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11 March 2009SLEEPING PILLS: THE DRUGS

Insomnia is not a new disease. The ancient Egyptians remarked that one of the worst things in life is to be in bed and be unable to sleep. The word ‘hypnotic’ comes from the name of the Greek god of sleep, Hypnos. Throughout the centuries, drugs have been available to help with sleeplessness. However, as more and more hypnotic drugs have become available, more and more people have come to suffer from insomnia. It is possible that modern life is more competitive than life in the past, and insomnia becomes a symptom of modern, busy city life. It is also possible that people are more aware that there is a drug for treating insomnia, whereas in the past people suffering from insomnia would have had to put up with it rather than seek treatment. Hence this gives an artificial increase in the number of people with insomnia who take sleeping pills.

The first sleeping pills

For many years, opium and alcohol were the only remedies for helping insomnia. In 1869, chloral hydrate was discovered and became the first synthetic hypnotic drug. This was widely used at that time and is still used even now. Choral hydrate is relatively short acting; it is marketed in Australia as Noctec, Dormel, and Chloralix.

Barbiturates

Barbiturates were manufactured in 1912 and were used extensively for the next 60 years as a tranquillizer to calm the anxious. In a moderate dose they can be used as a hypnotic for sleeping. In an even higher dose they can be used in general anaesthesia, knocking people out completely for surgical operation.

After many years it became apparent that a lot of people abused barbiturates, becoming addicted to them. There were serious withdrawal symptoms. People who were on high doses of these pills could not stop taking them and needed a higher and higher dose to have the same desirable effect. People who were on high doses for a long time and stopped suddenly experienced serious withdrawal symptoms. Not only could they not sleep, but also they could go into convulsion and could even develop temporary psychotic illness. These pills have a narrow safety margin, and people have overdosed either accidentally or on purpose. Remember the sad cases of Marilyn Monroe and Elvis Presley?

Benzodiazepines

Because barbiturates could be so dangerous, scientists began searching for an alternative drug. In 1954 Dr Leo H. Sternbach experimented with about 40 new chemicals in the Roche Laboratory, New Jersey. He was very disappointed with these chemicals, as they were all inappropriate and did not have any hypnotic or tranquillizing effect. He gave up after months of testing and turned his attention to other research projects. There was one last chemical with the code Ro5-0690 that he did not feel like testing anymore and it was left on the bench.

Two years later this last chemical was again looked at. It was tested properly at the Roche Laboratory, and was found to have all the desirable properties—it was a hypnotic, a relaxant, and a sedative. In 1957 this substance was identified as benzodiazepine, which is now better known as Librium. In 1960 the US Food and Drug Administration approved it for human use. The whole pharmaceutical industry then went crazy and started to discover more and more benzodiazepine-like substances. These drugs are sought after by patients and doctors alike, and a multi-billion dollar industry has grown up around them. There are now hundreds of these chemicals, with Valium being the most well known.

Benzodiazepine—the answer?

There are many reasons why benzodiazepine is so well received. The drug is significantly more safe than barbiturates. There are fewer cases of death from overdose, and the withdrawal symptoms are less dramatic than with barbiturates. It has both hypnotic and sedative properties, so, if you cannot sleep, take a pill; if you are under stress, take a pill; if you are tense, take a pill; and so on. Benzodiazepine became the solution to a lot of psychological problems. For a while it seemed that there was no need for psychologists or psychiatrists. Patients who normally saw an analyst daily felt that benzodiazepine had helped them. Benzodiazepine became the magic answer for us members of an increasingly busy and stressful world. The days of working on the farm, milking a few cows, and having an afternoon nap are disappearing fast. Society is becoming more and more competitive, and we are not well equipped to deal with this. Most doctors are not trained to sort out or help patients with problems of stress or insomnia, and their patients are too impatient to see doctors for lengthy counselling anyway. They want instead instant answers to their very complicated problems. Benzodiazepine seemed to be the answer.

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