect psychomotor reactions. There is no addiction to it and there is no withdrawal syndrome. Indicated for insomnia caused by tension, anxiety, inability to relax, especially for persons with a tendency to emotional lability and emotional stress reactions.

Alternative drugs

Glycine is a controversial drug, about which experts have different opinions: whether it has any effect. The thing is that the amino acid has difficulty penetrating the BBB. And in order to get a real result, doses are required much higher than those found in all known drugs. On the other hand, there are studies (here and here) that document the positive effect of glycine on sleep. One thing is for sure - it is safe, and no one has canceled the placebo effect.

Magnesium takes part in the inhibition of nerve impulses, so its deficiency is manifested by irritability, increased excitability, and sleep disorders. In this case, magnesium preparations are suitable.

Interesting: Insomnia can also be caused by a lack of vitamin D, A, and group B.

Homeopathy is a separate layer of medicines that coexist in state health centers and pharmacies along with allopathic medicines and should not be discounted. They can be used in children; their big advantage is that they have practically no contraindications, except for individual sensitivity and pregnancy.

Non-medicinal products

There are many dietary supplements available that affect the nervous system. Their components are largely adopted from medicines. There are dietary supplements of valerian, motherwort in combination with magnesium and B vitamins, melatonin, glycine and others. Separately, I would like to say about tryptophan, which is currently present only in dietary supplements. Tryptophan is an essential amino acid, from which serotonin is formed in the light, and melatonin in the dark. When taken as a supplement to food, it may help improve daytime mood and nighttime sleep quality.

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Side effects

The interaction of alcoholic beverages and sleeping pills causes side effects. Staying in one position for a long time during sleep can cause positional compression of the limbs. Impaired blood flow to the limb leads to kidney failure due to the accumulation of waste products in the muscles. In severe cases, the victim's limb is amputated due to necrotic changes.

Other side effects include retrograde amnesia, disorders of the digestive system, and drug dependence. In this regard, it is necessary to avoid drinking alcoholic beverages during the treatment of insomnia.

Requirements for drugs

There are current requirements for effective and safe drugs:

• creation of natural physiological sleep;
• absolute harmlessness for different categories of people;
• absence of unwanted reactions;
• no memory problems;
• lack of addiction and psychological dependence.

But perfect sleeping pills have not yet been identified. New benzodiazepine-type hypnotics have advantages over barbiturates. But due to the nature of the inducible sleep and the side reactions, they do not fully meet physiological needs.