New England Journal of Medicine, Journal Watch: http://psychiatry.jwatch.org
Q: What can I do to sleep better?
A: Sleep disorders can be temporary or long-term problems that affect the quantity or quality of sleep. Whether you have trouble falling asleep, difficulty maintaining sleep, or sleeping but not feeling rested, it is important to pinpoint the underlying cause of your sleep problems. Your doctor can diagnose your problem and help find the best treatment for you. If problems such as sleep apnea have been ruled out, and you have taken steps such as limiting stimulants, darkening the room and setting a regular sleep schedule, here are some treatment possibilities.
Over the counter medications (available without a prescription) such as Benadryl usually contain an antihistamine. They may be helpful for short-term bouts of insomnia, but tend to lose their effectiveness the more you take them.
Natural remedies are also available without a prescription. One of the most popular natural remedies for insomnia has been melatonin, a hormone involved in the regulation of sleep and wakefulness.
Herbal products such as valerian root, chamomile, and kava kava are promoted as natural remedies for insomnia. However, their safety and effectiveness have not been documented, and they are not regulated by the Food and Drug Administration.
Prescription medications promote sleep in different ways. Benzodiazepines act as a chemical in the brain and help regulate sleep. They are a controlled substance and are potentially addicting.
Sedatives and hypnotics are unique agents called non-benzodiazepine GABA agonists. Examples include Ambien, Sonata and Lunesta.
There is a newer class of sedative hypnotics that mimic the body's natural sleep by increasing the hormone melatonin. The drug, Ramelteon, is unique because it works with the body's natural circadian rhythm.
Another new drug approved by the FDA is Zolpimist. It is an oral spray that has the same active ingredient as Ambien, but has an advantage due to its rapid onset of action.
Barbiturates work in the brain by increasing certain chemicals that cause sleep. It is rare, however, for barbiturates to be used for a sleeping disorder because of their side effects.
Psycho-social stressors such as major life changes or losses can affect your ability to sleep. In such cases, counseling or therapy may be helpful. Clinical depression can affect sleep. Antidepressants are sometimes used to treat both conditions simultaneously.
Lifestyle changes may be helpful. For example, cognitive refocusing therapy can address difficulty falling asleep. A single session helps to eliminate bedtime ruminations by teaching how to focus on non-arousing thoughts such as song lyrics or recipes.
Dale Elena Eccellente, is a licensed professional counselor, chaplain and caregiver. She is a volunteer with the Grillo Health Information Center, which offers free and confidential research to help improve health decisions. Contact the Grillo Center located at 4715 Arapahoe Ave, by phone 720-854-7293, or via GrilloCenter.org. No research or assistance should be interpreted as medical advice. We encourage informed consultation with your physician or medical practitioner.