Sleeping medicine: find out when it is safe to take – 11/27/2023 – Balance

Since the 1960s, the pharmaceutical industry has been launching medicines to treat insomnia, a condition that affects around 35% of the population, according to the Brazilian Sleep Association. Despite many advances, to this day the options available on the market are indicated for specific cases and for short periods.

Benzodiazepines, such as Rivotril (clonazepam) and Valium (diazepam), were the first promises for those who wanted to sleep well. It was not long before prolonged use of these substances was associated with tolerance, dependence, cognitive impairment and behavioral changes.

In the 1990s, Z drugs arrived, such as zolpidem and zopiclone. Capable of inducing sleep in minutes, they act for up to eight hours. These medications emerged as alternatives to benzodiazepines, avoiding a possible “hangover” the next day and without the risk of dependence. But the expectation was not confirmed.

“Over time, it was realized that Z drugs also caused dependence and tolerance, and that their use should be punctual and strictly supervised by the doctor”, says psychiatrist Mário Eduardo Costa Pereira, professor of clinical psychopathology at Unicamp (State University of Campinas).

Scientific evidence has shown that all immediate-acting drugs can lead to some degree of dependence, as the user easily associates the medication with the effect it brings, explains psychiatrist Marcelo Kimati, coordinator of the Interdisciplinary Center for Drug Studies (NIED) at UFPR (Federal University of Paraná).

Despite the risks, hypnotics, as medications that induce sleep are called, are recommended as the last treatment option, after a thorough clinical evaluation.

Insomnia can be associated with conditions ranging from mood disorders to respiratory problems, and this needs to factor into the doctor’s decision, says psychiatrist Marcelo Heyde, professor at PUC-PR (Pontifical Catholic University of Paraná).

A polysomnography exam is capable of revealing, for example, a case of apnea, in which the patient is unable to maintain quality rest because their breathing stops repeatedly during the night. “The condition demands specific treatment and taking zolpidem would only make everything worse”, says Heyde.

When insomnia is associated with depression, the doctor may, depending on the case, prescribe antidepressants that also help improve sleep, such as Trazodone, avoiding exposing the individual to drugs with greater potential for dependence and tolerance.

But, for experts, the most important thing is to provide guidance on sleep hygiene. Having a quiet place to sleep, away from screens (including cell phones) and other items not strictly linked to rest, is essential for quality rest.

Another scientifically proven tool for better sleep is CBT (cognitive behavioral therapy), which can integrate practical actions such as sleep diaries and stimulus control strategies.

It is only if none of this works that a medicine like zolpidem can come into play, reinforces the Unicamp professor. And, if the patient needs the medication, the doses must be controlled by a psychiatrist in the quantity and time determined after medical evaluation.

“There are people who wake up at night and take another zolpidem to go back to sleep, increasing the dose as they go. There are also those who take more than the prescribed amount, at a time when they are more anxious. This is extremely dangerous”, says Heyde.

Prolonged use is another big problem. Although these drugs can be used for a few weeks, the average use among the general population is seven years, says Kimati. In comments on social media Sheet During a chat about zolpidem, readers said they had been using it for more than five years.

Kimati also points out that to this day there is no safe hypnotic for long-term use. “As time passes, our metabolic capacity decreases, and a small dose can be felt by the body as a larger dose when we get older. This could explain, for example, why benzodiazepines are among the main causes of mental confusion among the elderly.” In the midst of so many unknowns, there is little care.

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