Hypnotic Drugs for 1984

  • I. Oswald
Conference paper
Part of the Psychopharmacology Supplementum book series (PSYCHOPHARM, volume 1)


It is still insufficiently recognised that hypnotics and anti-anxiety drugs are one and the same and that the regular intake of these drugs will be followed by withdrawal phenomena, including complaints of insomnia and anxiety. The long-acting, cumulative drugs like phenobarbitone or flurazepam cannot in reality be withdrawn abruptly owing to their persistence in the tissues, and so they do not cause sharp rebound phenomena, though they cause impaired skills and judgement by day.

Very short life drugs, like triazolam, are followed by immediate and severe withdrawal insomnia in older people and their regular nighttime intake may cause regular daytime withdrawal symptoms of enhanced anxiety. A hypnotic with a half-life of about 10 hours may be the most sensible compromise to provide sleep by night without serious positive or negative daytime effects, though some eventual withdrawal features will be inevitable. The benzodiazepines lead to a degree of tolerance, but this is never complete and their positive effects are sustained over many months.

Increased sleep duration has been assumed to be a necessary feature of an effective hypnotic. However, hypnotic drugs for the future might not lengthen sleep, but improve it’s restorative value and the subjective satisfaction given to the patient.

Key Words

Alcohol Anxiety Chloral Flurazepam Fosazepam Glutethimide Loprazolam Lormetazepam Methaqualone Methyprylone Nitrazepam Paraldehyde Protein synthesis Tolerance Trazodone Urinary cortisol Visual analogue scales Withdrawal rebound phenomena 


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  1. Adam K, Adamson L, Březinová V, Hunter WM, Oswald I (1976) Nitrazepam: lastingly effective but trouble on withdrawal. Br Med J 1:1558–1560PubMedCrossRefGoogle Scholar
  2. Adam K, Oswald I, Shapiro C (1984) Effects of loprazolam and of triazolam on sleep and overnight urinary Cortisol. (To be published)Google Scholar
  3. Allen S, Oswald I (1976) Anxiety and sleep after fosazepam. Br J Clin Pharmacol 3:165–168PubMedGoogle Scholar
  4. Castleden CM, George CF, Marcer D, Hallett C (1977) Increased sensitivity to nitrazepam in old age. Br Med J 1:10–12PubMedCrossRefGoogle Scholar
  5. Danait J, Rebiere A (1978) Daily variations of the in vivo (3H) leucine incorporation into the cerebellar and cerebral proteins of the normal and hypothyroid young rat. Experientia (Basel) 34:264–265CrossRefGoogle Scholar
  6. Dement W, Greenberg S (1966) Changes in total amount of stage four sleep as a function of partial sleep deprivation. Electroenceph Clin Neurophysiol 20:523–526PubMedCrossRefGoogle Scholar
  7. Haider I, Oswald I (1970) Late brain recovery processes after drug overdose. Br Med J 2:318–322PubMedCrossRefGoogle Scholar
  8. Jochemsen R (1983) Clinical pharmacokinetics of benzodiazepine hypnotics. Drukkerij JH Pasmans BV, ’s-GravenhageGoogle Scholar
  9. Kales A, Bixler EO, Soldatos CR, Vela-Bueno A, Jacoby J, Kales JD (1982) Quazepam and flurazepam: long-term use and extended withdrawal. Clin Pharmacol Ther 32:781–788PubMedCrossRefGoogle Scholar
  10. Montgomery I, Oswald I, Morgan K, Adam K (1984) Trazodone enhances sleep in subjective quality but not in objective duration. Br J Clin Pharmacol (in press)Google Scholar
  11. Morgan K, Oswald I (1982) Anxiety caused by a short-life hypnotic. Br Med J 284:942CrossRefGoogle Scholar
  12. Oswald I (1973) Drug research and human sleep. Annu Rev Pharmacol 53:243–252CrossRefGoogle Scholar
  13. Oswald I (1980 a) Sleep studies in clinical pharmacology. Br J Clin Pharmacol 10:317–326PubMedGoogle Scholar
  14. Oswald I (1980 b) Sleep as a restorative process: Human clues. Prog Brain Res 53:279–288PubMedCrossRefGoogle Scholar
  15. Oswald I, Priest RG (1965) Five weeks to escape the sleeping-pill habit. Br Med J 2:1093–1099PubMedCrossRefGoogle Scholar
  16. Oswald I, Adam K, Borrow S, Idzikowski C (1979) The effects of two hypnotics on sleep, subjective feeling and skilled performance. In: Passouant P, Oswald I (eds) Pharmacology of the states of alertness. Pergamon Press, Oxford, pp 51–63Google Scholar
  17. Oswald I, Adam K (1980) Benzodiazepines cause small loss of body weight. Br Med J 281:1039–1040PubMedCrossRefGoogle Scholar
  18. Oswald I, French C, Adam K, Gilham J (1982) Benzodiazepine hypnotics remain effective for 24 weeks. Br Med J 284:860–863CrossRefGoogle Scholar
  19. Petursson H, Lader MH (1981) Withdrawal from long-term benzodiazepine treatment. Br Med J 283:643–645CrossRefGoogle Scholar
  20. Spinweber CL, Johnson LC (1982) Effects of triazolam (0.5 mg) on sleep, performance, memory and arousal threshold. Psychopharmacology (Berlin) 76:5–12CrossRefGoogle Scholar
  21. Wulff MH (1959) The barbiturate withdrawal syndrome. Electroencephalogr Clin Neurophysiol [Suppl] 14:1–161Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1984

Authors and Affiliations

  • I. Oswald
    • 1
  1. 1.Royal Edinburgh HospitalUniversity Department of PsychiatryGB-EdinburghUK

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