DON’T YOU WISH YOU COULD ALWAYS SLEEP SOUNDLY?
In any position, any place, for as long as you needed, with nothing to bother you?
Some of my favorite photos are of my labrador retriever sleeping in odd positions, odd places, and at any time of day (or sometimes, practically ALL day).
But too often sleep doesn’t come that easily.
And when that happens, we often feel more like this:
Eyes wide open, trying to rest, but any movement, any noise, even sometimes any thought keeps us awake.
It’s estimated that up to a third of adults suffer from insomnia.
Insomnia is defined as difficulty getting to sleep or staying asleep, even when there’s an opportunity to do it. Chronic insomnia happens at least three nights a week for three months or longer and is estimated to occur in about one in five adults. Acute insomnia is somewhat more common, but typically only lasts for a few days to a few weeks. Both are more common in women than men, and tend to affect older adults more often than younger adults.
Insomnia comes in different forms — some people fall asleep just fine but then wake up a few hours later and can’t get back to sleep, others feel like they take forever to actually get to sleep, and still others find that they wake early in the morning well before it’s time to get up. But the common thread in these situations is the way sleeplessness affects daytime functioning. Problems like tiredness, forgetfulness, inability to concentrate, loss of balance, and irritability may make normal tasks difficult. Not only that, but chronic insomnia can actually lead to other health problems, like obesity, high blood pressure, heart disease, anxiety, and depression.
What causes insomnia?
Most of us have had the experience of laying awake the night before a big exam or long-awaited event. Many of us have received bad news and found ourselves unable to sleep. These types of stress often lead to acute, or short-term, insomnia that resolves by itself as the stress subsides. Other causes of acute insomnia can be illness, changes in daily schedules, or environmental factors (like when the air conditioning goes out during a heat wave).
When stress becomes a long-term issue, chronic insomnia can result. Health problems like anxiety or depression can be a cause of chronic insomnia, as can chronic pain, restless leg syndrome, and obstructive sleep apnea. Certain medications for depression, Parkinson’s disease, high blood pressure, cold symptoms, and lung disease can also be causes of insomnia.
The first step in treatment is NOT medication, though.
Of course there are prescription and non-prescription medications and dietary supplements that can be used to treat insomnia. And it may seem like a good idea to use a medication to get improved sleep. But there are a number of problems with that approach. Here are a few of them:
Many symptoms of insomnia — daytime drowsiness, loss of balance, lack of concentration, poor memory — can actually be caused or worsened by sleep medications. The risk of side effects from these medications, even the non-prescription ones, increases with age, so that those of us most likely to have insomnia are also the most likely to suffer side effects from sleep medications.
Sleep aids may interact negatively with other medications being taken.
Using medications for sleep as the first step in treatment often ends up to be the last step in treatment; if sleep medications seem to help they may end up being used routinely. While many of these medications do not cause addiction, routine use may result in dependence, where the person either believes they need the medication to sleep or the body actually comes to depend on their effects.
When sleep medications are used routinely for a period of time, stopping them abruptly can result in rebound insomnia, which can often be worse than the original sleep problem being treated.
So what IS the best way to evaluate and treat insomnia?
The first step in treatment is to visit your primary care provider AND your pharmacist to see if there are treatable causes of insomnia. If depression, anxiety, or another health problem is causing insomnia, for example, successful treatment of the disorder may result in resolution of insomnia. If medications may be causing insomnia, a thorough review of all medications, including when they are being taken, may help resolve insomnia.
If treatable problems aren’t found, the next step is to give some thought to sleep hygiene. Poor sleep hygiene is an often-overlooked cause of sleep disorders, including chronic and acute insomnia. “Hygiene” can be defined as “conditions that promote good health”. Usually hygiene refers to cleanliness, but here we’re talking about setting things up so that sleep patterns can be improved. Things to take into account when trying to improve sleep hygiene include:
Sleep environment (noise, temperature, light)
Consistent times for sleep (both bedtime and wake time — even on weekends!)
Timing of meals relative to sleep times
Caffeine intake (both amount and timing)
Getting enough exercise, but not exercising really close to bedtime
Limiting other activities while in bed (such as TV, video games, surfing the web)
Finally, cognitive behavioral therapy (CBT) with a licensed therapist is an option in treating insomnia. For more information, check out these articles about insomnia, sleep hygiene, and CBT.
If you or someone you love suffers from insomnia, use all the tools available to help resolve the problem, saving medications for last. For questions about how medications affect your sleep, contact us at BetterMyMeds!
Betty Chaffee, PharmD, is owner and sole proprietor of BetterMyMeds, a Medication Management service devoted to helping people get the maximum benefit from their medications.