Treating Insomnia - Treatment, Medication and Drugs for Insomnia

Many people are unaware that common over-the-counter medications can cause side effects that could jeopardize their health and impair their ability to perform everyday activities. Some of these side effects can be felt, but others can't. Side effects you can feel are physical reactions such as dizziness, drowsiness, double vision, headache and vertigo. Those you can't feel, like confusion, depression or slow reactions, usually undermine or alter your perception, attention and judgment. They can be especially dangerous if you're involved in activities that require mental alertness and concentration.

Medicines contain chemical agents that affect the living processes. These effects may be helpful, but they may also have an adverse impact. And a recent survey found that half of all American adults are taking at least one medication at any point in time the type of work you do and your work environment can affect your response to or awareness of side effects. For example, an individual responsible for observing gauges in a control room may feel the drowsy effects of antihistamines more than someone employed in active physical work.

Environmental factors such as heat, humidity, cold or exposure to chemicals may alter the effects of certain medications. Someone working in a hot and humid environment will perspire heavily, resulting in dehydration and an electrolyte imbalance. This imbalance can alter the way drugs metabolize.
Patients and physicians need to be mindful of any workplace factors that could aggravate side effects of medications.

When our natural pattern of sleep is disturbed, we experience insomnia -- a sense of having had inadequate sleep quality or quantity. Almost everyone experiences brief bouts of insomnia, often caused by stress or worries, physical discomfort, medication effects, or a change in our sleep schedule. These acute episodes of insomnia usually last only a few nights and our sleep schedule returns to normal after the situations that caused the sleep disruption have been resolved. About 10% of Americans, however, experience chronic insomnia -- sleep problems that last for months or even years. If a person experiences insomnia for a month or more, some form of treatment is typically needed to restore the person's sleep back to normal.

Although secondary insomnia should be addressed by a physician, people suffering from primary insomnia may be able to help themselves. Keeping a detailed sleep history or sleep diary can help a physician identify factors related to insomnia and whether other sleep disorders (such as sleep apnea, narcolepsy or restless legs syndrome) are the cause of the insomnia. To keep a sleep diary, keep track of the time you go to bed each night, when you wake up during the night, how long you are awake, and what time you arise in the morning. You should also note things that might be affecting your sleep, such as your mood, your diet, and your environment. It may be helpful to have a physical examination and a sleep test as well.

The first step in dealing with a sleep problem is an accurate assessment of its nature, severity and causes. Then, an appropriate diagnosis can be made and treatment implemented. When a patient reports excessive daytime sleepiness, it may be helpful to refer them to a sleep clinic. A thorough assessment, including a poly somnography, will help identify the presence of restless legs syndrome or sleep apnea. In the cases where an underlying medical cause is identified, the most appropriate management strategy, involves treatment of the underlying medical condition.

As mention in above paragraphs to facilitate the assessment process, a number of assessment tools are available. The sleep diary provides an overall view of the patient's sleep pattern that is more reliable than global questions about their sleep, and it also benefits the patient by actively engaging them in the management process. The patient is required to record the timing of sleep and wakefulness across the 24-hour period for one week. It is important to emphasize that the times written down need only be estimates, not accurate measurements. In addition, the sleep diary can be an adjunct to patient education. Elderly patients may become aware that they are napping during the day and that this reduces the amount of sleep they will require at night. Others can readily see an erratic pattern of going to sleep to the daily time of final awakening and detect changes in sleep behavior with different bedtimes.

Following are the some suggestions treatment of insomnia:

Relaxation for Insomnia

Patients presenting with sleep difficulties are often unable to relax and switch off at night due to stress, worry or anxiety. Relaxation is incompatible with increased arousal, so techniques that help patients relax facilitate both onset and the maintenance of sleep. There are numerous relaxation techniques available, including progressive muscle relaxation suitable for patients experiencing physical tension and mental imagery to stop a racing mind. It is important the patient feels comfortable with the technique chosen. Relaxation techniques are most effective if they have been well practiced during the day and early evening.

Cognitive therapy for Insomnia

Cognitive therapy uses positive thoughts to counteract the negative about sleep. It focuses on identifying dysfunctional sleep cognitions and replaces these with more adaptive substitutes. >. It is important to note that although cognitive therapy is a highly effective treatment, it often requires the health professional to work closely with the patient. It may take several visits to reinforce the message and support the patient.

Bed Rest for Insomnia

Bedtime restriction therapy is based upon the recognition that excessive time spent in bed often perpetuates insomnia. Sleep spread out over a longer portion of the day becomes fragmented, with frequent intervals of wakefulness. During these intervals of wakefulness, negative emotional thoughts become increasingly conditioned to the bed and to the attempt to sleep. Bedtime restriction therapy reduces the amount of time spent in bed. This will ensure that sleep only occurs between the set bedtime and wakeup time. Sleep will then be of higher quality over a shorter period. This is a very effective treatment in cases where excessive wakeful time is spent in bed. The effects are long term, provided the treatment is followed conscientiously. However patients should be informed that this is a difficult management method to adhere to. Support and encouragement from a partner or close friend to get through the first few nights and days should be recommended.

Bright Light for Insomnia

Sleep-onset insomnia and early-awakening insomnia are amendable to treatment with bright light therapy. Light influences the timing of the circadian rhythm of core body temperature. Behavioral sleepiness has been shown to vary dramatically and predictably with the circadian temperature cycle. Normal sleep is embedded within a 10-hour phase of sleepiness, centered on a minimum core body temperature. This phase is bordered by two zones of wakefulness.

The patient with delayed sleep phase syndrome should be exposed to bright light shortly after sunrise and should avoid bright light in the evening. The exposure time will vary, depending on cloud cover and personal need. On a sunny day, exposure of 20 minutes may be sufficient, but 30 to 60 minutes is recommended. It is important to instruct the patient not to look directly at the sun.

Drugs Commonly Used in the Treatment of Insomnia

Following are the few medicines that can be used with doctor’s advice only

Clonazepam (Klonopin)
Clorazepate (Tranxene)
Estazolam (ProSom)
Lorazepam (Ativan)
Oxazepam (Serax)
Quazepam (Doral)
Temazepam (Restoril)
Triazolam (Halcion)

It is important to know when to refer a patient for further work-up by a sleep specialist. Polysomnographic evaluation is required in patients suspected of having sleep apnea. Patients should also be referred to a sleep specialist if insomnia is refractory to standard behavioral and pharmacologic therapies or if the patient's medical condition or medications cannot explain the symptom of insomnia.

Behavior Modification a cure to Insomnia

Do you often have trouble getting to sleep at night or find yourself waking up frequently and feeling exhausted in the morning? Typical symptoms of insomnia include a difficulty falling asleep, waking frequently during the night or early morning, and not feeling refreshed from sleep. Because individuals require different amounts of sleep, insomnia is not defined by the number of hours of sleep a person gets or by how quickly they fall asleep, but by the quality of sleep achieved. Insomnia results in daytime tiredness, a lack of energy, an inability to concentrate, and irritability.
Because of the close connection between behavior and insomnia, behavior therapy should be a significant part of treatment of insomnia. When causes of insomnia can be directly identified, addressing the primary cause may alleviate the insomnia. Stress reduction, good sleep hygiene and possibly medication may help improve sleep quality. Relaxation techniques may be especially helpful in preparing the body to sleep. Exercise, done early in the day, can also be helpful in reducing stress and promoting deeper sleep.

Behavior therapy helps people replace ways of living that don't work with ways of living that do work. Behavior therapy focuses on helping people achieve specific goals and gaining more control over their lives. The Association for Advancement of Behavior Therapy identifies some common goals of behavior therapy:

  • A way of acting: like using the bedroom only for sleep;
  • A way of feeling: like understanding how stress affects sleep;
  • A way of thinking: like learning that 8 hours of sleep isn't necessary for everyone;
  • A way of dealing with physical or medical problems: like integrating diet and exercise to promote sleep
  • A way of coping: like training people in self-management skills.

A number of well-controlled scientific studies have shown that these behavioral strategies are the most effective approach for chronic primary insomnia.

Improving your sleep habits and your sleep environment is the next important treatment step. The following tips will help to improve your sleep quality.

  • Avoid stimulants such as caffeine 4-6 hours before bedtime.
  • Avoid drinking alcohol 4-6 hours before going to bed.
  • Eat a light, easily digestible snack before bed but avoid large meals before bedtime.
  • Avoid exercising within 3-4 hours of bedtime.
  • Give yourself a quiet period or calm time for at least one or two hours before bed.
  • Develop a regular pre-sleep routine.
  • Improve the comfort of your bed if needed.
  • Make your bedroom a place to sleep. Don't eat, read, drink, smoke, or watch TV while in bed.
  • Reduce noise and disruptions.
  • Reduce light in the bedroom.
  • Maintain a regular temperature.
  • If you can't sleep -- don't stay in bed. Get out of bed, move to another room, and return to your bed when you are tired.
  • Avoid daytime napping. Daytime napping can alter your body's natural circadian rhythm, making it difficult to get to sleep when you should.
  • Bed will help your body to establish a consistent bed time get up at the same time every day.
  • Establishing a regular time that you get out of bed will help your body to establish a consistent bed time.

Being physically relaxed before bed has been shown to improve sleep. For many people, all that is required is to do a relaxing activity for an hour or two before bed (take a bath, watch TV, read a book). Some people, however, have difficulty relaxing before bed. Listed below are three proven methods to help you relax.

Diaphragmatic breathing: Slow deep breaths from your diaphragm (belly breathing) are a simple and easy way to induce relaxation. Sit comfortably and put a hand on your stomach (between your rib cage and your belly button). Take a slow deep breathe and let your stomach expand, pushing your hand out as you breathe in. As you exhale, let your stomach go back down. Let your shoulders and chest relax. Your diaphragm does all the work. A few slow deep breaths should encourage relaxation.

Visual imagery relaxation: Imagine yourself in peaceful and comfortable situations apart from your daily life where you leave your cares and worries behind. Imagine taking a walk in a beautiful, peaceful environment. For people who can imagine the situations easily, this is a good method of relaxation to assist with sleep difficulties. Pairing this exercise with diaphragmatic breathing can be very relaxing.

Progressive muscle relaxation: Progressive muscle relaxation is a technique where you tense, hold and then relax your muscles, one muscle group at a time. Some people prefer this form of relaxation because it provides them with something to do as they relax and holds their attention better than the other types of relaxation.

Try these relaxation strategies to see which one works best for you. Also feel free to experiment with when best to do these relaxation strategies. Some people prefer to do these relaxation exercises an hour or two before bed to start their "wind down" period. Others prefer to use these relaxation exercises once they are in bed to promote sleep. With regular practice, you should find that you are able to induce a relaxed state with your body and mind in a relatively short period of time.
Many people with insomnia have come to associate the bed with being awake and anxious about sleeping instead of being relaxed and asleep. Because of all the time spent in bed not sleeping, you have learned to associate the bed with racing thoughts, agitation, alertness, restlessness, and sleeplessness. Some people notice that it is easier to fall asleep in a living room chair than in bed. Stimulus control treatment helps you re-associate the bed with sleep. There are three simple rules to follow as part of this treatment approach.

1- Use your bed/bedroom for sleep and sex only; do not watch TV, listen to the radio, eat, or read in bed. Using your bed for watching TV, eating, reading, discussing family problems, doing leftover work from the office, or other non-sleeping activities, promotes wakefulness and strengthens your associations of your bed as a place to be alert and active. Barring these activities from your bed and bedroom will help promote the concept that "bed" means sleep

2- Go to bed only when you are tired. People with insomnia often make the mistake of going to bed before they are sufficiently tired. As such, they are not able to sleep, and anxiety and ensuing sleeplessness result. Be sure that you are really feeling sleepy when you go to bed.

3- Get out of bed if you can't fall asleep within 20-30 minutes, and return to bed only when you feel sleepy. Repeat this step as often as necessary during the night. People with insomnia report that they often experience nights where they lay awake for hours on end "trying to sleep." With mounting anxiety, they look at the clock, calculate time left until morning, and worry about how awful they are bound to feel the next day. Such a pattern of behavior causes the bed to become not a place for restful sleep, but rather, a place of anxiety and frustration. To break this association, remember the "bed is for sleep only" rule. After a short period of not sleeping, you need to get out.


Highly Recommended: Insomnia Cure at The Sleep Ninja

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