Stress, too many trips, professional worry, bereavement or a change in life can keep us awake at night and prevent us from reaching for too many days in a row the eight hours of sleep we would need on average. In addition to the natural remedies that can be used against sleep disorders if the disorder is transient and does not assume worrying dimensions, there are also sedative-hypnotic drugs. The term sleeping pills is not widely used. We asked Dr. Vincenzo Tullo, neurologist in charge of sleep medicine and headache expert at Humanitas, to explain to us what they are and when they are used.
Hypnotic drugs for sleep disorders
Today, researchers are investigating a neurotransmitter that could have great responsibility for sleep disorders. Hopes are high, but in the meantime, it is possible to use a pharmacological treatment to treat these disorders. The medicines that can be taken are called hypnotic drugs and not sleeping pills and there are two broad groups: the old, but still used, benzodiazepines and non-benzodiazepines. These drugs can help you fall asleep or simply prolong your sleep. One of the major risks associated with this treatment is dependence, which is why neurologists strongly recommend limited and time-limited use.
Sleep disorders: what are the causes?
True insomniacs are around 9%, and then there are 6-7% of short dormitories, which are fine with only four to five hours of sleep, while 12% concern subjects who are not properly insomniac but deprived of sleep by choice, work or lifestyle. Sometimes insomnia hides a medical condition or a sleep disorder that can be investigated thanks to polysomnography, a kind of sleep X-ray that measures the heartbeat, oxygen saturation in the blood, brain activity, eye and body movements, can reveal the real causes of the disorder.
Among these is obstructive apnea, which causes daytime sleepiness. 40% of cases relate to insomnia and are treated with CPAP, a device that helps ventilate the respiratory tract. Or you may find that insomnia is a consequence of the restless legs syndrome, which is treated with dopaminergics.
When insomnia is secondary to depression or anxiety, antidepressants can improve both conditions at the same time. At low dosages they tend to increase deep sleep.
New drugs for insomnia work on a brain molecule
Classic sleep medications, such as benzodiazepines, act as sedatives, modifying the action of so-called GABA receptors to facilitate the inactivity of the brain. A new group of drugs under study, DORA, decrease sleepless nights by blocking the brain orexin receptors.
In 2014, the Food and Drug Administration approved the first orexin receptor antagonist, a neuropeptide produced by the hypothalamus, whose chronic deficiency causes narcolepsy, a disease characterized by excessive drowsiness. Blocking this brain molecule that keeps us awake could prove to be a turning point in therapies against insomnia.
But these medications are so new that their long-term benefits and risks are yet to be studied. The ideal drug for sleep does not yet exist and for long-term insomnia, the primary therapy remains the absolute behavioral one, usually without drugs but through cognitive-behavioural therapy. It goes without saying that some “precautionary” measures such as avoiding the evening use of tablets and mobile phones, reducing caffeine and avoiding daytime naps, keeping stress at bay, remain of great help.