Need To Catch Some Shut-Eye? Tips on Getting the Sleep You Need

I Am Having Trouble Sleeping. How Common Is This?

Insomnia, which is defined as difficulty falling asleep, staying asleep, or both, is one of the most common health conditions - roughly 40 to 50 percent of people have trouble sleeping.

Sometimes insomnia can just be a short-term problem - maybe your internal clock is off from air travel, or maybe your lack of sleep is due to a more chronic problem - like undiagnosed depression, acid reflux or pain. The first step is to examine your lifestyle habits to see if your insomnia is preventable. Think about your habits, and how you can change them.

Who Is Most At Risk For Insomnia?

Losing a night or two of sleep can happen to anyone, but certain risk factors can increase the chances for chronic insomnia.

As we get older, especially past 60 or 65 years of age, insomnia may be more prevalent. Women, especially due to menopause or other hormonal changes, may have a greater risk of insomnia. Life stresses or mental health conditions can aggravate sleep patterns, as can financial woes. Jet lag, working night shifts, and mourning the loss of a loved one can also affect how we rest.

Caffeine: It May Be In Places You Wouldn't Expect

Monster-sized energy drinks? Triple Venti Latte? We all know that caffeine keeps us awake - but how much do we really consume?

Caffeine can be found in coffee, tea, soft drinks, chocolate, energy drinks, some OTC medications, and in other hidden places. Guarana, which contains some of the highest concentrations of caffeine in any plant, is often found in energy drinks. If you are tossing and turning at bedtime, it may be best to avoid caffeinated products after lunch if you want a good night's rest.

I Avoid Caffeine, and I'm Still Having Trouble Sleeping. What's Up?

Caffeine may not always be to blame. Certain behavioral habits, also called "sleep hygiene", might need adjustment.

Going to bed and getting up at the same time - even on weekends, exercising regularly - but at least 4 hours before bed, not watching TV in the bedroom, avoiding alcohol and cigarettes in the evening, and turning off electronics at least 30 minutes before bed can promote a more restful night of sleep. For some people, a warm bath or a good book is relaxing, too.

When Should I See A Doctor?

Medical conditions may interfere with normal sleep patterns. Insomnia can occur when a person is under stress, in pain or has another medical condition. Anxiety, heartburn, frequent urination, restless leg syndrome, asthma, and depression can prevent sleep or cause people to wake up in the middle of the night.

Medical treatment of the underlying condition can often improve nighttime rest. If you have tried to adjust bedtime routines and cut back on caffeine, and you are still having trouble getting a good night's sleep, it may be time to contact your doctor.

What Other Options Are Available to Help Me Get to Sleep?

Behavioral therapies that can teach you new sleep habits can be very effective for insomnia. Your doctor may recommend these as a first line of treatment.

Behavioral therapies may include education about good sleep habits, learning methods to relax, focused breathing, methods to replace negative worries, and readjusting use of the bedroom for sleep and sex only. Phototherapy and chronotherapy, techniques to reset your "sleep clock" may be used. In some circumstances, your doctor might prescribe a trial of sleep medicine.

I'm Worried About Using Sleeping Pills - Are They Safe?

Sleeping pills known as "sedative-hypnotics" are usually for short-term use. Sleep medicines can be useful while you try to adjust your sleep habits; however, as many of these medications can be addicting, it is important to limit their use.

Any sleep drug can cause next-morning drowsiness for activities that require mental alertness, including driving. Sleep medications are also known for a wide range of drug interactions, so it is important that your pharmacist complete a drug interaction review with all of your prescription, over-the-counter, and herbal medicines.

Let's Review Medicines for Sleep: Benzodiazepine Sedative-Hypnotics

Benzodiazepines (BZDs) are a class of drugs that work on specific receptors in the brain to promote sleep. BZDs have many different uses, for example they can be used as sedatives to help with sleep, to reduce anxiety, to help treat and prevent seizures, and as muscle relaxants.

Examples of BZDs that are used to help with sleep include triazolam (Halcion), estazolam, flurazepam, temazepam (Restoril) and lorazepam (Ativan). BZDs are generally only recommended for short-term use, as they can be addicting.

Medicines for Sleep: Nonbenzodiazepine Sedative-Hypnotics

Nonbenzodiazepines are similar to benzodiazepines but they work on the more focused sleep centers of the brain. They are shorter-acting but can still cause next-day drowsiness, impairment of alertness and driving, and complex sleep behaviors that some people forget, like eating or driving in the middle of the night.

Examples of these drugs include zaleplon (Sonata), eszopiclone (Lunesta), and zolpidem (Ambien, Ambien CR, Zolpimist, Intermezzo). Some sleep agents are available in the lower-cost generic form; be sure to ask your pharmacist.

Take Note: Precautions for Use of Sedative-Hypnotics

The drowsy effect with sleep medications may last into the next day which could impair driving safety, work function and decision-making; it is important to use only the dose prescribed by your doctor.

You should not drink alcoholic beverages while you are taking any of these medications; it could slow your breathing and cause extreme drowsiness or confusion. If you are pregnant or planning a pregnancy, use alcohol, have kidney, liver or lung problems, have sleep apnea, or need to work or care for people at night (for example - you're on-call or have small children), be sure to tell your doctor.

Side Effects with Sedative-Hypnotics Can Be Serious

Sedative-hypnotics are strong medications. Side effects can be serious, and you should pay attention and follow the warnings for these drugs.

Common side effects may include unusual behaviors like driving or eating in the middle of the night after using one of these medications. "Amnesia", or loss of memory of these events may occur. Driving can be more dangerous in the morning, as the effect of the medication may not have worn off. Avoid taking other sedative-type drugs, or any pain medication that contains a narcotic. And definitely don't take these drugs with alcohol.

Ramelteon (Rozerem): Other Medications Used for Sleep

Ramelteon (Rozerem) is a sleep medication that works best in people who have trouble initially falling asleep. It is not a controlled substance, but requires a prescription.

Ramelteon works by attaching to the melatonin receptors in the brain and helps to signal to the body that it's time for sleep. It should be taken within 30 minutes of bedtime, but avoid taking this drug with a meal that has a high fat content. Ramelteon is unlikely to cause next-day drowsiness or to be addicting; however, it can have side effects like headache, dizziness and nausea.

Antidepressants: Other Medications Used for Sleep

Doxepin (Silenor), a tricyclic antidepressant, is approved for sleep in low doses and may be most useful for patients who have trouble staying asleep. Dry mouth, blurred vision, dizziness and urine retention may occur as side effects. Unusual sleep behaviors, such as walking, driving, eating or engaging in other activities while asleep is also a risk.

Other sedating antidepressants, such as trazodone or amitriptyline, have been used for sleep but are not specifically approved fo this use.

Melatonin: Other Medications Used for Sleep

Melatonin is a hormone produced in the brain. The release of melatonin is stimulated by darkness and suppressed by light, which suggests it may be involved in normal wake-sleep patterns.

Melatonin is available over-the-counter (OTC) in tablet form as a dietary supplement. Melatonin supplements might be helpful in treating jet lag or insomnia, but research suggests the effect is mild. Melatonin is not approved by the FDA for insomnia because it is an OTC dietary supplement.

Antihistamines: Other Medications Used for Sleep

Antihistamines, such as diphenhydramine (Nytol, Sominex, Simply Sleep), are available over-the-counter without a prescription and are used for sleep. Special caution should be used with antihistamines, especially in the elderly. When antihistamines are used for sleep, side effects such as next-day drowsiness, dry mouth, urine retention, blurred vision, dizziness or unsteadiness may occur.

Adjusting lifestyle and sleep habits, getting regular exercise, and avoiding too much caffeine should be your first step to improve sleep patterns.

Investigational Drugs for Insomia: Orexin Antagonists

A new class of sleep medications, called the dual orexin 1 and 2 receptor antagonists (DORA), are under investigation. DORA drugs block orexin, which is a brain chemical that keeps people awake. Safety and effectiveness clinical trial results look promising, and approvals could have blockbuster market potential of over $1 billion per year.

The first drug in this class to be reviewed by the FDA is called suvorexant, developed by Merck. Final FDA decision on suvorexant approval is expected by Q3 or Q4 2013.

Finished: Need To Catch Some Shut-Eye? Tips on Getting the Sleep You Need

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Sources

  • Drugs.com Insomnia. Harvard Health Guide. Available at http://www.drugs.com/health-guide/insomnia.html. Accessed May 12, 2013.
  • Wickwire EM, Collop NA. Insomnia and sleep-related breathing disorders. Chest. 2010;137:1449-1463
  • Schutte-Rodin S, Broch L, Buysse D, at al. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008;4:487-504.
  • Up to Date. Patient Information: Insomnia (Beyond the Basics). Available at http://www.uptodate.com/contents/insomnia-beyond-the-basics. Accessed May 15, 2013.
  • Mayo Clinic. Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills. Available at http://www.mayoclinic.com/health/insomnia-treatment/SL00013. Accessed May 15, 2013.
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