Insomnia

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Insomnia

Have difficulty sleeping 3 nights a week or more

Having trouble falling asleep, frequent awakenings during the night, waking too early and inability to get back to sleep, or waking feeling unrefreshed are not normal sleep patterns. All are symptoms of insomnia, the inadequate or poor-quality sleep experienced by over one-half of American adults — more often in women and the elderly — a few nights a week or more. Keeping a sleep diary can help you report these symptoms to your doctor.

Types of Insomnia:

Short term or acute insomnia, due to a temporary situation such as stress, jet lag, change or loss in a job or relationship, can last up to one month and is treatable. It is important to address the underlying cause. Effective and safe prescription medications, such as hypnotics, are available.


Long-term, chronic or primary insomnia, which is experienced for a month or longer, can be due to many causes such as underlying medical, physical or psychological condition, another sleep disorder or adopting poor sleep habits over time. It is essential to get a medical diagnosis. In addition to an appropriate use of medications, education on behavioral and other techniques as well as good sleep practices can improve sleep.
Consequences of Insomnia:

Insomnia is a risk factor for depression and can significantly affect your quality of life. Consequences of not getting enough good sleep can include daytime fatigue, impaired mood, depression and psychological distress, decreased ability to concentrate, problem-solve, make decisions, risk for injury, driving drowsy, and illness.

Good Sleep Practices You Can Use in Managing Your Insomnia

There are many actions you can take that may help you sleep better. Sleep experts recommend the following tips for good sleep:

A relaxing bedtime routine can make it easier to fall asleep:

Engage in a relaxing, non-alerting activity such as reading or listening to music. For some people, soaking in a warm bath or a hot tub can be helpful. Avoid job-related work and household chores that are mentally and physically stimulating.


Do not eat or drink too much before bedtime.


Create a sleep-promoting environment that is quiet, dark, cool and comfortable.
During the day:

Consume less or no caffeine.


Avoid alcohol and nicotine, especially close to bedtime.


E xercise, but not within 3 hours before bedtime.


Avoid naps, particularly in the late afternoon or evening.


Keep a sleep diary to identify your sleep habits and patterns.
Establish a regular bedtime and get up at the same time every day. Do not stay in bed to make- up for lost sleep or beyond your regular rise time.

Over-the-Counter (OTC) Medications:

Non-prescription, over-the-counter sleep aids are often antihistamines prescribed for allergies. They are readily available and may be useful for some individuals in some situations, but you should be aware of side effects like prolonged sleepiness or the possibility of interactions with other medications. It is best to consult a physician for advice on treating your sleep problem.

Seeking Professional Treatment for Insomnia

Working together with your physician or a sleep specialist can help you develop a treatment plan that best meets your needs.

Behavioral therapy for insomnia is offered typically by a psychologist, psychiatrist, or other health practitioner or counselor with specialized training. Several visits to the therapist are usually required regardless of the specific behavioral therapy used. Some of the more common behavioral approaches include:

Relaxation training often involves reducing tension and muscular relaxation exercises.


Cognitive therapy is conducted with a therapist who helps the patient with attitudes and beliefs which may contribute to poor sleep.


Stimulus control trains people to use their bed and bedroom for sleep and sex only. Persons with insomnia are encouraged to spend time awake or when having difficulty sleeping in another room engaged in a relaxing activity until they are sleepy and ready to return to bed.
Prescription medications that promote sleep are called hypnotics. All of the hypnotics listed in the following chart have been approved in the U.S. and are safe and effective for treating insomnia. Medications differ by dose and duration of action.

Most individuals take hypnotics a few nights or a few weeks at a time. A few may benefit from long-term use. Research indicates that when used nightly, hypnotics remain effective for at least several weeks and probably longer. The most common side effects include morning sedation, memory problems, headaches and a night or two of poor sleep after stopping the medication.

Recommended Dose*

(mg-milligrams)

LONG HALF-LIFE**

Flurazepam (Dalmane)
15-30 mg

Quazepam (Doral)
7.5-15.0 mg

INTERMEDIATE HALF-LIFE

Estazolam (Prosom)
1-2 mg

Temazepam (Restoril)
7.5-30 mg

SHORT HALF-LIFE

Triazolam (Halcion)
.125-.250 mg

Zolpidem (Ambien)
5-10 mg

ULTRA-SHORT HALF-LIFE

Zaleplon (Sonata)
5-10 mg


*Dose refers to how much of the drug is prescribed. Scientists have established the effective dose range for each hypnotic. It is important not to take more than your physician prescribes.

**Half-life refers to how much time it takes for half of the medication to be eliminated from the body. Those that are long-acting may cause lingering sedation. Hypnotic medications approved for use in recent years have short or ultra-short half-lives and do not cause daytime sleepiness if used according to a doctor's instructions.