Insomnia affects one out of every three people in the US each year.
The most effective treatments involve identifying and addressing causes. The most common causes include depression, anxiety and stress. Foods, drinks (especially caffeine and alcohol), nicotine and medications can also be responsible.
One of the things that people with this often talk about is the stress that they're under. Many folks don't realize that sleep is a very dynamic state for the brain. Our brains "process" a lot of what happens to us at night as we sleep.
Normal sleep has architecture. There are several stages of sleep with increasing "depth" of sleep until rapid-eye movement sleep is attained. This is when we dream. All of these sleep stages are essential; without proper sleep, especially REM sleep, we can actually become psychotic.
Often, when folks stop using sleeping pills, they have a long period of "rebound insomnia" which may represent the brain getting "caught up on overdue processing."
It's important to treat insomnia properly, but unfortunately, a lot easier to just "throw a sleeping pill at it." Sleeping pills are generally not indicated for long-term use, as they disrupt the sleep architecture. Many heavy alcohol consumers pass out which they consider to be sleep. It's not. Processing isn't done when the brain is assaulted with these chemicals.
There are two types of insomnia: sleep-onset and sleep-maintenance. It can be important to differentiate, as there are different therapies that work better for one than the other. Some medications help folks to initiate but not maintain sleep, others do both.
How much sleep do we need?
Most adults need eight hours of sleep. As we get older we may have problems sleeping due to age-related changes and other conditions.
Sleep apnea is common in loud-snoring sleepers. Sometimes the tongue or other tissues will fall back, actually blocking the airway and causing loss of breathing that can go on for many seconds, causing a partial arousal from sleep that interferes with the sleep architecture. There are many therapies available, ranging from losing weight, to using an air-pressure mask or even surgical approaches to help open the airways more.
Restless legs syndrome is a sense of being unable to hold the legs still due to a tingling/crawling sensation under the skin of the legs that is relieved by moving the legs around.
Periodic limb movement disorder is a similar condition that involves more than the legs.
Prostate enlargement in men, as they age, can also cause frequent awakening and trips to the toilet. There is a similar condition called "nycturia' in which folks with borderline heart function are able to get circulation to their vital organs and body but at the expense of kidney flow. At night, the blood is shunted more to the kidneys, causing more urine production in those with heart failure.
What can we do to get better sleep?
. Try to get to bed at the same time daily.
. Don't take naps longer than 15 to 20 minutes.
. Avoid caffeine after lunch.
. Avoid alcohol in the evening.
Don't lie in bed for a long time trying to sleep. After 30 minutes get up and do something quiet for a while, then return to bed when you feel sleepy.
Ask your doctor if any of your medications can be keeping you awake. If you have pain problems, ask for help with that as well.
. Exercise a little every day. Regular exercise (but not to soon before bedtime) is also essential for the body to rest effectively. It's also a great stress-reliever.
There are over-the-counter remedies that can work quite well for occasional bouts of insomnia.
. L-Troyptophan at 100 to 300 mg of 5-HTP is a precursor to serotonin. It can be helpful in raising serotonin levels to allow for normal sleep.
. Melatonin at doses of 5 to 10 mg. normally rises as we go to sleep. If these levels are low, taking supplements at bedtime can be helpful. While the levels can be tested with lab work, it's often easier to just try taking it to see if it helps. It's a safe supplement. This agent also has anti-aging properties.
. Folate and iron supplements can help those who suffer from RLS.
Niacin or vitamin B3 at doses of 100 mg. or possibly higher also helps folks to relax. It can also cause uncomfortable skin flushing/itching, however.
. Magnesium at 250 mg. may help, it may also loosen stool however.
. Chamomile tea is also very relaxing, helpful and appears safe for regular use.
Somonex and similar agents contain diphenhydramine, also known as benadryl, which is an antihistamine, can disrupt sleep architecture
. Valeriana officianlis dried root or tea, at 2 to 3 grams, or capsules from 150 to 300 mg. can help. This is related to Valium and may cause sleep architecture disturbances however.
. Passiflora incarnate (best used with 5-HTP) 300 to 450 mg can also help.
There are several classes of drugs that are useful to produce sleep.
Tri-cyclic anti-depressants, such as Amitryptiline, are safe for long-term use, but can increase risk of falls and cause drowsiness the next day and "hangover."
Certain other anti-depressants also work well. Remeron, at a dose of 15 mg., has sedating qualities but may cause weight gain. It can be used long-term without interruption or danger of sleep architecture changes.
Seroquel is a mood stabilizer/anti-psychotic that is very interesting in that it causes sedation at doses less than 300 mg., but above that, the effect disappears.
Many of the serotonin-active antidepressants help. Typically, depression causes insomnia as well, so if the depression can be improved, the sleep disorder typically resolves as well.
Lunesta is a prescription drug recently released that is advertised as being safe for long-term use. These drugs need to be used cautiously, however, many other drugs initially touted as safe were later found to have problems.
Rozerem is a sleeping pill that works on the brain's melatonin levels. It's also advertised as being safe for long-term use.
Ambien, AmbienCR, Restoril and Sonata. There's a long list of "sleeping pills," including drugs advertised for short-term treatment of anxiety such as Valium, Xanax and Klonopin. These drugs all disrupt sleep architecture and can be taken for short-term intermittent use. It's unwise to take them more than three to four days per week. They can be very useful for rare intermittent insomnia and have the advantage of largely being available generically (this means inexpensively).
If you can't sleep, you may need to see your doctor in pursuit of safe and sweet dreams.
R.J. Oenbrink of Tequesta Family Practice is a board certified doctor of osteopathy. His offices are located at 395 Tequesta Drive, Suite B. Send your questions to: firstname.lastname@example.org. He is available to speak to groups on this or a variety of other topics. Please call his office, if interested, at (561) 746-4333.