doses to diminish the patient’s physical and mental responses without affecting
the patient’s consciousness.
With increased doses, the patient experiences a hypnotic effect causing the
patient to fall asleep. Even higher doses of sedative-hypnotics anesthetize the
patient. Such is the case of the ultra-short-acting barbiturate thiopental sodium
(Pentothal) that produces anesthesia.
Sedative-hypnotics and barbituates were first used to reduce tension and anx-
iety. However, other medications have been developed for this use. Chronic use
of any sedative-hypnotic should be avoided.
It is important to understand that sedative-hypnotics are not the same as sleep
medications purchased over-the-counter such as Nytol, Sominex, Sleep-eze, and
Tylenol PM. Over-the-counter sleep medications such as diphenhydramine con-
tain an antihistamine not barbiturates to achieve sedation.
Short-acting sedative-hypnotics are ideal for patients who need assistance
falling asleep but who must awaken early without experiencing a lingering
aftereffect from the medication. Intermediate-acting sedative-hypnotics are use-
ful to sustain sleep. Patients may experience residual drowsiness (hangover)
after awakening.
The use of sedative-hypnotics for sleep (hypnotic) should be short term or
there is a chance that the patient could become dependent on the medication
or develop a tolerance. Patients who take high doses of sedative-hypnotics over
long periods must gradually discontinue the medication rather than abruptly
stopping the drug which can cause withdrawal symptoms. Sedative-hypnotics
should not be administered to patients who have severe respiratory disorders or
who are pregnant.
Before a patient is prescribed a sedative-hypnotic to aid with sleep, the patient
should try non-pharmacological methods that promote sleep such as:- Arise at a specific hour in the morning.
- Take few or no daytime naps.
- Avoid heavy meals or strenuous exercise before bedtime.
- Take a warm bath, read, or listen to music before bedtime.
- Decrease exposure to loud noises.
- Avoid watching disturbing television before sleep.
- Avoid drinking a lot of fluids before sleep.
- Drink warm milk before sleep.
See sedative-hypnotic–benzodiazepine provided in the Appendix. Detailed
tables show doses, recommendations, expectations, side effects, contraindica-
tions, and more; available on the book’s Web site (see URL in Appendix).(^274) CHAPTER 15 Nervous System Drugs