Trumm Drug

Trouble Sleeping? Treatment of Insomnia

Insomnia is clinically defined as a complaint of difficulty with falling asleep, difficulty with maintaining sleep, or feeling unrested after a full night of sleep. Insomnia may be a short-term problem, or it may be a long-term and chronic problem. Short-term insomnia usually lasts less than 3 weeks, whereas chronic insomnia is when symptoms exist longer than 1 month. Either way, it is frustrating to the individual who is experiencing it; and it is common as it is reported that more than 50% of the population experiences insomnia at some point in their lifetime.

At different stages in life, a person may be more prone to developing insomnia and for different reasons. It is said that young people often complain of having trouble falling asleep. Middle aged adults and the elderly complain of waking up multiple times throughout the night, or waking up early and not being able to fall back asleep.
Various causes for insomnia are stress, anxiety, depression, excessive alcohol use, consumption of caffeine, nicotine use, pregnancy, illness, jet leg, use of medications, sleep apnea, exercising before bedtime, and more.

Treatment for insomnia depends on whether the insomnia is a short-term or chronic. It also depends on if the cause of insomnia has been identified. Sleep hygiene is important regardless. Good sleep hygiene consists of the following recommendations:

§ Establishing regular bedtimes and wake-up times
§ Avoiding reading or watching television in the bedroom
§ Avoid forcing sleep
§ Avoiding daytime naps if possible
§ Exercising regularly, but avoiding before bedtime
§ Decreasing the use of nicotine, alcohol, or caffeine if used regularly
§ Decreasing the amount of liquids consumed before bedtime

There are also medications that can be used for treating insomnia; products exist over the counter without a prescription, and there are those that require a prescription from a doctor. Common over-the-counter agents for sleep often incorporate use of an antihistamine (Benadryl, Tylenol PM, Advil PM). Antihistamines often have sedating properties and are safe to use. Prescription medications used for sleep may include antidepressants (amitriptyline, nortriptyline, mirtazapine, nefazadone, etc.) Specific antidepressants can be sedating and therefore, helpful. Another prescription medication used for insomnia is Trazadone. This medication is also very sedating, and is a good choice for patients when you want to avoid addiction or tolerance to the medication. Ambien (zolpidem) and Lunesta are other commonly used medications. They help with all the major complaints surrounding insomnia. Sonata (zaleplon) is another optional medication. This medication is best used in patients who have problems with falling asleep, and not so much with the other complaints of insomnia. The last and most common class of medications used for insomnia are the benzodiazepines (lorazepam, alprazolam, temazepam, triazolam, diazepam, etc.) These medications are very safe, help individuals get to sleep faster, and increase the amount of time one is asleep. Though prescription medications are helpful, it should be noted that time off from some of these medications is important as tolerance and dependence with some may become a problem.

Herbal products are also advertised as helping with insomnia (melatonin,valerian). It should be advised that these products are not FDA approved or regulated. Herbal products also have the potential for interacting with lots of medications, and use should always be confirmed with a doctor or pharmacist.

Resource: Dipiro JT, Talbert RL, Yee GC, et al. Insomnia. Pharmacotherapy. A Pathophysiologic Approach. 2005. pp1321-1332.

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