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I've suffered from insomnia for years, primarily in the form of not being able to get to sleep rather than frequent or early wakenings. On average, I only get four to five hours sleep a night and often have to make this up with a quick nap when I get home from work - creating a viscious cycle! I think I've tried almost every cure going from excercise to relation tapes and warm milk - but occasionally I do give in and turn to chemicals.
Over the years I have been prescribed many different forms of sleeping tablet from bezodiazepines to old style sleep inducing anti-depressants and even barbituates. I have found most of these to be intolerable in terms of a next day hangover effect, though all of them have worked in the short term. In recent years, however, my GP has been keen to prescribe zopiclone - one of the new generation sleeping tablets. I'm not sure if this has anything to do with the zopiclone calender, notepad and pen holder he has on his desk, but usually I agree with him.
Zopiclone is a non-benzodazepine tranquillizer. It does, however, have a very similar effect to valium and tempazapam, working on the same receptor sites in the brain. Chemically, Zopiclone belongs to the class of drugs known as cyclopyrrolones. These drugs were discovered in the 1980s by scientists looking for a non-habit forming alternative to traditional sleeping pills. They were looking for a sedative chemical which would not be easy to overdose on, has minimal side effects and would not cause tolerance. Zopiclone was licensed in 1989 and has been increasingly prescribed since. Zopiclone was recently added to the Misuse of Drugs Act as a Class C drug and is only available in the UK on prescription.
How Zopiclone works (the technical bit)
For those of you interested in what zopiclone does to your brain, it works by enhancing the action of a neurotransmitter (a chemical substance in your brain that transmits nerve impulses). This substance is called gamma-aminobutyric acid (GABA). GABA inhibits the transmission of nerve signals, thereby reducing nervous excitation and thinking in the brain. This accounts for the calming and relaxing properties of Zopiclone. Unlike bezodiazepines, it is thought that Zopiclone only targets one type of GABA receptor making tolerance in the majority of users less likely. Additionally, Zopiclone has a short half life (the time it takes for drugs to be cleared from the body) of only 1.2 hours. For comparison, the bezodiazepine Temazapam has a half life of 15 hours. This is why scientists believe Zopiclone has less residual hangover effects than other sleeping pills and also why zopiclone does not work as well for people who suffer from frequent wakenings.
The usual dose is one 7.5mg tablet per night 30 -60 minutes before bed, though this varies with age and health. The first time I took Zopiclone one tablet knocked me out within an hour and I woke up the next morning feeling reasonably refreshed. It does cause an uncomfortable metallic taste in the mouth, as other reviewers have reported, and this lasted most of the day. Another effect I immediately noticed, perhaps due to this taste, was that I didn't feel like eating until teatime the next day. The first few times I took the drug it worked fine at that dose but within a week the effect was wearing off and I upped the dose to two tablets and then eventually three to get the same effect. I'm not sure if this is just me or a psychological effect of taking sedating drugs, but I found the theory that tolerance does not develop unfounded. I certainly wouldn't recommend taking more than prescribed as I have found that the rebound insomnia and anxiety is really quite bad after taking higher doses. After taking zopiclone for around two weeks I found that my sleep was actually worse than before and took another couple of weeks to right itself. I took zopiclone last week after a break of almost six months and found that it really didnt work for me anymore. It did make me feel calmer and I slept eventually, but the initial knock out effects had certainly worn off and I felt quite spaced out and shaky during the day.
If you stick to the dose, zopiclone can work well for people in the short term. It does make you feel more relaxed and when you first take it it really does knock you out. For people who have difficulty falling asleep due to stress or one off life events it is a lifesaver. In comparison with other tranquillizers and sedatives, the next day effects are less and at the one tablet a night dose you don't feel the urge to keep taking it.
Zopiclone is not a cure for insomnia. In fact, it can make the problem worse with rebound insomnia occuring after only a few weeks of use. GPs are likely to only prescribe the drug for a month or so, so this is not something you want to become dependant on. Zopiclone, as with all tranquillizers, completely alters the way you sleep and this can have its own negative effects. In laymans terms, such drugs stop you entering the most refreshing sleep phase where you dream. In the long term, this can alter you day to day behaviour and I have found it can make you more irritable and grumpy. In recent years there have been studies into the withdrawal and dependence effects of Zopiclone. Some studies, often funded by drug companies, have found little evidence of withdrawal symptoms or dependance. Others have highlighted many cases where people have become dependant on zopiclone and have experienced withdrawal symptoms, in line with other tranquillizers and sedatives. The World Health Organisation had more complaints about Zopiclone than any other medicine in 2001/2002, ranking above tempazapam and valium. I personally think that if you have had problems with other medications or alcohol Zopiclone is not for you - a quick search on the Internet reveals people recounting their problems with the drug.
The Patient Information Leaflet lists a number of common and not so common known side effects of the drug. Here are the main ones:
Effects on the gastrointestinal system: a bitter or metallic taste in the mouth, dry mouth and feeling sick or being sick
Effects on the nervous system: headache, dizziness, drowsiness, irritability, light headedness, lack of co-ordination, aggressiveness, confusion, depression, amnesia, hallucinations or nightmares
Allergic reactions: rashes, which may be itchy
Other: sometimes sleeplessness has occurred on stopping the tablets, usually following prolonged use.
Zopiclone is only available on prescription in the UK and I don't think it is available in the US (i may be wrong). It comes in packs of 28, either 7.5mg tablets or 3.5mg tablets. In the UK, it is often known by the name Zimovane. It is not recommended for use in the elderly or those with various liver/kidney problems - for more information speak to your GP.
Zopiclone does work as a sleeping tablet but that sleep can come at a price. I personally like to find out as much about a drug as possible before I take it as at the end of the day the companies that manufacture these products are not charitable concerns trying to ease human ills . They are some of the most profitable organisations in the world with vested interests and vocal shareholders. The available evidence on Zopiclone is conflicting and as with all drugs its a good idea to question your GP about the latest research and the experiences of other patients. Any good GP will welcome your questions and concerns. As a long term insomniac, however, sometimes there is no alternative than a good knock out pill and Zopiclone is certainly that.
To those of you reading this in the dead of night, knowing you have to get up early for work and are unable to sleep - you have my sympathy!
The British National Formularly is the GPs handbook on prescription medications in the UK. It is a useful source of information, particularly on drug interactions and can be accessed from here: www.bnf.org
I'm a bit late with this but I think many people will be interested in your review. Curiously, many drugs help you sleep but you end up feeling knackered in the morning anyhow! Right that the more you use a certain tablet the less effect it seems to have. Tel
morgjgriff 09.04.2004 19:38
Being a person with an over-active mind, especially of a night, I too find it hard to sleep. I've found Valerian Root helps me relax, I also listen to "Sailing by" and "The Shipping Forecast" on Radio 4 as I setlle down. It's strangely very soothing! Very well written op about a drug I didn't realise existed. Ciao for now - J
C_W_Monkey 09.04.2004 12:00
it's good to see someone writing about this who isn't a doctor, personal experience, thank you... I'm going to go and write one on my old acne tablets now, thanks for the inspiration