The most widely used drugs in this group are benzodiazepines . Recently, a new class of hypnotics, imidazopyridines, for example, zolpidem, has been used to treat insomnia. Drugs are not prescribed daily, but only several times a week, in order to help the patient, exhausted by insomnia, sleep. The choice of sleeping pills is determined by complaints. If, for example, the main difficulty is the inability to fall asleep, then fast-acting short-acting sleeping pills are shown. If the patient complains of frequent awakenings at night and the inability to fall asleep after that, long-acting sleeping pills will be more effective. Long-acting hypnotics contain active metabolites that cause drowsiness in the morning.
Not recommended daily intake of sleeping pills , because addiction and dependence may develop. The addiction is that the drugs lose their effectiveness and require the appointment of higher doses. In addition, after discontinuation of the drug, patients often experience increased insomnia (the so-called recoil phenomenon). Addiction and recoil are less likely to occur with zolpidem than with benzodiazepines. However, zolpidem has a very weak anxiolytic effect and therefore does not help patients with a high level of anxiety. Doses and regimen of the most common sleeping pills are shown in the table. It would be unfair to assert that as a result of treatment, the sleep of patients with insomnia is completely normalized, however, very good results can be achieved in most patients using combined pharmacological, behavioral therapy and adherence to sleep hygiene recommendations.
Idiopathic insomnia
1. The course of idiopathic insomnia . Idiopathic insomnia is a sleep disorder, mainly due to the pathology of the sleep-wake cycle. This disease usually worries patients throughout their lives. The group of patients suffering from idiopathic insomnia is heterogeneous. Most of them had a bad dream since childhood. Violations are aggravated by the influence of psychoemotional stress and stress. In addition, it is noteworthy that patients of this group have an atypical reaction to stimulants and sedatives.
Idiopathic insomnia is often accompanied by impaired sleep hygiene and mental disorders. Therefore, over time, from idiopathic insomnia, the disease can turn into psychophysiological insomnia, and then into insomnia associated with mental illness.
2. Diagnosis of idiopathic insomnia . The diagnosis of idiopathic insomnia is made when the disorder occurs out of touch with emotional stress or another causative factor that could potentially cause sleep disturbance. It is also necessary to exclude somatic and mental diseases. In some cases, insomnia reaches such an extent that there are marked disturbances in awakening and wakefulness.
3. Treatment and prognosis of idiopathic insomnia . There is no single approach to the treatment of idiopathic insomnia, because the group of patients is heterogeneous and the therapy is mainly empirical. Some patients respond well to heterocyclic antidepressants, such as amitriptyline or trazodone, prescribed overnight. The effective dose is selected individually and varies from 25 mg to 200 mg. In addition to pharmacological treatment, supportive behavioral therapy and adherence to sleep hygiene recommendations are indicated.