Sleeping Pills

Sleeping pills are technically known as hypnotics and they include a number of drugs with different mechanisms of action.


Seeping pills are quite logically served in situations when we need to induce sleep. They are more suitable for short-term use. In addition to sleep induction, these drugs may have other effects such as suppression of anxiety and muscle relaxation.

Mechanism of action

The mechanism of action varies in different hypnotics, but the effect is similar. Hypnotics act within the brain, strengthening a buffering neurotransmitter known as GABA (gamma-aminobutyric acid). Neurotransmitters are generally speaking substances located in central nervous system that ensure transmission of nerve impulses between the nerve cells. The GABA neurotransmitter decreases brain activity, induces calm and sleep.


Hypnotics are divided into several generations. The higher the generation is, the more physiologic (natural) is the effect and the better is the quality of induced sleep. Higher generations of sleeping pills have also generally fewer side effects.

1st generation

The first generation of sleeping pills are so-called barbiturates. The effect is relatively strong and insensitive and the quality of induced sleep is rather low. Therefore, their use in this indication almost disappeared in favor of other generations.

2nd generation

The second generation of drugs are the so-called benzodiazepines. These drugs belong among the most commonly used (and also abused) hypnotics. In addition to hypnotic effects, these drugs also have a significant anxiolytic effect (suppress anxiety). Most commonly used benzodiazepines are oxazepam, midazolam, alprazolam, diazepam, bromazepam, clonazepam and tetrazepam.

3rd generation

The third generation of hypnotics is the most advanced in terms of the quality of induced sleep and in the lowest frequency and severity of adverse effects. Most commonly used substances are zolpidem, zopiclone and zaleplon.

Adverse effects

Overdose of benzodiazepines may cause impairment of consciousness, disturbance of the respiratory center and even threaten the patient's life. Benzodiazepines should not be combined with alcohol. When a patient uses benzodiazepines chronically, they should not be abruptly discontinued; otherwise an unpleasant insomnia may occur. The regular use of hypnotics may cause addiction and the discontinuation of usage may lead to withdrawal symptoms such as headache, muscle pain, anxiety, palpitations and restlessness. Benzodiazepines should not be administered to patients with myasthenia gravis. Advanced hypnotics (third generation) have a smaller amount of side reactions and apparently lower risk of addiction. In older people, however, they sometimes cause confusion with hallucinations and delusions.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources