Hypnotics make you sleepy and are used as a short term treatment of insomnia (or difficulty in getting to sleep or staying asleep). Chlormethiazole ('Heminevrin') can also be used to help agitation and restlessness, and to help alcohol withdrawal symptoms. Insomnia i.e. difficulty in going to sleep or staying asleep, is not an illness itself but can cause distress and make some conditions worse e.g. bipolar mania. Any causes of insomnia should, where possible, be identified and treated. The principles of 'sleep hygiene' should also be taken seriously. These principles of sleep hygiene are:

1. Avoid excessive use of caffeine, alcohol or nicotine. A hot milky (decaffeinated) drink at bedtime may help

2. Do not stay in bed for a long time if you are not asleep

3. Avoid daytime naps or long periods of inactivity

4. A warm bath or exercise a few hours before bedtime may help sleep

5. Avoid strenuous exercise or mental activity near bedtime

6. Make sure that the bed and bedroom are comfortable and avoid excess noise and temperature (ear-plugs may help if there is much noise)

7. Get up at the same time every morning, regardless of how long you slept (this makes sure that you are ready for sleep the next night)

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To help you choose, click on the links for the main options (self-help and help from others), the main medicines, and a handy chart comparing the main medicines for:

• Insomnia - main options, main medicines and handy chart

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Hypnotics make you sleepy and are used to help as a short term treatment of insomnia (or difficulty in getting to sleep or staying asleep). They help to calm you down and can make you sleepy, particularly if you are also anxious.

Insomnia i.e. difficulty in going to sleep or staying asleep, is not an illness itself but can cause distress and make some conditions worse e.g. mania. Any causes of insomnia should, where possible, be identified and treated. The principles of "sleep hygiene" should also be taken seriously. The principles of sleep hygiene are:

1. Avoid excessive use of caffeine, alcohol or nicotine. A hot milky (decaffeinated) drink at bedtime may help
2. Do not stay in bed for a long time if you are not asleep
3. Avoid daytime naps or long periods of inactivity
4. A warm bath or exercise a few hours before bedtime may help sleep
5. Avoid strenuous exercise or mental activity near bedtime
6. Make sure that the bed and bedroom are comfortable and avoid excess noise and temperature (ear-plugs may help if there is much noise)
7. Get up at the same time every morning, regardless of how long you slept (this makes sure that you are ready for sleep the next night).

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Take your medication at bedtime as directed on the medicine label. Take it about half an hour before you want to go to sleep. Do not take another if you wake up later unless specifically told to do so. 

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Tablets and capsules:

Tablets and capsules should be swallowed with at least half a glass of water whilst sitting or standing. This is to make sure that they reach the stomach and do not stick in your throat. It is especially important that you take chloral hydrate with plenty of water or milk to avoid it upsetting your stomach.

Liquids:

Your pharmacist should give you a medicine spoon. Use it carefully to make sure you measure the correct amount. (Ask your pharmacist for a medicine spoon if you do not have one).

You should take chloral hydrate with plenty of water or milk to avoid it upsetting your stomach. Chloral hydrate syrup and chlormethiazole syrup ("Heminevrin") do not taste very nice. You could add fruit juices or squash to help this if you like.

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They should start to work about half an hour to an hour after you take them for insomnia. Your doctor may need to adjust the dose to suit you, if they do not work or make you too sleepy the next morning.

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This should be discussed with your doctor as people respond differently. They are fairly safe drugs if used sensibly. They should be taken in as low a dose as possible for the shortest time possible. This would ideally be for no longer than about one month to help you get over your problems. If you need to take them for longer you should discuss this regularly with your doctor. Taking them only when required or every few days (e.g. alternate nights) can be a useful way to use these drugs safely.

It is not recommended that chlormethiazole is taken for longer than nine days if used to help alcohol withdrawal.

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Due to the effects that these drugs have on the brain they can sometimes produce a type of dependence (or addiction) in some people if taken regularly every night for more than about four to six weeks. Dependence or addiction means that you cannot manage without them because if you stop them you get "withdrawal" symptoms. These withdrawal symptoms could at worst include e.g. anxiety, tension, poor concentration and most commonly difficulty in sleeping ("rebound insomnia"). This is unlikely at normal doses or if not taken every night. These symptoms may occur several days after stopping your drug. They may last for a few weeks but could go on for longer. If you have taken them for a long period of time you may need to stop them gradually by reducing your dose over a period of time to prevent these effects. It is also true to say that many people suffer no withdrawal symptoms at all when they stop, even if they have been taking hypnotics for a while. You should thus make sure that you discuss your particular treatment with your doctor. For further discussion, click here.

If someone has a drink problem and is taking chlormethiazole to help the withdrawal symptoms it is not a good idea to take clomethiazole for more than about nine days. They may then get hooked on the clomethiazole.

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Take the dose as soon as you remember. If you take it too late at night you may feel more drowsy the next morning.

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Chloral hydrate is probably best not stopped suddenly if you have been taking more than one dose regularly every day for more than about four to six weeks or more. If you do you may get some withdrawal effects as mentioned above. If you take them only when really necessary this is better than taking them continuously and can help stop you depending on them. You should discuss this with your doctor.

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Hypnotics are used to help you sleep and therefore should make you feel drowsy. You may however feel drowsy the next morning so you should not drive (see below) or operate machinery until you know how they affect you. You should be careful as they may affect your reaction times, even if you feel OK.

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It is not thought that any of these hypnotics cause any changes in weight. If you do start to have problems with your weight, however, tell your doctor next time you meet as he or she can arrange for you to see a dietician for advice.

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Drugs can affect desire (libido), arousal (erection) and orgasmic ability. These hypnotics do not have any known significant effects. Unless of course you have already gone to sleep.

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You should have no problem with any foods or drinks, other than alcohol (see separate question).

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You should avoid alcohol while taking these drugs as it may make you feel more sleepy. This is particularly important if you need to drive or operate machinery and you must seek advice on this. The hypnotics can also increase the effects of alcohol. If you take alcohol the next day e.g. lunchtime this can also make you feel more drowsy than you would expect.

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Chloral hydrate can "interact" with some anticoagulants, and chlormethiazole can "interact" with cimetidine ("Tagamet" - a treatment for stomach ulcers). They can all also "interact" with other sleeping drugs and some antidepressants by increasing their sedative effects. This also does not necessarily mean the drugs can not be used together, just that you may need to follow your doctor's instructions very carefully. Make sure your doctor knows about all the medicines you are taking. Some other medicines e.g. some antihistamines (for hay fever) can make you drowsy. Combined with your hypnotic this could make you even drowsier. You should tell your doctor before starting or stopping these or any other drugs and ask your pharmacist before buying any medicine over the counter.

This does not necessarily mean that this will happen in everyone or that some of these medicines can not be used together. It just that you may need to follow your doctor's instructions very carefully. There are many other possible drug interactions (e.g. you can try an external on-line drug interactions checker, although this is nothing to do with our site).

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You should have no problems with "The Pill" and any of these medicines.

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It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur "spontaneously" in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed it's main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups:
A = Studies show no risk, so harm to the unborn child appears only a remote possibility
B = Animal and human studies indicate a lack of risk but are not fully conclusive
C = Animal studies indicate a risk but there is no safety data in humans
D = a definite risk exists but the benefit may outweigh the risk in some people
X = the risk outweighs any possible benefit

Chloral is classified as "C". There is no evidence of a teratogenic effect, but some problems have been reported and so you should seek personal advice from your GP, who may then if necessary seek further specialist advice. Clomethiazole is not classified, as it is not available in the USA. There is no evidence of a teratogenic effect, and animal tests show a low risk of danger but some problems have been reported and so you should seek personal advice from your GP, who may then if necessary seek further specialist advice.

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These hypnotics can reduce your ability to carry out skilled tasks such as driving or operating machinery. You may also feel drowsy the day after you take them, especially if you then drink alcohol. Until these effects wear off or you know how your drug affects you do not drive or operate machinery. You should be careful as they may affect your reaction times, even though you may feel OK.

If you are taking any medicines, the rules about driving will depend on the country you’re driving in. Click on the links below for advice:

• Medicines and driving in the UK (England, Scotland, Northern Ireland and Wales)

• Medicines and driving in the Republic of Ireland

General advice on driving safely

If you want to drive, you should take sensible steps to reduce any risk. These could include:

• Avoid driving when you are tired or ill

• Do not drive after having any alcohol as this can make any drowsiness worse (a third of all fatal road traffic incidents involve alcohol-dependent drivers)

• Avoid driving at night, dusk or in bad weather

• Avoid motorways, dual carriageways and the rush hour

• Give yourself plenty of time. Don’t rush

• Be extra careful if you have not slept well the previous night

As some medicines can affect your driving, be extra careful:

• If starting a new medicine

• After a change in dose (especially an increase)

• If you are on a high dose or seem very sensitive to side effects

• If you are taking any medicines for other symptoms e.g. antihistamines for hay fever or allergies

• If your medicine causes you blurred vision, drowsiness, poor co-ordination, poor attention

If you are driving less than 2000 miles a year, once you consider insurance, tax, MoT, repairs, maintenance, parking and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

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You should not need to have a blood test to check on your hypnotic.

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