Benzodiazepines act through the benzodiazepine receptor complex - gamma - aminobutyric acid, affecting the flow of chlorine. Benzodiazepine receptor agonists bind to the same receptor complex, but have different affinity towards different receptor subclasses. Drugs available on the market to treat insomnia without a prescription, include sedative antagonists histamine-1 - receptors (diphenhydramine and doxylamine) and melatonin, but their use is not supported by strict data. Randomized, controlled trials of antagonists histamine-1 receptors suggest that they improve sleep subjective, but conclusions limited to a small number of subjects, a brief period of drug administration and the lack of objective indicators; morning lethargy - a well-known side effect. Studies of melatonin, which included a small number of patients treated for brief periods with different doses and formulas, showed conflicting results. Many randomized trials have shown the effectiveness of benzodiazepines and benzodiazepine receptor agonists in the elimination of short-term insomnia, but no studies have gone beyond the limits of application within 6 months. Meta-analysis of 22 studies of benzodiazepines or benzodiazepine receptor agonist zolpidem (Ambien) demonstrated that these drugs lead to significant improvements in sleep latency, total sleep time, fewer awakenings and improve sleep quality. In a subgroup of nine studies that included relevant data, the average patient receiving medication to sleep faster than 71% of the control group, slept longer than 76% of the control subjects, woke up less than 74%, and marked a good quality sleep than 73 % the control group .. Short-term medications were more pronounced effect on sleep latency, whereas the preparations of the intermediate or long-acting, had a more pronounced effect on total sleep time. Another meta-analysis of benzodiazepine therapy (including drugs short, intermediate and long-acting) confirmed the beneficial effects of this class of drugs in total sleep time, but there was no significant effect on sleep latency. Studies benzodiazepine receptor agonist zaleplon (Sonata) showed 50% reduction in latency compared with the initial state, but had no significant effect on total sleep time - a result that is consistent with a very short half-life of the drug. Zaleplon, introduced after 3.5 hours after the disappearance of daylight, increased sleep for 4 hours, but did not lead to any of sleepiness during the day or to violations of intellectual activity. The six-month study of eszopiclone (Lunesta), a benzodiazepine receptor agonist with an intermediate half-life, recently approved for use in the U.S. showed 50% reduction in sleep latency and 65% reduction in the time of awakenings after sleep onset compared to baseline status.
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