Hypnotics. Their place in therapeutics

Sleep disturbance has become a subject of serious study only over the past few years, but even so there is already an increasing awareness of the nature of insomnia and a greater understanding of the role which hypnotics should play in clinical medicine. An hypnotic may be used to shorten sleep onset when there is difficulty in falling asleep, to reduce nocturnal wakefulness, or to provide an anxiolytic effect during the next day when insomnia is accompanied by a marked element of anxiety. The purpose of an hypnotic is to meet one or more of these clinical problems; to ensure that the patient is given the most useful medication, consideration must be given to duration of activity. This depends on the absorption, distribution and elimination characteristics of the drug. It is now appreciated that the most appropriate use of hypnotics is in the individual with insomnia of recent origin. An hypnotic with the most relevant pharmacokinetic profile should be used for the shortest period of time and then only as required, while low doses will ensure freedom from adverse effects. The place of hypnotics in chronic insomnia remains less certain. Their careful use may well be of benefit, though it must be part of a well defined clinical strategy. Assessment of the patient is essential to identify any specific conditions which would impair sleep.