Benzodiazepines
Benzodiazepines are the most well-known and most frequently-prescribed hypnotic medications, although their use in recent years is being increasingly replaced by newer nonbenzodiazepine hypnotic drugs and the hormone melatonin. Benzodiazepines are effective in the short term but tolerance to their hypnotic effects develops after 1 or 2 weeks, thus making them ineffective for long-term use. They are also a cause of hospital admissions, especially in the elderly who are more sensitive to their effects. When used for extended periods of time, Benzodiazepine withdrawal syndrome will always develop upon their discontinuation. This is characterized by excessive insomnia, anxiety, confusion, disorientation, insomnia, hot flashes, uncontrollable cold sweats, diaphoresis, chills, fever, uncontrollable perspiration, persistent unrelenting nightmares every night and perceptual disturbances. More severe withdrawal symptoms which occur can include seizures (some of which can be fatal), visual and auditory hallucinations, suicidal ideation, extremely severe panic attacks, depersonalization, tremors, delirium, delirium tremens and if not treated as an emergency by a proper medical staff death from a seizure can occur. Benzodiazepine withdrawal is a medical emergency and should be treated as such. It is a common misconception that drugs such as heroin, oxycodone, and other opiates are the most physically dangerous in withdrawal. Benzodiazepine addiction, is a far more dangerous dependency to have because unlike dependence to opiates and other drug classes, benzodiazepines and their counter-parts the z-drugs ( ambien for example) are lethal in withdrawal. Prescription hypnotics (Benzodiazepines and Nonbenzodiazepines included) should therefore be taken for the shortest duration of time with the least frequency possible, so as to avoid tolerance, drug dependence, and the adverse effects of long term use.
Benzodiazepines tend to exert their hypnotic effects at high dosage compared to the more moderate dosage needed for anxiolytic effects to be felt. The downside of the hypnotic properties of benzodiazepines is that they actually worsen the sleep architecture and thus the quality of sleep. They are also associated with an increased risk of road traffic accidents.
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