People with insomnia have trouble falling or staying asleep. A lack of sleep can cause you to be drowsy and less productive during the day. Insomnia can affect your work, school, social life, and health. It can be a short term or a long-term problem and there are many different causes of insomnia. It may be situational, such as shift work, stress, daytime napping, or jet-lag. Medical conditions such as depression, anxiety, allergies, acid reflux, and pain can cause insomnia or make it worse.
Poor sleep habits also contribute to insomnia so it is best to figure out the cause(s) before starting treatment with medication. Keeping a sleep diary for 2 weeks may be helpful in identifying reasons for the sleeplessness by tracking things such as caffeine intake, alcohol consumption, daytime napping, and sleep times. Changing these behaviors and practicing good sleep habits may be all that is needed to help you sleep better. Some good sleep habits to practice are sticking to a regular sleep schedule - even on the weekends. Avoid exercise late in the evening and do something relaxing instead. Make your bedroom quiet and the temperature comfortable. If you do not fall asleep within 15 to 20 minutes, get up and go to another room, and return to bed when you feel drowsy. Avoid alcohol, nicotine, caffeine, and Internet surfing near bedtime.
Medications can also cause insomnia. Drugs such as albuterol (used for asthma), Sudafed (pseudoephedrine) and phenylephrine, two common OTC (over-the-counter) decongestants, can be stimulating and should not be taken close to bedtime. Steroids such as prednisone, certain blood pressure medications and antidepressants can also be culprits. Ask your pharmacist if any of your medications may be causing your insomnia. He or she may suggest taking these medications at alternate times or changing them altogether.
What if good sleep habits don't help? Then speak to your pharmacist or health care provider about medication. Even if medicine is prescribed, you should still keep up good sleep habits. It is important not to self medicate for a long period of time with OTC drugs. Most non-prescription sleep aids contain antihistamines and/or melatonin, and can have side effects. Melatonin is a naturally occurring hormone in the body and levels may be low in people with insomnia. Darkness stimulates melatonin production and light inhibits it. The immediate-release melatonin is for people who have difficulty falling asleep, where as, the long acting melatonin is useful for people having difficulty staying asleep.
There are a number of sleep products available without a prescription that contain antihistamines. Nyquil (doxylamine) is a popular example. The brand Unisom comes in different colored boxes and each has different ingredients. Depending on the packaging, it can contain either melatonin, diphenhydramine, or doxylamine, so read labels carefully. ZzzQuil is a new liquid formulation that contains diphenhydramine, the same ingredient found in Sominex and Bendaryl. Antihistamines have side effects such as dry mouth, blurred vision, urinary retention, and cognitive impairment, especially in the elderly. Tylenol PM and Advil PM are antihistamine/ pain reliever combinations that may help patients that have pain which is a reason for their insomnia.
Your doctor may prescribe a sleep medication. There are several classes of prescription drugs that are used for insomnia. The one best for you depends on the underlying cause of insomnia, other medications you may be taking that can potentially interact, and your age. Some drugs work better in elderly patients than others. Benzodiazepines and sedative hypnotics are one class of drugs that are used for sleep issues. There are many drugs in this class and they vary according to how long they last in your system. Some examples of drugs in this category are Valium (diazepam), Restoril (temazepam), Halcion (triazolam), and Ativan (lorazepam). These drugs reduce sleep onset time, number of nighttime awakenings, and increase total sleep time. Lorazepam is useful for patients that have insomnia due to anxiety or stress. Other drugs used for insomnia are
Rozerem, Sonata, and Lunesta. Trazodone and mirtazapine are antidepressants that are commonly used for sleep as well.
Ambien and Ambien CR (zolpidem) are commonly prescribed drugs for insomnia. Intermezzo (zolpidem sublingual) is
a brand new FDA (Federal Drug Administration) approved drug indicated for middle-of-the-night awakening. There has recently been new information released regarding the appropriate dosing of zolpidem containing drugs in certain
populations. The FDA recommends the bedtime dose be lowered because new data shows that blood levels in the morning in some patients are high enough to cause
impairment of activities such as driving and operating machinery. Women seem to be more susceptible to this risk because they eliminate zolpidem from the body more slowly than men, leaving more of it in the system for a longer period of time. Therefore the new guidelines suggest women be prescribed Ambien 5mg or Ambien CR 6.25mg and for men, either Ambien 5 or 10mg or Ambien CR 6.25 mg-12.5mg.
Hopefully these sleep tips will help you get the rest you need
in order to enjoy life to the fullest and stay healthy, safe, and productive throughout your day!
- Vanessa Andricola, Pharm D