Hypnotics

HYPNOTICS. - All those agents that induce or provoke sleep by depressing the excitability of nerve cells or by bringing about transient changes in the cerebral blood circulation. In a broad sense, therefore, even a hot footbath or a hot general bath or a heavy late meal can, for example, exert a sleep-inducing action. In a narrower sense, only those drugs capable of reproducing, through their pharmacodynamic action, the conditions of natural cerebral rest are called such. And since the principal mechanism through which this goal is achieved lies in a depression of psychic functions, the drug exerts a sedative action, which merges with the sleep-inducing one.

Hypnotics are distinguished from narcotics; while the former provoke sleep only by depressing cortical excitability, without modifying the cerebral blood circulation, the latter instead bring about a deeper sleep, accompanied by a greater blunting of reflexes and often also by notable cerebral circulatory changes; moreover, since they oxidize easily in the tissues, they alter the protoplasm of the nerve cells, whereas hypnotics merely make them less excitable.

The administration of a hypnotic first brings about a gradual weakening of the faculty of attention and muscular relaxation, then proceeds to the suspension of consciousness and of the functioning of those cortical and basal centers that normally coordinate sensory impressions and voluntary movements. In order for the state of physical relaxation and psychic clouding provoked by the hypnotic to be considered as analogous as possible to that provoked by physiological sleep, it is necessary that, like the latter, the sleep induced by the drug be easy to dispel at the moment of awakening, allowing the rapid and smooth return of consciousness, that is, free from any sense of torpor, and leave 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 those other signs that the individual may perceive as intolerance present themselves with a highly variable range of intensity depending on the subject. If the drug has depressed the individual's cerebral centers too deeply and the latter remains insensitive to external stimuli, one must speak of coma (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, must be limited to cases of absolute necessity, that is, in acute cases, in which it is foreseen that agitation and insomnia could cause, if they last a long time, a dangerous general exhausting effect. Moreover, addiction to the medication tends to develop, all the more harmful in that ever greater quantities of the drug will successively be required to obtain the sleep-inducing effect, whence the increase of deplorable possibilities of intoxication. In fact, 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; effects to be taken particularly into consideration when there is an absolute necessity not to further aggravate the patient's morbid conditions. The ideal hypnotic, effective for sleep as similar as possible to physiological sleep, despite continuous research and the new synthetic combinations of science and the pharmaceutical industry, still does not exist, although good ones worthy of consideration are currently available, each of which presents indications that may make it preferable according to particular circumstances; but all, none excepted, are open to some objection regarding their use. The most commonly used, often unfortunately obtainable, in the form of proprietary preparations, from obliging pharmacists, without a doctor's prescription, are the derivatives of barbituric acid (veronal, medinal, hypnal, numal, sandoptal, noctal, pernocton, proponal, luminal, gardenal, dial, sedival, somnifen, sonno, etc.) and the urethanes; practically non-toxic would appear to be certain ureic derivatives, such as bromural, neurinal, adaline.

The sleep-inducing action is preeminent in stupefacients (v.) and in narcotics properly so called, among which opium (v.) is classic, which in small doses is merely analgesic, in larger doses acts by narcotizing deeply, particularly through two of its alkaloids: narceine and morphine.

In the agitated life of today, in which individual, domestic, and social restlessness and dissatisfaction overstimulate and wear down the subject's psychic reserves, in particular his sensitivity and his volitional activity, placing him under the dominion of particular suggestions in contrast with the realities of his own 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 means of massive doses of these has been rising alarmingly. The immoderate and clandestine use of such medications has become a veritable calamity, penetrating even into social strata previously immune. 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 on the other organic functions renders the individual ever more abulic and more suffering, in search of a new period of calm that he will be able to obtain only with ever higher and ever more toxic doses.

A more rigorous regulation of the sale of hypnotics is therefore imperative, not a few of which escape the legal provisions on stupefacients; while an even more effective remedy will be the psychic and moral education of the individual, so that, in the face of the bitter contingencies that may arise in life, he may find, in the balance of the mind and the peace of the spirit, the effective remedy and avoid the danger of self-harm to his own physical and psychic integrity.

Guido Tegoni