HYPNOTICS. – All those agents that induce or provoke sleep by depressing the excitability of nerve cells or bringing about transitory modifications of cerebral blood circulation. In the broad sense, therefore, even a warm footbath or general bath, or a copious evening meal, may, for example, exert a hypnagogic action. In the narrower sense, the term refers only to drugs capable, through their pharmacodynamic action, of reproducing the conditions of natural cerebral rest. And since the principal mechanism by which this aim is achieved lies in a depression of the psychic functions, the drug consequently exerts a sedative action, which merges with the hypnagogic one.
Hypnotics are distinguished from narcotics; whereas the former induce sleep only by depressing cortical excitability, without modifying cerebral blood circulation, the latter instead produce deeper sleep, accompanied by a greater dulling of the reflexes and often also by considerable cerebral circulatory changes; moreover, since they are readily oxidized in the tissues, they alter the protoplasm of the 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, and then proceeds to suspension of consciousness and of the functioning of those cortical and basal centers that normally coordinate sensory impressions and voluntary movements. For the state of physical relaxation and psychic clouding produced by the hypnotic to be considered as closely analogous as possible to that produced by physiological sleep, it is necessary that, as with the latter, the sleep induced by the drug should be easily dispelled upon awakening, permitting the rapid and gentle return of consciousness, free from any sense of torpor, and leaving the individual in that state of well-being that follows physiological sleep. From this point of view, however, individual susceptibility varies greatly, and nausea, headache, mental confusion, general torpor, and all the other signs that the individual may experience as intolerance appear with extremely variable intensity according to the subject. If the drug has depressed the individual’s cerebral centers too deeply and the person remains insensitive to external stimuli, coma (v.) and a state of poisoning. To a greater or lesser extent, all hypnotics possess a toxic equivalent, and are therefore never entirely harmless; their use should, as far as possible, be limited to cases of absolute necessity, that is, to acute cases in which agitation and insomnia, if prolonged, are expected to cause a dangerous general exhaustion. Moreover, habituation to the medication tends to develop, all the more harmful because increasingly larger quantities of the drug will subsequently be required to obtain the hypnagogic effect, hence increasing the unfortunate possibility of intoxication. Indeed, besides depressing cortical excitability, hypnotics, to a greater or lesser degree according to their nature, exert a depressant action on respiration, the heart, digestion, and metabolism; these effects must be given particular consideration when there is an absolute need not to aggravate the patient’s morbid condition further. The ideal hypnotic, effective in producing sleep as similar as possible to physiological sleep, still does not exist, despite the continuous research and new synthetic combinations developed by pharmaceutical science and industry. At present, however, there are some good ones worthy of consideration, each of which has indications that may make it preferable in particular circumstances; but all, without exception, are open to some objection regarding their use. The most commonly used, and unfortunately often obtainable in the form of proprietary preparations from obliging pharmacists without a physician’s prescription, are derivatives of barbituric acid (veronal, medinal, ipnal, numal, sandoptal, noctal, pernocton, proponal, luminal, gardenal, dial, sedival, somnifen, sonno, etc.) and the urethanes; certain urea derivatives, such as bromural, neurinal, and adalin, would in practice appear to be non-toxic.
The hypnagogic action is particularly marked among stupefacients (v.) and the narcotics properly so called, among which opium (v.) is the classic example: in small doses it is simply analgesic, while in larger doses it acts by producing profound narcosis, particularly through two of its alkaloids, narceine and morphine.
In the agitated life of the present day, in which individual, domestic, and social unrest and dissatisfaction overstimulate and wear down the subject’s psychic reserves, especially sensitivity and volitional activity, placing the person under the domination of particular suggestions at odds with the realities of his or her existence, and driving the person to a paroxysm of morbid susceptibility and even to genuine states of anguish, the search for some respite has multiplied the use of hypnotics, while the incidence of suicides through massive doses of them has risen alarmingly. The immoderate and clandestine use of such medications has become a genuine calamity, penetrating even social strata previously immune to II. The evil tightens through a vicious circle in which the slow and insidious depressant action of hypnotics, narcotics, and stupefacients on the cerebral cortex and other organic functions renders the individual increasingly abulic and distressed, in search of a new period of calm that can be obtained only with ever higher and increasingly toxic doses.
A more rigorous regulation of the sale of hypnotics is therefore imperative, since not a few of them escape the legal provisions governing stupefacients; an even more effective remedy, however, will be the psychic and moral education of the individual, so that, in the face of the bitter contingencies that may arise in life, the person may find, in mental equilibrium and peace of spirit, an effective remedy and avoid the danger of self-inflicted harm to physical and psychic integrity.