Hypnotics

Hypnotics are medications used to induce or maintain sleep. They are primarily prescribed for insomnia and related sleep disorders. The term encompasses several drug classes with different mechanisms and safety profiles.

Common classes include benzodiazepines (such as temazepam, oxazepam, triazolam) and the newer non-benzodiazepine hypnotics, often called Z-drugs (zolpidem, zaleplon, eszopiclone), which act on GABA-A receptors to promote sleep with variable effects on sleep stages. Barbiturates are older hypnotics that are rarely used today due to high risk of overdose and tolerance. Other agents include melatonin receptor agonists (ramelteon), orexin receptor antagonists (suvorexant, lemborexant), and sedating antihistamines (diphenhydramine) used over the counter, though these can cause anticholinergic effects and next-day impairment. Some evidence supports the use of supplements but not essential.

Use and safety: hypnotics are generally recommended for short-term treatment of insomnia, at the lowest effective dose, because of risks of dependence, tolerance, withdrawal, and cognitive or psychomotor impairment. Elderly patients are particularly sensitive to falls and confusion. Potential adverse effects include daytime drowsiness, confusion, anterograde amnesia, and, rarely, sleepwalking or other complex sleep behaviors. They can interact with alcohol and other CNS depressants and may worsen sleep apnea or respiratory disease.

Guidelines emphasize nonpharmacologic options such as CBT-I as first-line therapy, with hypnotics considered when sleep difficulties persist for a limited period.