Sedativehypnotics

Sedative-hypnotics are commonly referred to as sedatives and are the mildest form of central nervous system depressant. Sedative-hypnotics are given in low doses to diminish the patient's physical and mental responses without affecting the patient's consciousness.

With increased doses, the patient experiences a hypnotic effect causing the patient to fall asleep. Even higher doses of sedative-hypnotics anesthetize the patient. Such is the case of the ultra-short-acting barbiturate thiopental sodium (Pentothal) that produces anesthesia.

Sedative-hypnotics and barbituates were first used to reduce tension and anxiety. However, other medications have been developed for this use. Chronic use of any sedative-hypnotic should be avoided.

It is important to understand that sedative-hypnotics are not the same as sleep medications purchased over-the-counter such as Nytol, Sominex, Sleep-eze, and Tylenol PM. Over-the-counter sleep medications such as diphenhydramine contain an antihistamine not barbiturates to achieve sedation.

Short-acting sedative-hypnotics are ideal for patients who need assistance falling asleep but who must awaken early without experiencing a lingering aftereffect from the medication. Intermediate-acting sedative-hypnotics are useful to sustain sleep. Patients may experience residual drowsiness (hangover) after awakening.

The use of sedative-hypnotics for sleep (hypnotic) should be short term or there is a chance that the patient could become dependent on the medication or develop a tolerance. Patients who take high doses of sedative-hypnotics over long periods must gradually discontinue the medication rather than abruptly stopping the drug which can cause withdrawal symptoms. Sedative-hypnotics should not be administered to patients who have severe respiratory disorders or who are pregnant.

Before a patient is prescribed a sedative-hypnotic to aid with sleep, the patient should try non-pharmacological methods that promote sleep such as:

• Arise at a specific hour in the morning.

• Avoid heavy meals or strenuous exercise before bedtime.

• Take a warm bath, read, or listen to music before bedtime.

• Decrease exposure to loud noises.

• Avoid watching disturbing television before sleep.

• Avoid drinking a lot of fluids before sleep.

• Drink warm milk before sleep.

See sedative-hypnotic-benzodiazepine provided in the Appendix. Detailed tables show doses, recommendations, expectations, side effects, contraindications, and more; available on the book's Web site (see URL in Appendix).

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