Benzodiazepine or “Z” Hypnotic for Insomnia

Chronic insomnia has an effect on over 15 per cent of the whole population and it is considered to be more prevailing comparing with cancer, AIDS, urinary problems, hearth diseases, diabetes, etc. Recently researches have evaluated the grand total of insomnia which was between $30 and $35 billion. Notwithstanding insomnia is highly occurred disease, it still not considered as an extreme threat to health.

Insomnia, or sleeplessness, is a sleep disorder which is characteristic for a person who is unable to fall asleep or to stay asleep for a long period of time that makes a person feel exhausted and unhappy the next morning³. There known to be two classes of insomnia – primary and secondary. According to statistics, around 30 % of population in United Kingdom is suffering from secondary type of insomnia. Primary insomnia is the one that cannot be connected with an existing psychiatric or environmental reason (for instance, drug addiction or medications). Secondary insomnia considers as a disorder characterized by a situation when signs of insomnia appear from a primary medical disease, mental conditions or other sleeping disorders. It may also occur from the usage, abuse or contact with certain substances.

Approximately one third of population in United Kingdom has episodes of insomnia. It has been calculated that insomnia is more common disease in women and tends to appear with age. The choice of treatment depends on the source of the insomnia, in other words person must be aware of the causative agent of the disorder ³. Thus, there can me various options for treatment, either behavioural and lifestyle changes or medicines. Moreover, insomnia can be a consequent of a certain disease, including stroke, brain lesions and tumours, asthma, arthritis, Parkinson’s and Alzheimer’s diseases, etc. The first step to be taken for curing insomnia is discovering if the problem is being resulted from the previously mentioned medical conditions. If it is, it is vital to treat that condition at all costs in order to make insomnia vanish.

Benzodiazepines or the ‘Z medicines’ are the most appropriate and relevant medicines for treating insomnia. Nowadays many doctors believe that “Z” hypnotics are much “better” than benzodiazepines for the treatment of insomnia. For instance, in 2002 more than 3.9 million prescriptions were written for them the cost of which was around £15.9 million ².

Benzodiazepines (sometimes is called colloquially as “benzo” and often abbreviated “BZD”) are considered as tranquillisers that are created for reducing agitation and stimulate calm, peacefulness and sleep. This type of medicines should be considered only in cases when people are suffering from severe insomnia than lead to a serious despair and misery. Although all benzodiazepines help people to fall asleep, they also result into a serious dependency. That is why, it is recommended to prescribe patients with insomnia only the short-acting benzodiazepines (with short-lasting effects)².

Benzodiazepines which are commonly used for the cure of insomnia involve flurazepam (Dalmane), triazolam (Halcion), estazolam (ProSom), quazepam (Doral), temazepam (Restoril), estazolam (ProSom), and lorazepam (Ativan). The core components of these kinds of medicines are Valium and Ativan which provide a soporific impact that is very helpful for sleeplessness treatment¹.

Initially, benzodiazepines appeared on the open trade in the late 1960s. Valium is considered to be one of the first and remained being favoured as a tranquilizer and sedative. The process of their work is quite easy. The neurological processes in human brain are intricate and the everyday rhythm of sleep-wake activities is an essential element of them. When someone’s sleep is intermittent and disrupted, not only is the lack of sleep an annoyance, but it can lead to the further psychological impairment including even numerous serious outcomes to the whole organism. Generally, human biological clock which normally runs in accordance with the natural world automatically forms rhythmic rises and falls in brain melatonin, a natural sleep element⁴. When one suffers from insomnia, this natural process is disturbed: one can experience falling asleep, staying asleep, or returning to sleep early in the morning.

Benzodiazepines join with the GABA receptor in human cerebrum, a neurotransmitter, aiming to enlarge a chemical element that leads to somnolence or calming. Most benzos act very fast and have a short half-life period that enables them to be extremely helpful for treating insomnia on the initial and middle stages (problems with stating asleep, walking at night)⁴.

As a whole, benzodiazepines are secure and efficacious in the near future, although informative damage and inconsistent outcomes such as violence or behavioural inhibition can happen from time to time⁵. Long-term use of benzodiazepines is arguable since there are a lot of worries about inauspicious psychological and physical consequences, high questioning about their advantages and the ability of the medicine lead to physical dependence and tolerance. Because of the face that benzodiazepines cause the unfavourable effects related to their long-term usage, elimination of benzodiazepines, as a whole, results into improved physical and mental health. Most of all, the older generation is at a higher risk of suffering from both short- and long-term harmful effects. Additionally, elimination of the long term benzodiazepine dependency may lead to tinnitus as a side effect⁵.

Talking about side effects of the benzodiazepine intake, one can say that these drugs must be taken only under the guidance of a doctor. Due to the fact that they can develop an addiction, it is only permitted to use them for short-term treatment. There are possible risks for elimination in cases if these medicines were used for more than two weeks. In such cases, the doctor should help the patient to wean from the addiction. The most likely occurred side effects are considered to be nausea, dizziness, headache, somnolence, uncertainty, depression and many others. In addition, benzodiazepines are commonly abused and easily overdosed.

There are some recommendations for people who take benzodiazepines. They are as follows:

One must be aware of the driving safety, since these medication can make people sleepy in the morning;

One must pay attention to the job performance and decision-making since benzodiazepines lead to dizziness;

One must never take benzodiazepines with alcohol or mix it with other calming drugs, since it can lead to poisoning;

One must strictly follow the doctor’s prescription and recommendation regarding benzodiazepines intake;

It is highly recommended to use benzodiazepines only for short-term treatment, sue to the fact that it causes addiction⁶.

There is a great risk for causing an extreme dependence and addiction to these sleeping drugs. Furthermore, these medications cannot be eliminated instantaneously, because there will be a high possibility of spasms and other withdrawal side effects. As an alternative, the dose of the medicine must be gradually reduced before being completely stopped. All in all, the use of this prescription medication with the aim to treat chronic insomnia is not fully recommended, since there are other options⁷.

An alternative for benzodiazepines is called nonbenzodiazepines. In the history of insomnia treatment, these drugs appeared soon after the benzodiazepines. They are considered better since the side effects are less harmful and they not so addictive. Nevertheless, benzodiazepines still hold a position in medicine as a cure for anxiety and are still utilized for insomnia, too.) Nonbenzodiazepines are a class of prescription drugs that are almost identical to benzodiazepines, although side effects of nonbenzodiazepines appears to be less frequent and less acute comparing with traditional benzodiazepines since these medicines work for a shorter period of time.

Nonbenzodiazepines used to treat insomnia involve eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien). There is a serious restriction for taking these medicines with alcohol or other calming drugs. In general, nonbenzodiazepines are not addictive; however, they may be if being taken every night for a long period of time.

Similar to the benzodiazepine medications, the nonbenzodiazepines operate by joining to the receptors for a chemical messenger in the cerebrum which is named GABA. These chemical messengers, or so-called neurotransmitters, work by travelling amidst nerve cells to perform signals within the cerebrum. Being joined to the receptors for GABA, these drugs can stimulate sleeping⁷.

Unluckily, these sleeping drugs are not assigned for everybody. Indeed, some people should be very cautious while using them, or even better, to avoid using them. These medicines are able to restrain your consciousness or respiratory system, since it may slow down or even stop one’s breathing. If person has a history of dependency, psychiatric disorder, or he/ she is in the older age, he/ she is better to avoid using these medications⁸.

The risk for side effects is very much alike to other sleeping pills, however, due to the shorter period of intake, people have fewer chances to have continuous sleepiness or feel “hung-over” in the morning. Notwithstanding, one must need to observe the potential advantages and side effects of the medicines with his/ her doctor before starting one of these medications to treat his/ her insomnia.

There considered to be several types of nonbenzodiazepines, such as:

Eszopiclone. It is commonly sold under the trademark name Lunesta® (produced by Sepracor group). It is less efficacious than some other insomnia medications; however, it has several distinctive advantages. Eszopiclone is not likely to cause patient’s addiction, or, if it is, the chances of it are at a very low level. Furthermore, eszopiclone is less likely to be used recreationally. Another distinctive feature is appropriateness for long-term usage. The most regular side effects which were noticed by physicians are considered to be loss of coordination and dizziness.

Zaleplon. It is mostly used to cure insomnia, and is produced by King Pharmaceuticals under the trademark name Sonata®. In spite of the fact that zaleplon is not a substitution for benzodiazepine, it still produces a lot of of the similar side effects: anterograde amnesia (incapability to recollect things, particularly at the time of the medicine’s intake), uncertainty, daytime somnolence, agitation, and hallucinations. Zaleplon usually cause dependence.

Zolpidem. It is produced under different trademark names; the most popular name is Sanofi-Aventis’ Ambien®. It is assigned for short-term insomnia treatment. U.S. Air Force tends to employ zolpidem as a “no-go” drug with the purpose of making pilots’ sleep easier and calmer after an operation. Zolpidem is also used off-label to cope with the restless legs syndrome. If to take this medicine for a long period of time, it will have a high possibility to become addictive or at least to give rise to dependence. It performs numerous side effects, including hallucinations and/or misconception, anterograde amnesia, reduced motor coordination, and impaired sense of evaluation¹⁰.

Zopiclone. It is a short-acting hypnotic drug which was initially first established by Sepracor group, and currently manufactured by Sanofi-Aventis. In the United States, it is sold under the analogue of eszopiclone, and sold under multifarious other trademark names around the world. The most commonly noticed side effects of the zopiclone are a constant bitter metallic taste in the mouth, dry mouth, and headache⁸.

Chloral betaine. It was generally known by the trademark name Welldorm®. It is one of a group of drugs that is called hypnotics or sleeping pills. Hypnotics make people sleepy and are utilized as a short-term treatment of insomnia (or inability to get to sleep or stay asleep). Chloral betaine was firstly available in the United Kingdom in the 1870s. It has been widespread there over the years but is now utilized less frequent than it used to be. Nowadays it is accessible in many countries, but not in Republic of Ireland⁹.

To conclude, both bezodiazepine drugs and non-benzodiazepine tranquilizers operate in the cerebrum on the GABA receptors, as many medicines utilized with the purpose to induce sleep. There is a slight distinction amidst the benzodiazepines and Z medicines, however, if one does not work, then addressing to another one will definitely not help as well.

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