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- What is insomnia?
- Symptoms of insomnia
- Causes of insomnia
- Prevention of insomnia
- Risk factors for insomnia
- Complications of insomnia
- When to see a doctor about insomnia
- Diagnosis of insomnia
- Conventional treatment of insomnia
- Alternative/complementary treatment of insomnia
- Living with insomnia
- Caring for someone with insomnia
Conventional treatment of insomnia
Conventional treatment of insomnia (unless it is persistent and pervasive) usually consists of lifestyle advice on avoiding certain stimulants and trying to relax more. Medication are normally prescribed if the insomnia is very severe and other more conservative strategies have not succeeded.
Medication
There are a number of medications that can be prescribed by a docotr (or purchased over-the-counter without prescription) for insomnia:
- Anti-anxiety medications - these medications are prescribed to help reduce any anxiety symptoms (or anxiety disorders) that are the underlying cause of the insomnia. These medications help to reduce levels of anxiety and this is thought to help people relax and get to sleep more easily. There are a number of side effects associated with these types of medications and they do not suit everyone. Common examples are: Alprazolam (Xanax®), Diazepam (Valium®), Oxazepam (Serax®)
- Anti-depressant medications - there are a number of different types of anti-depressant medications that can be prescribed for reducing depression that has either been caused by the insomnia or was there before the insomnia and is the cause of the insomnia. These medications help to improve mood and is this is thought to help people calm down and get to sleep more easily. There are a number of side effects associated with these medications and new research suggests that they may not be effective for depression anyway, that it is more effective to use other methods for depression instead. Common examples are: MAOIs: Phenelzine (Nardil®), Tranylcypromine (Parnate®), Isocarboxazid (Marplan®), SSRIs: Citalopram (Cipramil®), Paroxetine (Seroxat®), Fluoxetine (Prozac®), Tricyclics: Amitriptyline (Triptafen®), Clomipramine (Anafranil®), Imipramine (Tofranil®)
- Anti-histamine medications - the sedating type of these medications can be purchased without a prescription at the chemist. There are a number of side effects associated with these medications (arrhythmia in particular) and they should not be taken by people with heart rhythm disorders (unless specified and monitored by a doctor) or people with depression or other mental health disorder (as these medications can make these disorders much worse). Common examples are: xxxxxx
- Barbituate medications - these are an older type of sedative, which are highly addictive, both physically and mentally and which act on the central nervous system to produce mild sedation to anaesthesia effects. Barbituates have a high potential for lethal overdose and are not prescribed as much today as a sedative, except in special cases. Common examples are: Amobarbital (Amytal®), Pentobarbital (Nembutal®), Phenobarbitol (Luminal®), Secobarbital (Seconal®)
- Benzodiazepine medications - these sedatives are also muscle relaxants commonly prescribed in people with insomnia for short term use. High dosage, combined with long term use can result in addiction. Even short term use in some people can result in rebound wakefulness (more insomnia than you started with). Discuss any side effects with your doctor and do not suddenly stop taking any medication you have been. Common examples are: Alprazolam (Xanax®), Chlordiazepoxide (Librium®), Diazepam (Valium®), Estazolam (Prosom®), Lorazepam (Ativan®), Nitrazepam (Mogadon®), Oxazepam (Serax®)
- Non-benzodiazepine medications- these sedatives are a new class of drugs, which are similar to the benzodiazepines, but are not in the same class of drugs. The non-benzodiazepines tend to have less problems with addiction, but long term use of these drugs is still not recommended. Common examples are: Eszopiclone (Lunesta®), Zaleplon (Sonata®), Zolpidem (Ambien®), Zopiclone (Imovane®, Zimovane®)
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Other strategies / therapies
There are a number of other strategies that some doctors will recommend first, before prescribing medications, as many of those medications can be habit-forming and do not treat the underlying issues:
- Avoid stimulation before bed - caffeine, exercising late at night, watching too much television, using computers late at night all have a stimulanting effect and should be avoided for a few hours before you go to sleep. In addition to this, some doctors will recommend you avoid having a television in the bedroom because this provides more stimulation too close to sleep and can disturb sleep by causing strange dreams and nightmares
- Counselling - if you cannot go to sleep because there is a stressful situation in your life which is making you worry too much, your doctor can recommend some counselling to help you deal with it and in this way, you can reduce the worry, be advised on some strategies to help your situation and this will alll help you get some more restful sleep. If you have been diagnosed with an anxiety disorder, depression or some other mental health disorder, your doctor will recommend you undertake some sort of psychotherapy to help you manage your condition. Psychologists today usually recommend CBT, cognitive behavioural therapy and mindfulness, both of which have a great deal of success in helping people with any type of stress/worry to anxiety and depressive illness. In Australia, a certain number of your sessions with a psychologist are covered under Medicare
- Hot and cold packs on the legs - to reduce the pain symptoms of restless legs syndrome that some people experience, a general recommendation (other than pain medication) is to use alternating hot and cold packs on the legs which can help reduce the pain and inflammation symptoms and if pain is reduced, this can help induce sleep more easily
- Regular sleep routine - your doctor will recommend you try to get your sleep routine more regulated as this wll help to reset your body clock (circadian rhythm) back to a more normal level and this should help you sleep better. It will take a lot of hard work and effort to achieve this and it needs to be done on a regular basis to make it work
- Relaxation - some doctors will recommend you engage in some type of relaxation therapy, as this is known to help people relax, reduce anxiety and tension and ultimately help you sleep better. Some good forms of relaxation are: meditation, tai chi and yoga. Your doctor will suggest that you can try a CD/DVD or join a class, but ensure you find a reputable one
- Supplements for restless legs syndrome - if you have the neurological disorder restless legs syndrome, your doctor may recommend you take certain supplements, especially if you have been confirmed to have lower than normal blood levels of these nutrients. Most commonly, iron, folic acid, magnesium and vitamin B12 (cyanocobalamin) will be prescribed as they are known to reduce the symptoms of restless legs syndrome either from primary or secondary causes
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< 8: diagnosis 10: alternative treatment > Last reviewed: 19 January 2010 || Last updated: 19 January 2010
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NOTE: Mega doses of any type of vitamin, mineral, amino acid or herbal supplement cannot cure illnesses and in fact can be very dangerous and produce toxic side effects and interfere with medicine you are taking. Always ensure you consult your doctor before taking any type of complementary supplements.
Disclaimer: This guide is not intended to be used for diagnostic or prescriptive purposes. For any treatment or diagnosis of illness, please see your doctor.
