Nitrazepam (Hypnote)

Nitrazepam is effective in initiating and maintaining sleep even when used for a prolonged period. It produces sleep like natural sleep, that is, it does not inhibit REM sleep which is a part of natural sleep. Most people can tolerates this drug. Moreover, it is not addictive. The only problem with this drug is that it has a sustained action, and residual sedative action 'occurs on the day following its administration. This drug is also unsuitable for patients who develop sudden breathing difficulty and wake up because of it. Its dose of 5 to 10 mg is effective in producing good sleep and is superior to diazepam which is frequently used in India for inducing sedation and sleep. The latter drug is used in insomnia due to anxiety.

Non-benzadiazepine Drugs

A number of new drugs have been developed to induce sleep without disturbing the sleep cycle.

Melatonin (Eternex 3 mg)

It is a hormone of pineal gland. It maintains 'biological clock' which regulates sleep-wake cycle. When sleep sleep is disturbed due to changes in biorythms (jet-lag) melatonin can induce sleep headace, itching and confusion (some preprations like zytonin have vitamin B6) at night. It can cause fatigue, headache, itching and confusion.

Zaleplon (Zaplon, Zaso 5 mg, 10 mg tab.)

It rapidly induces sleep but total sleep time is unchanged and therefore daytime hangover is less. It may cause headache, nausea and stomach upset.

Zolpidem (Aoldem, Zolpid 5 mg, 10 mg)

This drug induces sleep quickly and increases total sleep time. Dependence potential is less with its use. Its usual dose is 5 to 10 mg at night.

Choosing a Right Treatment in Elderly

A common cause of sleeplessness in elderly is age related changes in the sleep cycle. Loss of family support, prostatic enlargement with frequent urination at night, dementia or depression should be looked for and treated. Restriction of excessive fluid intake in elderly, avoiding drugs which cause insomnia and use of short acting hypnotic in smaller doses (because drug disposition is changed in them) initially are some useful measures. Sometimes a glassful of warm milk can be a good hypnotic. Milk contains 'tryptophan' which is needed to make serotonin. Yoga exercises alongwith meditation can help those who do not have any discernible cause.

Drugs which stimulate the CNS can cause sleeplessness. These include caffeine, nicotine, ephedrine, amphetamine, appetite suppressants, nasal-decongestants, (Phenylpropanolamine). Other drugs like chloroquine, ciprofloxacin, metronidazole, levodopa, some anti-depressants (fluoxetine) and diuretics, if used in evening/at night can cause sleeplessness. Stopping their use or substituting any of them with alternative drugs can treat insomnia.