Insomnia is defined as “difficulty initiating or maintaining sleep” either over a short period of time or as a chronic problem. It is believed to affect 30 – 35% of adults and is common in the elderly. In some cases difficulty sleeping can be related to short-term stress (anxiety, worry, environment) that leads to sleep disturbances. In other cases, underlying medical conditions can cause chronic insomnia.
So, what should you try first to get a better night’s sleep?
1. Start by trying to establish a regular sleep pattern. This includes getting the recommended six to eight hours of sleep a day.
2. Try to avoid anything that can cause a feeling of wakefulness close to bedtime. This includes caffeine (coffee, energy drinks, tea, soda) and nicotine (cigarettes).
3. Set up a good sleep environment (no noise, light or other disturbances).
4. Don’t eat a large meal right before bedtime.
5. Avoid exercise 2 to 4 hours before bedtime.
6. Avoid watching TV or reading while in bed.
7. Review your medications with your doctor or pharmacist to make sure none of them may be affecting your sleep. Adjusting dose times for some medicines can help, so talk to your pharmacist if you have any further questions.
If you’re still having trouble sleeping, there are a few over-the-counter medication options as well:
8. Melatonin, a hormone in the body, is linked to good sleep health. Taking supplements can help in regulating sleep cycles, although the effect may be short-term and limited. It should be taken 1 hour before bedtime at only recommended doses.
9. Other herbal products such as Valerian, Kava and Chamomile have limited scientific data to support benefits and may not be helpful.
10. First generation antihistamines such as diphenhydramine and doxylamine cause drowsiness and are beneficial as short-term sleep aids. These are available under many names including Unisom, Benadryl, Sominex,and others. However, they should be avoided by some people and may have some adverse interactions, so ask your doctor or pharmacist first. You can also develop a tolerance, so do not use antihistamines for more than 14 consecutive nights.
If you are still having sleep disturbances after practicing good sleep habits and trying over-the-counter products, it may be time to discuss prescription options your health care provider. There are several prescription sleep aids available, including: Ambien (zolpidem), Lunesta (eszopiclone), Sonata (zaleplon) Restoril (temazepam), Rozerem (ramelteon), trazodone (Desyrel), and amitriptyline (Elavil).
These medications should only be used after a full medical assessment and under the direction of your doctor. Each prescription also has its own set of side effects to deal with. Most often this includes morning drowsiness, sleep walking, and difficulty operating vehicles or machines, although side effects are specific for each different drug. You should also not use alcohol with these drugs.
Sleep studies and treatment of underlying conditions are also options, so talk to your provider to find the treatment that best suits you.
Newsflash reminder: The FDA recently made a safety announcement regarding Ambien (zolpidem) and reduced the recommended dose for women from 10mg to 5mg for immediate release products and from to 6.25mg for extended release forms (Ambien CR).
Sleep well till next week!
The GoodRx Pharmacist