Hypnotics and Anxiolytics
Hypnotics and anxiolytics are prescribed to treat insomnia and anxiety, amongst other related conditions.
- Treat anxiety and insomnia.
- One of the most common types is benzodiazepines.
- Also include certain types of antidepressants.
If you are concerned about your anxiety levels or inability to sleep, you can speak with one of our GPhC-registered clinicians via our online video consultation service, from 9.30am-4.30pm, Monday to Friday.
What are hypnotics and anxiolytics?
Hypnotics and anxiolytics are commonly prescribed drugs that can treat a variety of conditions. They work on the central nervous system in a way that can provide relief against insomnia and various anxiety related conditions, including generalised anxiety disorder (GAD).
Hypnotics and anxiolytics are available in many forms, with benzodiazepines the most common. Whilst these are effective treatments for the conditions mentioned above, they can lead to addiction when used on a long-term basis, and therefore other treatment options may be explored if the problem is ongoing. These include antidepressants for anxiety and older style antihistamines for insomnia
What is insomnia?
Insomnia is an inability to sleep properly. More accurately, it can be defined as not being able to fall asleep or stay asleep throughout the night. It can lead to symptoms including fatigue, irritability and poor concentration. The amount of sleep you need varies from person to person, but for most adults it should be between seven and nine hours. For children, this increases to nine to 13 hours and babies 12 to 17. In the long term, insomnia can lead to various mental health difficulties and impact on the immune system.
What causes insomnia?
It’s not clear what causes insomnia in some cases, but in most instances it’s triggered by a combination of stress, anxiety, mental health difficulties, shift work, jet lag, discomfort, a bad sleep environment (such as too hot or cold), noise and the use of substances (including alcohol, prescription medications or recreational drugs).
How is insomnia treated?
In most cases, insomnia can be treated by making changes to your lifestyle; for example, avoiding alcohol and caffeine, refraining from eating large meals before bed, and avoiding napping during the day. You can also maintain your sleeping pattern by going to bed and waking up at the same time each day, creating a comfortable bedroom environment, exercising (but not for a few hours before bed) and relaxing for at least an hour before bed (which can include reading or having a bath).
Should these measures prove ineffective, medication may then be considered, although treatment will only last for a few weeks due to the risk of addiction. In some cases, talking therapies, primarily cognitive behavioural therapy (CBT), may also be suggested. CBT is a talking therapy that looks to challenge and change negative thought patterns.
What is generalised anxiety disorder?
Generalised anxiety disorder is a chronic feeling of anxiety that can range from mild to severe. While we all feel anxiety at some point in our lives, such as before a job interview, it can be persistent for some people and have a debilitating effect, and result in the development of various health conditions. These may include panic disorders, phobias, social anxiety and post traumatic stress disorder (PTSD).
Physical health risks may also increase, such as heart conditions, as well as back and muscle pains. Other symptoms include feeling on edge, irritability, not being able to concentrate, a sense of dread, dizziness, dry mouth, fatigue, palpitations, pins and needles, insomnia, sweating, shaking, problems catching your breath, nausea, stomach aches and trembling.
What causes generalised anxiety disorder?
Anxiety can be caused by many factors. In some cases, there may be a specific trigger, such as being in a confined space if you are claustrophobic, but generalised anxiety rarely has one specific cause that is easy to pinpoint. This, in itself, can lead to further anxiety.
How can generalised anxiety disorder be managed?
While the condition is often long-term, there are many ways in which you can manage symptoms, including medication, talking therapies and self-help. Medications range from short term treatments, such as benzodiazepines, to longer-term medications, such as antidepressants. Talking therapies can be extremely effective in managing anxiety symptoms, most notably CBT, and applied relaxation may also be of benefit. This consists of systematically relaxing your muscles under the direction of a trained therapist once a week for around three to four months.
Self-help techniques and lifestyle changes have also proven to be highly effective for many people, such as getting regular exercise (around two and a half hours a week) and avoiding certain substances that can heighten anxiety levels, such as alcohol and caffeine. There are many support groups available that can assist you in your day to day life too.
If you would like to speak to a registered clinician about hypnotics and anxiolytics, or any related conditions, our online video consultation service is available from 9.30am-4.30pm, five days a week. Our clinicians can also issue fit notes and referral to specialists for treatment, where suitable.
What side effects can hypnotics and anxiolytics cause?
All medications come with some risk of side effects, so it is important that you understand what these are before you start treatment. Your prescribing clinician can discuss any potential side effects with you, and you can refer to the patient information leaflet supplied with your medication for specific information about side effects.
Side effects can vary from one form of hypnotics and anxiolytics to the next. The following information refers to benzodiazepine diazepam, and may not therefore refer to your specific treatment.
The following side effects can be a sign of a serious reaction to the medication and require immediate medical attention.
Uncommon (may affect up to 1 to 100 people): respiratory depression.
Rare (may affect up to 1 in 1,000 people): respiratory arrest, loss of consciousness, Jaundice (yellowing of the eyes and skin).
Very rare (may affect up to 1 in 10,000 people): severe allergic reactions that include wheezing, swelling of your lips, tongue and throat or body, rash, fainting or difficulties swallowing.
Other side effects to be aware of include:
Very common (may affect more than 1 in 10 people): drowsiness.
Common (may affect up to 1 in 10 people): fatigue, confusion, loss of coordination and tremors.
Uncommon (may affect up to 1 in 100 people): muscle weakness, memory loss, difficulties concentrating, balance disorders, dizziness, headache, slurred speech , stomach and intestinal problems such as nausea, vomiting, constipation, diarrhoea, increased salivation, allergic skin reactions in the form of itching, skin redness and swelling and skin rash.
Rare (may affect up to 1 in 1,000 people): excitation, agitation, restlessness, irritability, aggressiveness, memory loss, inappropriate behaviour, delusion, rages, psychoses, nightmares, hallucinations, decreased alertness, depression, withdrawal emotionally, insomnia, slow heartbeat, heart failure, cessation of heartbeat, low blood pressure, fainting, increased mucus in the lungs, dry mouth, increased appetite, altered liver enzyme test results, an inability to urinate, loss of bladder control, breast enlargement in men, impotence, changed sex drive, blood disorders, sore throats, nose bleeds and infections.
Very rare (may affect up to 1 in 10,000 people): low white blood cells levels and higher blood enzyme levels.
The following side effects have been reported but their frequency has not yet been properly measured: blurred vision, double vision and involuntary eye movements.
Can hypnotics and anxiolytics cause interactions with other medications?
You should inform your prescribing doctor of any treatments you have recently taken, or are currently taking, before starting treatment. The following information relates to diazepam.
Diazepam may not be suitable for you if you are taking: Sodium oxybate; antidepressants; antipsychotics; antihistamines; general anaesthetics; sedatives; hypnotics; erythromycin; muscle relaxants; strong painkillers; barbiturates; hypertension medications; diuretics; nitrates; antacids.
The following treatments have been known to affect peoples’ mental health, as well as make breathing more difficult when used alongside diazepam: Disulfiram, epileptic medications, theophylline, cimetidine, omeprazole, esomeprazole, rifampicin, hypericum perforatum (St John’s wort), amrenavir, atazanavir, ritonavir, delavirdine, efavirenz, indinavir, nelfinavir, zidovudine or saquinavir fluconazole, itraconazole, ketoconazole, voriconazole, isoniazid, oral contraceptives, cisapride, corticosteroids, levodopa, valproic acid, ketamine, lofexidine, nabilone, alpha blockers, beta blockers and moxonidine.
Warnings and precautions when taking hypnotics and anxiolytics
It’s important that you tell your prescribing clinician about any other health conditions that you have, whether related to your symptoms or not, before starting treatment.
In the case of diazepam, you should avoid using this treatment if you have any of the following conditions: allergies to any of its ingredients, breathing problems, depression, hyperactivity, have a phobia, mental illness, myasthenia gravis, sleep apnoea, severe liver disorders, porphyria, are looking to become or are pregnant.
Diazepam may also not be suitable if any of the following apply to you: problems with your heart, lungs or kidney failure, you have been grieving recently, you have low levels of albumin in the blood, you have a personality disorder, you have a poor blood supply to the brain, you experience breathing difficulties, you are a smoker, you experience depression, suicidal thoughts, epilepsy or are elderly.
Diazepam, like all benzodiazepines, can be addictive if it’s used for more than a few weeks at a time. It can also stop being effective in a very short time in some instances, which is called tolerance. Experiences of withdrawal can be avoided by reducing your treatment gradually under the supervision of your prescribing clinician. If you do not do this, it can lead to the following: depression, nervousness, difficulty sleeping, irritability, sweating, an upset stomach, diarrhoea, or the symptoms you are being treated for returning.
Are hypnotics and anxiolytics safe to take if you are pregnant or breastfeeding?
While this may depend on the medication itself, many hypnotics and anxiolytics are unsafe to use if you are pregnant or breastfeeding. If you are pregnant, suspect you might be pregnant, are planning on becoming pregnant or are breastfeeding, you should make your prescribing clinician aware of this before starting treatment.
What types of hypnotics and anxiolytics are available?
There are many different types of hypnotics and anxiolytics available. The main difference between hypnotics and anxiolytics is that hypnotics are prescribed to treat conditions that often affect people at night, such as insomnia, whereas anxiolytics tend to be prescribed to treat conditions that are more likely to occur during the day, such as anxiety.
The most commonly prescribed medication of the two types of treatment is benzodiazepines, with more than 20 derivatives available. Barbiturates are an older form of anxiolytic and are rarely prescribed these days due to the health risks involved, such as respiratory depression.
There are also several different types of antidepressants that may be referred to as anxiolytics, although they are more likely to be prescribed for depression or a combination of anxiety and depression. Other hypnotics include anaesthetics and antihistamines.
Can hypnotics and anxiolytics interact with food and alcohol?
It depends on the specific treatment. Alcohol can increase the sedative effect of diazepam and many other benzodiazepines. On the other hand, caffeine may reduce the sedative effect of these drugs and impact on their functionality. Grapefruit juice can increase the amount of diazepam in the blood.
You should discuss any potential interactions between your medication and food and alcohol with your prescribing clinician prior to starting treatment.
Can hypnotics and anxiolytics affect your ability to drive?
Because hypnotics and anxiolytics act as a sedative, it may impair your ability to drive. In many cases, it’s illegal to drive while taking these treatments if your judgement has been affected. Therefore, you should wait and see how these treatments affect you before driving. If you are unsure, consult your prescribing clinician.
Can I buy hypnotics or anxiolytics over the counter?
No. Hypnotics and anxiolytics are prescription-only treatments.
How can I buy hypnotics or anxiolytics online?
You can discuss hypnotics or anxiolytics with a GMC-registered clinician using our online video consultation service. Appointments are available between 9.30am and 4.30pm, Monday to Friday. Our clinicians can also issue referrals to specialists for treatment and fit notes, where appropriate.