|Online since 2002|
About Insomnia?In 2002 the National Sleep Foundation polled Americans about their sleep problems. The poll revealed that 58% of adults experienced symptoms of insomnia a few nights a week or more. 45% of those under 55 experienced frequent symptoms and 62% of those over 55 have frequent symptoms.
Types of InsomniaThere are various types of insomnia, each with varying degrees of severity:
1. Transient insomnia may last from one day to a week.
2. Short-term insomnia may last from one to three weeks.
3. If you are unable to consistently sleep well for a period of between three weeks to six months, it's called acute insomnia.
4. Chronic insomnia may last from three weeks to a year or more.
Insomnia PatternsThe pattern of your insomnia typically falls into one of the following patterns.
1. Onset insomnia is when you have difficulty falling asleep at the beginning of the night.
2. Middle-of-the-Night Insomnia (middle insomnia) is characterized by difficulty returning to sleep after awakening in the middle of the night. Also referred to as nocturnal awakenings.
3. Terminal (or late) insomnia is waking up too early in the morning.
Symptoms of InsomniaThe consequences of insomnia are impaired performance, similar to those of sleep deprivation. Its effects can vary according to its causes. Symptoms may include one or more of the following;
Causes of insomniaThere are many possible causes insomnia. It can be caused by another disorder or it can be a primary disorder. Certain mental disorders have been associated with a specific pattern of insomnia.
Diagnosing InsomniaDiagnosing the many different sleep disorders is best done by specialists in sleep medicine. These are board certified sleep physicians.
Treatments for InsomniaIt is important to identify the cause of your insomnia before deciding on a treatment. Medical causes and psychological causes of insomnia have very different treatments.
Non-drug StrategiesNon-pharmacological strategies are superior to hypnotic medications, such as Ambien, for insomnia because;
Cognitive Behavior TherapyIn cognitive behavior therapy, patients are taught improved sleep habits and relieved of counter-productive assumptions about sleep. The effects of cognitive behavior therapy have a lasting effect on treating insomnia long after the therapy has been discontinued.
Drugs for InsomniaSleeping tablets and other sedatives have the potential of causing psychological dependence. This happens when the individual comes to believe that they can't sleep without the drugs. In reality it is just the oppisite. Chronic users of hypnotic medications do not have better sleep than chronic insomniacs who do not take medications. In fact, chronic users of hypnotic medications actually have more regular nighttime awakenings than insomniacs who do not take hypnotic medications. This is why short term or occasional use of hypnotics can be benefitial but long term use may be detrimental to sleep.
Benzodiazepines for InsomniaThe most commonly used class of hypnotics prescribed for insomnia are the benzodiazepines. These drugs unselectively bind to the GABAA receptor. Both benzodiazepine and nonbenzodiazepine hypnotic medications have a number of side effects such as day time fatigue, motor vehicle crashes, cognitive impairments and falls and fractures. Elderly people are more sensitive to these side effects. These sedatives may also cause physical dependence which may manifest in withdrawal symptoms. These include drugs such as flunitrazepam, temazepam, triazolam, midazolam, flurazepam, nitrazepam and quazepam. While benzodiazepines induce unconciousness, they actually worsen sleep because they promote light sleep whilst decreasing time spent in deep sleep such as REM sleep. An additional problem is that with regular use, day time rebound anxiety can emerge.
Non-benzodiazepines for InsomniaNonbenzodiazepine sedative-hypnotic drugs, such as Ambien (zolpidem), Sonata (zaleplon), Imovane (zopiclone) and Lunesta (eszopiclone), are a newer classification of hypnotic medications. There is some controversy about whether these non-benzodiazepine drugs are superior to benzodiazepines. These drugs appear to cause both psychological dependence and physical dependence though less than traditional benzodiazepines. They may also cause the same memory and cognitive disturbances along with morning sedation.
Antidepressants for InsomniaSome older antidepressants such as amitriptyline, doxepin, mirtazapine, and trazodone may have a sedative effect and are prescribed off-label to treat insomnia. The major drawback of these drugs is that they have too many side effects. The use of antidepressants in the treatment of insomnia can also lead to physical dependence and withdrawal may induce rebound insomnia which further complicates the problem in the long-term.
Melatonin for InsomniaMelatonin is effective in several types of insomnia and has demonstrated effectiveness equivalent to the prescription sleeping pill zopiclone in inducing sleep and regulating the sleep cycle. One particular benefit of melatonin is that it does not impair performance related skills. Melatonin agonists, including Ramelteon (Rozerem), seem to lack the potential for abuse and dependence. Natural substances such as 5-HTP and L-Tryptophan have been said to fortify the serotonin-melatonin pathway and aid people with various sleep disorders including insomnia.
Antihistamines for InsomniaAntihistamines with sedative properties [for example, diphenhydramine (Benadryl) used in Tylenol PM or doxylamine] are widely used in nonprescription sleep aids. While available over the counter, the effectiveness of these agents may decrease over time and the incidence of next-day sedation is higher than for most of the newer prescription drugs. It appears that dependence is not an issue with this class of drugs but antihistamines do not improve sleep and should not be used to treat chronic insomnia.
Atypical Antipsychotics for InsomniaCertain atypical antipsychotics such as quetiapine (Seroquel) are prescribed in low doses for their sedative effect but because of the possibility of neurological and cognitive side effects these drugs make a poor choice to treat insomnia. Over time the body builds up a tolerance to Seroquel and it may lose its ability to produce sleep.
Herbs for InsomniaHerbs such as valerian, hops, chamomile, evening primrose, lavender, and passion-flower have all been reported to provide some relief from insomnia. There have been multiple studies of Valerian and it appears to be modestly effective. Cannabis has also been proven to be an effective treatment for insomnia.
Anecdotal Remedies of InsomniaSome people get good results from the use of an elixir of cider vinegar and honey but so far the evidence for this is only anecdotal. Other anecdotal remedies include:
When to call a doctorIf insomnia lasts longer than three to four weeks call a doctor.
If insomnia interferes with your daytime activities call a doctor.
If insomnia interferes with your ability to function call a doctor.
For More InformationNational Sleep Foundation
1522 K Street, NW, Suite 500,
Washington, DC 20005
American Academy of Sleep Medicine
One Westbrook Corporate Center, Suite 920
Westchester, IL 60154
American Sleep Association
614 South 8th St, Suite 282
Philadelphia, PA 19147
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This consumer advocate website is protected by copyright © 2009 Askdocweb, Inc. All Rights Reserved. This is a layman's report on insomnia and is not intended to replace discussions with a health care provider. Do not use the information on this forum as a substitute for your doctor's advice. Always consult your doctor before taking any drug and follow your doctor's directions. Source material: Food and Drug Administration, Medline, Physician's Desk Reference, and the largest community of people in the world, those who are concerned about side effects and healthcare.