Insomnia – a common problem
It’s been three years since this article was originally posted. But one of the most common problems patients still ask me about is difficulty sleeping. It was time to pull this article out, update it, and repost it. Ruby, the lab in the photos, isn’t with us any more. But she set a great example of what it’s like to sleep soundly, and to be alert when you’d rather be sleeping!
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 our 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.
The definition of insomnia is “difficulty getting to sleep or staying asleep, even when there’s an opportunity to do it”. Chronic insomina happens at least three nights a week for three months or longer and affects about one in five adults. Acute insomnia is more common, but typically only lasts for a few days to a few weeks. Women are more likely to have insomnia than men, and older adults more than younger adults.
People experience insomnia in different ways. You may fall asleep easily but then wake up a few hours later and find it impossible to get back to sleep. Maybe you feel like it takes forever to actually get to sleep, but once you do you sleep soundly. Or you fall asleep easily, stay asleep for several hours, but wake early in the morning well before it’s time to get up. The common thread in all types of insomnia is the way sleeplessness affects your day. Problems like tiredness, forgetfulness, inability to concentrate, loss of balance, and irritability may make your usual activies 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. Maybe we received bad news and then couldn’t sleep. The stress we feel at those times usually leads to acute, or short-term, insomnia that goes away when the stress subsides. Illness, changes in daily schedules, or environmental factors (like when the air conditioning goes out during a heat wave) can also cause acute insomnia.
Sometimes stress doesn’t subside though. When that happens, acute insomnia can turn into chronic insomnia. Health problems like anxiety, depression, chronic pain, restless leg syndrome, and obstructive sleep apnea can cause chronic insomnia. And some medications for depression, Parkinson’s disease, high blood pressure, cold symptoms, and lung disease can be causes of insomnia.
The first step in treatment is NOT medication, though.
Of course there are medications that can be used to treat insomnia. And it may seem like a good idea to use one to help you sleep better. 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. And the side effects from sleep aids, even the non-prescription ones, are more common in those over 65, exactly the people who are most likely to have insomnia.
Sleep aids may interact negatively with other medicines.
If you try a sleep aid as a first step, it may end up being the last step. What I mean is that if a sleep aid helps, you may decide to use it routinely instead of trying to manage it in other ways . And routine use of sleep aids can result in dependence on the medication to help you sleep.
When sleep medications are used routinely for an extended period of time, abruptly stopping them may cause 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. Work with your doctor to identify and treat depression, anxiety, or other health problems that may be causing your sleeplessness. Meet with your pharmacist for a thorough medication review to identify medications that might be adding to the problem.
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.
Beware of non-prescription sleep medications
Many non-prescription sleep aids contain an antihistamine called diphenhydramine. When it’s used to treat allergy symptoms, diphenhydramine commonly makes people drowsy. So it’s been marketed for years as a sleep aid. But it also has negative side effects like confusion, memory problems, balance problems, difficulty urinating, and even an increased risk of falls. Non-prescription sleep aids can be especially risky for those 65 and older.
If you or someone you love suffers from insomnia, use all the tools available to help resolve the problem, and save medications for last. If you feel you need to take that step and use a non-prescription medication to help, contact us at Better My Meds for more information about the safest ones to try.
As always, we welcome your comments and questions below, or contact us directly. We love hearing from you!
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.