-- "World Sleep Day" Series of Science Popularization of Zhanzhi Medical Center (1)
Li Xiaoye, Department of Pharmacy, Strategic Support Force Characteristic Medical Center (formerly 306 Hospital).
Edited by Liu Yan/Cui Yan, Medical Science Popularization Center
Editor's note: World Sleep Day is celebrated on March 21 every year. Sleep is an active process of the human body that restores the mind and relieves fatigue. Adequate sleep, a balanced diet and proper exercise are the three health standards recognized by the international community. In 2003, the Chinese Sleep Research Association officially introduced the "World Sleep Day" to China, and since 2008, the Chinese theme has been released, and the theme of World Sleep Day in 2024 is "Healthy Sleep for All". In response to this call, experts from the Department of Neurology and the Department of Pharmacy of the Strategic Support Force's Characteristic Medical Center wrote a series of popular science, calling on everyone to pay close attention to healthy sleep, popularize the scientific knowledge of healthy sleep, and achieve healthy sleep.
March 21 is World Sleep Day, and sleeping well, eating well, and feeling good are the three magic weapons for good health. Sleep is very important for everyone, adequate sleep can protect the brain, restore physical strength, and enhance immunity, but the incidence of insomnia is increasing day by day and gradually younger. According to the 2022 White Paper on Healthy Sleep in China, more than 300 million people in mainland China had sleep disorders in 2021, and the incidence of insomnia in adults was as high as 38.2%. According to the China Sleep Research Report (2023), in 2022, 47.55% of respondents slept less than 8 hours per night, and 16.79% slept less than 7 hours per night.
Insomnia is a common sleep disorder that manifests as difficulty falling asleep, maintaining sleep, or waking up early. Insomnia not only affects people's normal work and life, but also may increase the incidence of some diseases. When insomnia occurs, it is common to establish a regular routine through sleep hygiene education and change bad habits. However, when the above measures are not satisfactory, then some sedative-hypnotic drugs will be considered to help sleep.
It has been found that the names of common sedative-hypnotic drugs on the market are often similar, such as so-and-so zepam, so-and-so zolam, etc. So do they have the same effect, and what is the difference between them? Here are a few groups of drugs with similar names that have a sedative-hypnotic effect.
First of all, we need to understand the term "benzodiazepine receptor agonist", and many of the drugs currently used in clinical treatment of insomnia are "benzodiazepine receptor agonists". Based on their chemical structure, benzodiazepine receptor agonists can be classified as benzodiazepines and non-benzodiazepines. They can selectively or non-selectively act on different subunits on γ-aminobutyric acid (GABA) receptor A. Benzodiazepines act on the α1, α2, α3, and α5 subunits of GABAA receptors, and exert therapeutic effects such as sedative-hypnotic, anxiolytic, anticonvulsant, and muscle relaxation, but they also produce adverse reactions such as addiction and forgetfulness. Non-benzodiazepines mainly act on the α1 subunit of GABAA receptor, and have a weak effect on α2, α3, and α5 subunits, so they have strong sedative-hypnotic effects, and lack obvious anti-anxiety, anticonvulsant, muscle relaxant and other effects.
zopiclone vs. right zopiclone
Zopiclone is a non-benzodiazepine sedative-hypnotic with two enantiomers, left-handed (R) and right-handed (S), of which the main effect is the dextral isomer. zopiclone is a racemate, and right(S)zopiclone is the dextral isomer of zopiclone. Dexzopiclone has a stronger affinity for benzodiazepine receptors than zopiclone, so it has a higher titer strength. It has a shorter peak time, which means faster onset of action. The longer the half-life, the longer the time to act. However, if dexzopiclone is taken immediately after a high-fat diet, it may cause slow absorption of the drug, resulting in a reduced effect of dexzopiclone on sleep latency.
Estezolam vs. Alprazolam
Both are benzodiazepine sedative-hypnotics. Estezolam, also known as "sulepam", is used for anxiety, insomnia, nervousness, fear, anti-epilepsy, anti-convulsant. Alprazolam is mainly used for anxiety, nervousness, anti-panic, and can be used for hypnosis, but the label indication does not include anti-epileptic treatment. Alprazolam has a shorter peak time than estazolam and has a faster onset of action. It has a half-life of 12-15 hours, which is also shorter than estazolam, indicating that it acts for a shorter time in the body and clears faster.
Diazepam and lorazepam
Both are also benzodiazepine-type sedative-hypnotics. Diazepam, also known as "diazepam", has a long half-life and is a long-acting, moderate-strength drug. The longer the half-life, the longer the time it will be maintained in the body, so diazepam is more likely to have a hangover effect. The hangover effect refers to the appearance of symptoms such as dizziness, drowsiness, drowsiness, and fatigue in the morning of the next day of taking the drug, as if "waking up drunk". Lorazepam has a strong anxiolytic effect, which is 2~5 times that of diazepam, and is mostly used for patients with insomnia caused by anxiety.
Note: The "Routine Recommended Dose" in the table above is the usual recommended oral dose for adults in the treatment of insomnia
A healthy lifestyle is the foundation of a good night's sleep. Exercising and maintaining a good diet and rest habits can improve sleep quality and sleep status. The sedative-hypnotic drugs introduced above are all second-class psychotropic drugs, which are drug dependent and belong to the national controlled drugs, which should be used carefully according to the doctor's instructions, and should not be purchased and taken without authorization.
(The picture comes from the Internet)