Many of us have problems sleeping. It is estimated that 10% of adults meet criteria for insomnia, in which someone has difficulty falling or staying asleep. This leads to daytime sleepiness and impairment and can be quite distressing.
Episodes frequently arise from stress, shift work schedules or travel across time zones, but these usually resolve for a lot of people after a short time. However, many people can develop chronic insomnia especially if they have other health problems, both physical and mental health issues. In turn, having chronic insomnia can then lead to other long term serious health issues, such as depression, Alzheimer’s disease and high blood pressure.
So, what can be done to treat your insomnia and difficulty sleeping? Below are some strategies that may be recommended by your doctor.
Cognitive Behavioral Therapy (CBT)
CBT is the first line treatment for chronic insomnia recommended in the guidelines of several professional organizations. It involves changing behaviors and sleep patterns, often referred to as sleep hygiene. It’s best to discuss specifics with your doctor, who may refer you to a specialist in CBT (often a psychologist). In general, this will usually involve training you on the following:
· Restricting the amount of time you are in bed to the time you are actually sleeping
· Going to bed only when sleepy and getting out of bed when you cannot sleep
· Using a bed for sleep and sexual activities only (no watching TV or playing on your phone/tablet!)
· Avoid computer screens for 1-2 hours before attempting sleep. The blue light from phone and tablet screens can mimic daylight and affect your ability to get to sleep
· Avoiding napping during usual waking hours
· Try to go to bed and waking up at the same time each day
· Following healthy diet and exercise routines. Try to engage in at least 150 minutes of exercise per week (30 minutes a day, 5 days a week is a good start!)
· Limiting or avoiding the use of alcohol and other substances that may affect sleep such as caffeine and nicotine
· Practicing mindfulness and relaxation techniques (best learned with the guidance of a professional)
Over the counter (OTC) medications
For years, people have used OTC medications such as diphenhydramine (Benadryl) to help with their sleep. Data to support the effectiveness of these medications are weak. Furthermore, they can cause a host of side effects, including excess sedation, dizziness and dry mouth. It is probably best to not rely on these medications for help with sleep on a long-term basis.
More recently, OTC supplements containing melatonin, a natural hormone secreted during night hours, have become a popular “go to” for people who have problems sleeping. Unfortunately, the correct dose for treating insomnia with melatonin is not well defined, and clinical studies have shown that it only provides a small benefit in helping people get to sleep. It has not shown much effect on improving total sleep time.
Some small studies have shown benefits with the use of magnesium supplements and lavender. It is best to discuss the use of supplements with your doctor before trying them as it may be dangerous to use some of these if you have other health problems such as kidney disease.
Prescription Medications
Several types of prescription medications have been used for years to help with sleep. You have probably heard of some of these medications, which include clonazepam (Klonopin), Zolpidem (Ambien), and eszopiclone (Lunesta). These affect certain brain receptors, leading to a feeling of relaxation and drowsiness. Unfortunately, they have also been associated with drug dependence, memory lapses, and sleepwalking behaviors. So they should only be used on a short term, limited basis and under the close supervision of a doctor.
An old antidepressant, doxepin, is FDA-approved for insomnia. Other antidepressants, amitriptyline (Elavil) and trazodone, are not FDA-approved but have been used by some doctors to help people both get to sleep and maintain sleep.
A newer class of medications, called orexin receptor antagonists, are FDA-approved for use and help both initiate and maintain sleep in patients with insomnia. Daytime fatigue and abnormal dreaming are side effects, but it is believed they cause less memory impairment than other medications used for sleep. These are best used in older adults and in patients who have trouble maintaining sleep or waking up too early. Given that they are newer, they are usually more expensive and may be cost prohibitive if you do not have health insurance that will cover the cost.
Further testing
There are several medical conditions which may significantly affect sleep quality, such as sleep apnea and restless leg syndrome. These have their own specific treatment, so it is important to be tested specifically for these conditions if they are suspected. Your doctor may request an overnight sleep study, where your oxygen level, muscle movements, brain waves and heart rhythm will be monitored and studied to see if you meet criteria for diagnosis of sleep related conditions.
Hopefully you now have a better understanding of what types of things can be done to help you sleep better and what your doctor may recommend if you are someone who suffers from repeated episodes of insomnia. As always, discuss your specific situation with your doctor.
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