Sleeping Pills
Sleeping Pills (Hypnotics)
Section titled “Sleeping Pills (Hypnotics)”Sleeping pills are used to treat difficulty falling asleep and staying asleep (insomnia). Sleep disorders are among the most common conditions overall — up to 10% of the population suffers from chronic insomnia requiring treatment.
Types of Sleeping Pills
Section titled “Types of Sleeping Pills”Z-Drugs (Non-Benzodiazepine Hypnotics)
Section titled “Z-Drugs (Non-Benzodiazepine Hypnotics)”The so-called Z-drugs were developed as an alternative to benzodiazepines:
- Zopiclone (e.g., Imovane)
- Zolpidem (e.g., Stilnox, Ambien)
- Zaleplon (e.g., Sonata)
They work similarly to benzodiazepines via the GABA receptor but have a somewhat more favorable side effect profile.
Benzodiazepines as Sleeping Pills
Section titled “Benzodiazepines as Sleeping Pills”Older sleeping pills from the benzodiazepine group:
- Flurazepam
- Nitrazepam
- Temazepam
Other Substances with Sleep-Promoting Effects
Section titled “Other Substances with Sleep-Promoting Effects”- Sedating antidepressants: Mirtazapine, trazodone, doxepin (low-dose)
- Low-dose antipsychotics: Quetiapine
- Antihistamines: Diphenhydramine, doxylamine (over-the-counter, but with side effects)
- Melatonin: The body’s own sleep hormone
Zopiclone in Detail
Section titled “Zopiclone in Detail”What Is Zopiclone?
Section titled “What Is Zopiclone?”Zopiclone is a cyclopyrrolone derivative that has no chemical similarity to benzodiazepines. Like benzodiazepines, however, it enhances GABA-mediated neuronal inhibition by binding to central nervous system GABA receptors.
Effects
Section titled “Effects”- Hypnotic (sleep-promoting) effect comparable to benzodiazepine sleeping pills
- Half-life of approximately 5 hours provides effectiveness for sleep maintenance disorders as well
- No significant hangover effects the next day
- In elderly patients, no significant prolongation of the half-life (in contrast to many benzodiazepines)
Advantages Over Benzodiazepines
Section titled “Advantages Over Benzodiazepines”Studies show that zopiclone in therapeutic doses:
- Has a lower risk of dependence
- Causes fewer discontinuation reactions (e.g., rebound insomnia)
- Has less muscle-relaxing and respiratory-depressant effects
- Shows fewer adverse effects on cognitive functions
Clinical Study
Section titled “Clinical Study”In a large observational study with 2,416 patients across 811 general practices, the following was found:
- Zopiclone was effective for all forms of sleep disorders
- Subjective total sleep duration increased by an average of two hours
- Patients without physical stress factors or somatic comorbidities benefited the most
- Daytime well-being and alertness were impaired only in rare cases
- Adverse drug reactions occurred only sporadically
Side Effects
Section titled “Side Effects”Common (approx. 4% of patients):
- Bitter, “metallic” taste in the mouth
Occasional:
- Dry mouth
- Drowsiness
- Gastrointestinal complaints
Rare:
- Memory impairment
- Confusion
- Paradoxical reactions (restlessness, insomnia)
Addiction Risk
Section titled “Addiction Risk”Contraindications
Section titled “Contraindications”Zopiclone should not be taken in cases of:
- Severe respiratory insufficiency
- Severe hepatic insufficiency
- Myasthenia gravis
- Sleep apnea syndrome
- Known hypersensitivity
Interactions
Section titled “Interactions”- Alcohol intensifies the effect — no alcohol during use
- Other centrally depressant substances (sedatives, opioids) intensify the effect
- Certain medications can inhibit or accelerate the breakdown of zopiclone
Sleep Disorders in Mental Illness
Section titled “Sleep Disorders in Mental Illness”In Borderline Personality Disorder
Section titled “In Borderline Personality Disorder”People with borderline personality disorder frequently suffer from sleep disorders:
- Difficulty falling asleep due to rumination and tension
- Difficulty staying asleep
- Nightmares (especially with traumatic experiences)
In Depression
Section titled “In Depression”Sleep disorders are a common symptom of depression. Sedating antidepressants are often used here, treating both the depression and the sleep disorder.
Sleep Hygiene - Non-Pharmacological Approaches
Section titled “Sleep Hygiene - Non-Pharmacological Approaches”Before sleeping pills are used, non-pharmacological measures should be tried:
Sleep Environment
Section titled “Sleep Environment”- Cool, dark, quiet bedroom
- Comfortable mattress and pillow
- No electronic devices in the bedroom
Sleep Habits
Section titled “Sleep Habits”- Regular sleep and wake times
- No long afternoon naps
- Use the bed only for sleeping (not watching TV, working)
Before Bedtime
Section titled “Before Bedtime”- No caffeine from the afternoon onward
- No alcohol as a “nightcap”
- No heavy meals late in the evening
- Relaxation rituals (reading, warm bath)
- No exercise directly before bedtime
For Rumination
Section titled “For Rumination”- Write down thoughts
- Relaxation exercises
- Mindfulness exercises
Seroquel (Quetiapine) as a Sleeping Aid
Section titled “Seroquel (Quetiapine) as a Sleeping Aid”Quetiapine is an atypical antipsychotic that is frequently used as a sleeping aid at low doses.
Advantages
Section titled “Advantages”- No addiction potential
- Suitable for long-term use
- Additionally mood-stabilizing effect
Disadvantages
Section titled “Disadvantages”- Possible weight gain
- Metabolic side effects at higher doses
- Drowsiness may persist the next day