I recently got a bit of flack because I wouldn’t prescribe a certain brand of sleeping aid to a patient.
Besides this patient being on several other medications that I needed to be certain the sleeping aid wouldn’t conflict with, a warning had been issued that its use should be reduced particularly in women.
A recent national study reported that the number of Emergency Room visits related to adverse reactions from this medication had risen over 200% in the past 5 years. Women accounted for two thirds of those visits to the E.R., and half of the total visits involved patients who had combined anti-anxiety, narcotics and other medications with this sleep aid.
When asked if a medication is ‘safe’, I may be able to point to specific successful applications, but still be guarded as to prescribing the requested drug. However, knowing the recommendations from the medical community along with anecdotal evidence, I counsel my patients on both the benefits and side effects.
I saw one such unpleasant experience firsthand at a conference I attended. The evening before the event, the moderator had taken this medication to get a good night’s rest prior to the big day. During the night, he awakened to go to the bathroom. The combination of the confusing effects of the medication and being in a strange room caused him to smash into a wall of his room. He was brave and “went on with the show” even with a big nose, bruised and skinned face and arms. Boy, did that make an impression!
The reason people occasionally need sleep aids is quite legitimate. Not being able to sleep and awaken refreshed can have consequences to one’s safety, health and general functionality. Insomnia can create havoc in your life.
So, together let’s look at exactly what insomnia is and what you and your doctor can do.
What is Insomnia?
Insomnia is difficulty getting to sleep or staying asleep for long enough to feel refreshed the next morning, even though you’ve had enough opportunity to sleep.
Insomnia can be short-term or chronic but it always involves problems with falling asleep or staying asleep. Short-term insomnia (transient) can be caused by illness, stress, travel or environmental factors.
Long Term (chronic) insomnia may be due to underlying psychological or physical conditions.
What Does Insomnia Look Like?
It’s difficult to define what normal sleep is because everyone is different. Your age, lifestyle, environment and diet all play a part in influencing the amount of sleep you need.
The most common symptoms of insomnia are:
- difficulty falling asleep
- waking up during the night
- waking up early in the morning
- feeling irritable and tired and finding it difficult to function during the day
Who Is at Risk?
Anyone can get insomnia but it is more common in women than in men. It’s believed this is in part because women can have a more difficult time turning off their minds and many also have hormonal issues.
The elderly are particularly at risk for insomnia.
Children and adolescents also experience insomnia and it’s worthwhile to review sleep hygiene steps with them. Sometimes they are overstimulated by use of their digital gadgets after hours and under the covers. (More on this age group next newsletter)
The following questions form the basis of what is to be considered by the physician.
- How long does it take you to fall asleep at night?
- How many times during the night do you wake up?
- Do you experience daytime fatigue?
- Do you have a medical condition that may interfere with sleep?
- What medications do you take (including prescription drugs, over-the counter drugs, and herbs or supplements?)
- Do you drink alcohol or smoke?
What Causes Insomnia?
Stress and anxiety are common causes of insomnia but it can also be caused by medical or mental conditions such as asthma and depression. Also certain medications and misuse of alcohol or drugs are culprits.
Taking this condition to the most serious degree, given the safety and health factors involved, I am going to ask you to keep a Sleep Diary. This will help us to gain a better understanding of your sleep patterns. It can also help to decide which method of treatment to use. You should keep a sleep diary for a minimum of two weeks, recording information such as:
- the time you go bed
- how long it takes you to get to sleep
- the number of times you wake up in the night
- what time it is when you wake up
- episodes of daytime tiredness and naps
- what time you eat meals, consume alcohol, take exercise and when you are stressed
In between appointments, I will suggest a range of things you can do to help you get to sleep such as:
- avoiding heavy meals late at night
- setting regular times to wake up
- using thick curtains or blinds, an eye mask and earplugs to stop you being woken up by light and noise
- avoiding caffeine later in the day
In our next discussion on insomnia, I’ll go over Sleep Hygiene principles and the scientific basis for them. I’ll discuss how Cognitive Behavior Therapy, essential oils or Bach Remedies may be useful, especially in the youth population. While it is vital to establish adequate sleep patterns, it is necessary to do so safely.