HYPNOTICS. – All agents that induce or provoke sleep by depressing the excitability of nerve cells or by causing transient modifications in cerebral blood circulation. In a broad sense, therefore, even a hot footbath or a general hot bath or a late, heavy meal may, for example, exert a beneficial action. In a stricter sense, however, only drugs capable of reproducing, through their pharmacodynamic action, the conditions of natural cerebral rest are properly called hypnotics. Since the principal mechanism by which this effect is achieved involves a depression of psychic functions, the drug exerts a sedative action that blends with the beneficial effect.
Hypnotics are distinguished from narcotics; while the former induce sleep merely by depressing cortical excitability without altering cerebral blood circulation, the latter produce a deeper sleep accompanied by greater dulling of reflexes and often by notable cerebral circulatory changes; moreover, by oxidizing readily in the tissues, they alter the protoplasm of nerve cells, whereas hypnotics merely render them less excitable.
The administration of a hypnotic first causes a gradual weakening of the faculty of attention and muscular relaxation, leading then to suspension of consciousness and of the functionality of those cortical and basal centres that normally coordinate sensory impressions and voluntary movements. For the state of physical relaxation and mental dulling produced by nervous irritation to be beneficial—whether induced by physiological sleep or by a drug-induced sleep—it is necessary that the latter be easily dissipated upon awakening, allowing a rapid and smooth return of consciousness, free from any sense of drowsiness, and leaving the individual in that state of well-being which follows physiological sleep. Under this aspect, however, individual susceptibility varies greatly, and nausea, headache, mental confusion, general drowsiness, and all those other signs that the individual may perceive as intolerance, present an extremely variable range of intensity depending on the subject. If the drug has depressed the cerebral centres too deeply and the individual remains insensitive to external stimuli, one must speak of coma (q.v.) and of a state of poisoning. More or less, all hypnotics possess a toxic equivalent, so that they are never entirely harmless, and their use, as far as possible, should be limited to cases of absolute necessity, i.e., acute cases in which prolonged agitation and insomnia could cause a dangerous general exhaustion. Furthermore, tolerance to the drug tends to develop, and this is all the more harmful in that progressively larger doses of the drug will be required to achieve the desired effect, thus increasing the likelihood of intoxication. Indeed, in addition to depressing cortical excitability, hypnotics—each to a greater or lesser degree depending on their nature—exert a depressive action on respiration, the heart, digestion, and metabolism; effects that must be given particular consideration when it is essential not to aggravate the patient’s morbid condition further. The ideal hypnotic, capable of inducing a sleep as similar as possible to physiological sleep, despite continuous research and new synthetic combinations from science and the pharmaceutical industry, still does not exist, although some good ones are currently available and worthy of consideration; each of these has indications that may make it preferable under particular circumstances. Yet all, without exception, are open to some objection regarding their use. The most commonly used—often unfortunately obtainable, in the form of proprietary medicines, from obliging pharmacists without a medical prescription—are derivatives of barbituric acid (Veronal, Medinal, Ipnol, Numal, Sandoptal, Noctal, Pernocton, Proponal, Luminal, Gardenal, Dial, Sedival, Somnifen, Sonno, etc.) and urethanes; practically non-toxic would appear to be some urea derivatives, such as Bromural, Neuronal, and Adalin.
The beneficial action excels in the case of narcotics (q.v.) and true narcotics, among which opium (q.v.) is classic: in small doses it acts simply as an analgesic, in larger doses it produces deep narcosis, particularly through two of its alkaloids, narcotine and morphine.
In the agitated life of today, in which iniquity and individual, domestic, and social dissatisfaction over-excite and wear down the psychic reserves of the subject—particularly his sensitivity and volitional activity—placing him under the sway of particular suggestions at odds with the realities of his existence and driving him to a paroxysm of morbid susceptibility up to true states of anguish, the search for some pause of rest has multiplied the use of hypnotics, while the incidence of suicides by massive doses of these has risen alarmingly. The immoderate and clandestine use of such medications has become a veritable scourge, penetrating even social strata previously immune. The evil tightens its grip through a vicious circle in which the slow and insidious depressant action of hypnotics, narcotics, and narcotics on the cerebral cortex and other organic functions renders the individual ever more abulic and suffering, in search of a new period of calm that can only be obtained with ever-increasing and ever more toxic doses.
A stricter regulation of the sale of hypnotics is therefore imperative, as many of them escape the provisions of laws on narcotics; yet an even more effective remedy will be the psychic and moral education of the individual, so that, faced with the bitter contingencies that may arise in life, he may find in the equilibrium of his mind and the peace of his spirit the effective remedy and avoid the danger of self-inflicted harm to his physical and psychic integrity.