The Use of hypnotic drugs should be discouraged for the treatment of chronic insomnia. First There should be a diagnosis evaluation that can find the cause and facilitate resolution. Moreover, people that need to take a hypnotic should do it intermittently (2 or 3 times a week) preventing this way the development of tolerance and addiction that often appears with the use of such substances. It is not recommended to extend the use of hypnotic treatment more than 8 weeks and always accompanied by non-pharmacological measures.
Benzodiazepine hypnotics: They are the most effective because they are not selective agonists of GABA-A receptors and have less side effects than hypnotic drugs. In onset sleep insomnia it is desirable to use a short-acting drug, whereas in the problem of maintaining sleep a long-acting drug proved to be more effective. These substances have significant side effects, because they can cause cognitive impairment, drowsiness, dependence, tolerance, some lung diseases or aggravate the insomnia problem due to a “rebound ” effect after its withdrawal (after stopping treatment).
Non-benzodiazepine hypnotics: These product have been developed with the intention of producing effects comparable to benzodiazepines, but reducing its adverse effects. Unlike benzodiazepines, they are selective agonists the GABA-A receptor and have only hypnotic action. They have milder side effects and often cause insomnia “rebound”, so their use is sometimes inadvisable. Still, like other sleeping drugs should be used in short term and not for long periods.
Antidepressants: They are indicated for the treatment of insomnia associated with depression. They have the advantage of having a lower risk of abuse and dependence. Still, and despite being a good option for the treatment of chronic insomnia associated with depression, antidepressants have often other side effects.
Antihistamines: As an option mild cases it is possible to take advantage of hypnotic side effects so common in the antihistamines. However, antihistamines have other undesirable side effects such as drowsiness, muscle problems and anticholinergic effects that take a few days to disappear.
Melatonin: Is a very effective product in alleviating the problems associated with jet lag (jet lag) and reducing the time to sleep. The complete absence of side effects makes it the best choice for first-line treatment of insomnia. Melatonin is also an excellent option to relieve withdrawal problems caused by benzodiazepines and problems in persons with sleep-wake disorders (especially children and adolescents with mental disorders, autism and nervous system disorders.