For insomnia due to emotional disturbance other than depression and for refractory cases, a hypnotic drug may be temporarily required, especially if sleeplessness impairs the patient's efficiency and sense of well-being. Depressed patients should be given limited amounts to reduce the risk of attempting suicide with the hypnotic. Patients who awaken because of pain should receive analgesics at bedtime as the mainstay of treatment. Terms such as hypnotic, sedative, antianxiety drug, minor tranquilizer, and anxiolytic are often used interchangeably. The best term for drugs used primarily to induce sleep is hypnotic.
All hypnotics pose some risk of overdose, habituation, tolerance, addiction, and withdrawal.
For those with the greatest effectiveness and safety, see Table 173-2. Adverse effects include drowsiness, lethargy, hangover, and amnesia, especially after excessive intake of certain hypnotics. Hypnotics should be used with caution in patients with pulmonary insufficiency. In the elderly, any hypnotic, even in small doses, can cause restlessness, excitement, or exacerbations of delirium and dementia. If necessary, serum levels of many drugs can be measured.