I have always seemed to suffer from bouts of insomnia, but it's just getting very frustrating now. I was perscribed sleeping pills, which did work, but I would rather not rely on them. I have also used the herbal treatments, but they don't appear to work. I have had tried pretty much everything from counting sheep and warm milk, to yoga and meditation - but nothing works.
Why do people get insomnia, my partner goes to sleep almost instantly, where it takes me a good hour or so before I drift off. Any sleeping tips would be greatly appreciated! Thanks!
Best Answer - Chosen by Voters in yahoo
you have try all and put too much money on it and if it really means that much to you and then now i want to tell you two things for sleep [ 1--easy way 2--hard way]
1--the easy way is learn how to cool dwn your brain and heart and blood flow becose you can never sleep if this things are hot like in day time and so take fresh aire or tak off your cloth or make room more cool or no too much stress that can make all hot agein and other easy way is put small sald on tang that can hypnotis you to sleep but its not healthy if do too much or put some menthol oil on feet and focos on your feet becose you will fall in sleep if all oxigan go dwn
2--ok now lets look in hard way if you really love to sleep in time and it is tibetan dream yoga skill and its healthy if dont do too much and so now you cant sleep right? and then dont sleep tonight and tomarow untill night and i mean dont sleep one night and one day and its very hard becose you might want to sleep in day time by saying ''ohh now i am sleepy becose i did not sleep last night'' but dont that and dont sleep untill 11 pm at night and eat more good food and drink more coffee in day time or go out and have fune
ok after this i am 100% sure you will sleep easyly in 11 pm without spending too much money on sleep pill but one thing you must promis is that you must always wek up in time and thats the only key to sleep in time and the only key to our body clock and so this will not just put your sleep on line but will put all your mind and body and life on line and sometime you have to give your best if you love the best
Well since it's summer I've been sleeping at around 3 in the morning and waking at about 12.. I need to start waking up earlier because I have to go to sports practice, but i can't fall asleep. Any tips on how to fall asleep quickly or fix sleeping schedule?
Best Answer - Chosen by Voters
i have two way to get back your good night sleet on healthy life line!! and this are (easy way or hard way)
[but maybe its good to try the easy way first and the easy way are] 1-maditation or music or fresh aire or cool water before sleep becose the point is it makes our heart and brain more cool by slowing dwn blood flow and thats the only way to make our body to sleep in healthy way 2-stress and fear and worry might make our body more hot and that hot never let us slow dwn blood flow to keep our heart and brain cool and so be feithfull and pray and be cool and always tell to your self like '''first- thing-first ''' or like ''its too easy'' or act lik ;;ohh i am sleepy now .... i feel very sleepy... i have no power to think or feel now..''
[and its good if all works but if not & then welcom to hard way to rock and the hard way is] 1-do not sleep one night and one day untill 11 or 12 pm even it might makes you want to sleep in day time and eat good and drink more green tea or have more good fun to fool your brain to awek and it is very healthy if you dont do it too much and it is one of tibetan dream yoga teknik 2-we must 100% know and feel what sleep is mean for life and health and mind and even business and then promise that we will always wak up in 6 or 7 am and will always sleep in 11 and 12 pm and we will also teach this to our child too
thanks and wish it help you or come to my blog tell4thing.blogspot.com becose i have put more link of stress and insomnia but first try what i tell you before and come to my blog if it dont help but i am 90% sure it works becose i have insomneia and i have try it befor
thanks agein and wish you happy and healthy and good luck for what ever you do in life
Hi, i live in a house of many dogs and we have one very nervous australian shepherd. She barks a lot during the day and its something we deal with because its basically in her to do that. But now, at night, she kind of barks and whines in the hall instead of sleeping where she normally does. She feels fine and doesnt need to go to the bathroom. I think its because her sleeping schedule is off for some reason, but i dont know how to get a dogs sleeping schedule back on track.
Any idea/suggestions?
Thanks!
Best Answer - Chosen by Voters
1-take your dog for very long walk in 2 or 3 hour befor go to sleep or play one hour with dog and then it will put his body clock on line
2-wek him up in day time and dont let him sleep in day time or get him som new freind and so dog and dog knows what do right? thats big point for wek him up in day time or give hime some cat ooops sorry
3.read more dogs books or go to dog dr
4- if dog is very noicy at night time and then dog need lemongrass smell that can make dog quit
From http://www.factsaboutinsomnia.org/Drink_Water_and_Sleep.html
Our bodies are an amazingly balanced machine. From the time that we are born, there is a delicate balance that exists between us and the environment around us. Unfortunately, many of us do not do what is necessary for us to maintain that balance throughout our lifetime. Breathing in the air that is polluted and eating the wrong foods can make a big difference in how our bodies react on a regular basis. There may also be another problem, however, that is causing this imbalance and that is dehydration. This can cause problems in us that range anywhere from aches and pains to chronic insomnia.
Insomnia can come in many different forms but it is really just being unable to sleep or even to rest for more than a few moments at a time. If you have been dealing with this, even if you have only been dealing with it for a few days, you realize that it can be very frustrating to handle. You might be surprised, however, to find out that dehydration may be at the root of your insomnia. Although it is not typically something that many people may consider, drinking enough water to get yourself out of a dehydrated state may be just the ticket to help you to sleep better.
The amount of water that you're going to need to drink is considered by many to be excessive. The fact of the matter is, we are well over 90% water so any lack of it in our body is going to cause some serious problems. In order to truly be rehydrated, you're going to need to drink one half of your body weight every day in ounces of water. For example, a 200 pound man is going to need to drink 100 ounces of water. Although this may seem like a lot, it can easily be done by drinking five 20 ounce bottles of water throughout the day. Drink one when you get up, one before you go to bed and spread the other three out through the day.
You should also make sure that you are taking natural sea salt in order to allow the water to stay in your body long enough to hydrate you. Take a pinch of salt every time you drink water. If you start to swell a little bit, cut back on the amount of salt that you are taking and the swelling will go away quickly. It may seem like a simple cure but you would be surprised with how often dehydration is at the root of insomnia problems.
What is dehydration?
From http://www.medicinenet.com/dehydration/article.htm
Water is a critical element of the body, and adequate hydration is a must to allow the body to function. Up to 75% of the body's weight is made up of water. Most of the water is found within the cells of the body (intracellular space). The rest is found in what is referred to as the extracellular space, which consists of the blood vessels (intravascular space) and the spaces between cells (interstitial space).
Total body water = intracellular space + intravascular space + interstitial space
Dehydration occurs when the amount of water leaving the body is greater than the amount being taken in. The body is very dynamic and always changing. This is especially true with water in the body. We lose water routinely when we:
• breathe and humidified air leaves the body;
• sweat to cool the body; and
• urinate or have a bowel movement to rid the body of waste products.
In a normal day, a person has to drink a significant amount of water to replace this routine loss.
If intravascular (within the blood vessels) water is lost, the body can compensate somewhat by shifting water from within the cells into the blood vessels, but this is a very short-term solution. The body lives within a very narrow range of normal parameters, and signs and symptoms of dehydration will occur quickly if the water is not replenished.
The body is able to monitor the amount of fluid it needs to function. The thirst mechanism signals the body to drink water when the body is dry. As well, hormones like anti-diuretic hormone (ADH) work with the kidney to limit the amount of water lost in the urine when the body needs to conserve water. Go to http://www.medicinenet.com/dehydration/article.htm to learn more about it
Treatment Options for Insomnia
From http://www.sleep-deprivation.com/articles/types-of-sleep-disorder/lack-of-sleep/insomnia.php
Since many cases of insomnia stem from anxiety and stress, practicing relaxation techniques is one of the standard treatments experts recommend. Along with meditating, you may also want to practice deep breathing exercises before bed to get you in a relaxed state of mind. Other treatment options include:
• Adjusting medications: When prescription drugs cause your insomnia, especially blood pressure and some heart medicines, consult with your doctor. While he may prescribe another medication, he may also alter your dosage to improve your sleep.
• Creating a comfortable sleep environment: Making sure that your bedroom is quiet, dark and comfortable can do wonders for improving your sleep. Also, if you are in bed and having trouble sleeping, get up and do something. Staying in bed, tossing and turning, will only make you associate the bedroom with sleeplessness.
• Drinking more water: Some people start to experience insomnia after increasing their caffeine intake. In some people, dehydration can causes stimulants to build up within the blood stream, preventing sleep. For these people, drinking more water helps push the caffeine through their systems. In a few days, their sleep patterns return to normal.
• Exercising: Anxiety-related insomnia responds well to increased levels of physical activity. The increased blood flow and release of endorphins during physical activity eases stress, promoting better sleep and improving overall health.
• Treating the underlying condition: If a medical condition (such as acid reflux) is the cause of your insomnia, treating the condition preventing you from sleeping is the best way to improve sleep
Insomnia is a symptom[1] that can accompany several sleep, medical and psychiatric disorders, characterized by persistent difficulty falling asleep and/or difficulty staying asleep. Insomnia is typically followed by functional impairment while awake.
Both organic and non-organic insomnia without other cause constitute a sleep disorder, primary insomnia.[2] One definition of insomnia is "difficulties initiating and/or maintaining sleep, or nonrestorative sleep, associated with impairments of daytime functioning or marked distress for more than 1 month."[3]
According to the United States Department of Health and Human Services in the year 2007, approximately 64 million Americans regularly suffer from insomnia each year.[4] Insomnia is 41% more common in women than in men.
Types of insomnia
Although there are several different degrees of insomnia, three types of insomnia have been clearly identified: transient, acute, and chronic.
1. Transient insomnia lasts for less than a week. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe depression, or by stress. Its consequences - sleepiness and impaired psychomotor performance - are similar to those of sleep deprivation.[6]
2. Acute insomnia is the inability to consistently sleep well for a period of less than a month.[7]
3. Chronic insomnia lasts for longer than a month. It can be caused by another disorder, or it can be a primary disorder. Its effects can vary according to its causes. They might include being unable to sleep, muscular fatigue, hallucinations, and/or mental fatigue; but people with chronic insomnia often show increased alertness. Some people that live with this disorder see things as if they are happening in slow motion, wherein moving objects seem to blend together. Can cause double vision.[6]
Patterns of insomnia
1. Onset insomnia - difficulty falling asleep at the beginning of the night, often associated with anxiety disorders or the Delayed Sleep Phase Syndrome.
2. Middle-of-the-Night Insomnia - Insomnia characterized by difficulty returning to sleep after awakening in the middle of the night or waking too early in the morning. Also referred to as nocturnal awakenings. Encompasses middle and terminal insomnia.
3. Middle insomnia - waking during the middle of the night, difficulty maintaining sleep. Often associated with pain disorders or medical illness.
4. Terminal (or late) insomnia - early morning waking. Often a characteristic of clinical depression
Insomnia versus poor sleep quality
Poor sleep quality can occur as a result of sleep apnea or major depression. Poor sleep quality is caused by the individual not reaching stage 3 or delta sleep which has restorative properties. There are, however, people who are unable to achieve stage 3 sleep due to brain damage who lead perfectly normal lives.
Sleep apnea is a condition that occurs when a sleeping person's breathing is interrupted, thus interrupting the normal sleep cycle. With the obstructive form of the condition, some part of the sleeper's respiratory tract loses muscle tone and partially collapses. People with obstructive sleep apnea often do not remember awakening or having difficulty breathing, but they complain of excessive sleepiness during the day. Central sleep apnea interrupts the normal breathing stimulus of the central nervous system, and the individual must actually wake up to resume breathing. This form of apnea is often related to a cerebral vascular condition, congestive heart failure, and premature aging.
Major depression leads to alterations in the function of the hypothalamic-pituitary-adrenal axis, causing excessive release of cortisol which can lead to poor sleep quality.
Nocturnal polyuria, excessive nighttime urination, can be very disturbing to sleep.[8]
Some sleep disorders such as insomnia have been found to compromise glucose metabolism.[9]
Subjective insomnia
Main article: Sleep state misperception
Some cases of insomnia are not really insomnia in the traditional sense. People experiencing sleep state misperception often sleep for normal durations, yet for some reason severely overestimate the time taken to fall asleep. In such cases, a person with sleep state misperception may believe they slept for only 4 hours while, paradoxically, sleeping a full 8 hours.
Signs and symptoms
A survey of 1.1 million residents in the United States conducted by the American Cancer Society found that those who reported sleeping about 7 hours per night had the lowest rates of mortality, whereas those who slept for fewer than 6 hours or more than 8 hours had higher mortality rates. Getting 8.5 or more hours of sleep per night increased the mortality rate by 15%. Severe insomnia - sleeping less than 3.5 hours in women and 4.5 hours in men - also led to a 15% increase in mortality. However, most of the increase in mortality from severe insomnia was discounted after controlling for comorbid disorders. After controlling for sleep duration and insomnia, use of sleeping pills was also found to be associated with an increased mortality rate.
The lowest mortality was seen in individuals who slept between six and a half and seven and a half hours per night. Even sleeping only 4.5 hours per night is associated with very little increase in mortality. Thus mild to moderate insomnia for most people is associated with increased longevity and severe insomnia is only associated with a very small effect on mortality.
As long as a patient refrains from using sleeping pills there is little to no increase in mortality associated with insomnia but there does appear to be an increase in longevity. This is reassuring for patients with insomnia in that despite the sometimes unpleasantness of insomnia, insomnia itself appears to be associated with increased longevity.
It is unclear why sleeping longer than 7.5 hours is associated with excess mortality.[10]
Causes
Insomnia can be caused by:
• Psychoactive drugs or stimulants, including certain medications, herbs, caffeine, nicotine, cocaine, amphetamines, methylphenidate, MDMA and modafinil
• Fluoroquinolone antibiotic drugs, see Fluoroquinolone toxicity, associated with more severe and chronic types of insomnia[11]
• Restless Legs Syndrome can cause insomnia due to the discomforting sensations felt and need to move the legs or other body parts to relieve these sensations. It is difficult if not impossible to fall asleep while moving.
• Pain[12] Any injury or condition that causes pain. Pain can preclude an individual from finding a comfortable position in which to fall asleep, and in addition can cause awakening if, during sleep, the person rolls over and puts pressure on the injured or painful area of the body.
• Hormone shifts such as those that precede menstruation and those during menopause
• Life problems like fear, stress, anxiety, emotional or mental tension, work problems, financial stress.
• Mental disorders such as bipolar disorder, clinical depression, generalized anxiety disorder, post traumatic stress disorder, schizophrenia, or obsessive compulsive disorder.
• Disturbances of the circadian rhythm, such as shift work and jet lag, can cause an inability to sleep at some times of the day and excessive sleepiness at other times of the day. Jet lag is seen in people who travel through multiple time zones, as the time relative to the rising and setting of the sun no longer coincides with the body's internal concept of it. The insomnia experienced by shift workers is also a circadian rhythm sleep disorder.
• Certain neurological disorders, brain lesions, or a history of traumatic brain injury
• Medical conditions such as hyperthyroidism and rheumatoid arthritis[13]
• Abuse of over-the counter or prescription sleep aids can produce rebound insomnia
• Poor sleep hygiene, e.g., noise
• Parasomnia, which includes a number of disruptive sleep events including nightmares, sleepwalking, night terrors, violent behavior while sleeping, and REM behavior disorder, in which a person moves his/her physical body in response to events within his/her dreams
• A rare genetic condition can cause a prion-based, permanent and eventually fatal form of insomnia called fatal familial insomnia.[14]
• Physical exercise. Exercise-induced insomnia is common in athletes, causing prolonged sleep onset latency.[15]
Sleep studies using polysomnography have suggested that people who have insomnia with sleep disruption have elevated nighttime levels of circulating cortisol and adrenocorticotropic hormone They also have an elevated metabolic rate, which does not occur in people who do not have insomnia but whose sleep is intentionally disrupted during a sleep study. Studies of brain metabolism using positron emission tomography (PET) scans indicate that people with insomnia have higher metabolic rates by night and by day. The question remains whether these changes are the causes or consequences of long-term insomnia.[13]
Insomnia can be common after the loss of a loved one, even years or decades after the death, if they have not gone through the grieving process. Overall, symptoms and the degree of their severity affect each individual differently depending on their mental health, physical condition, and attitude or personality.
A common misperception is that the amount of sleep required decreases as a person ages. The ability to sleep for long periods, rather than the need for sleep, appears to be lost as people get older. Some elderly insomniacs toss and turn in bed and occasionally fall off the bed at night, diminishing the amount of sleep they receive.[16]
Potential complications of insomnia.[17]
Diagnosis
Specialists in sleep medicine are qualified to diagnose the many different sleep disorders. Patients with various disorders including delayed sleep phase syndrome are often mis-diagnosed with insomnia.
If a patient has trouble getting to sleep, but has normal sleep pattern once asleep, a circadian rhythm disorder is a likely cause.
Treatment for insomnia
In many cases, insomnia is caused by another disease, side effects from medications, or a psychological problem. It is important to identify or rule out medical and psychological causes before deciding on the treatment for the insomnia.[18] Attention to sleep hygiene is an important first line treatment strategy and should be tried before any pharmacological approach is considered.[19]
Non-pharmacological
Non-pharmacological strategies are superior to hypnotic medication for insomnia because tolerance develops to the hypnotic effects. In addition, dependence can develop with rebound withdrawal effects developing upon discontinuation. Hypnotic medication is therefore only recommended for short term use, especially in acute or chronic insomnia.[20] Non pharmacological strategies however, have long lasting improvements to insomnia and are recommended as a first line and long term strategy of managing insomnia. The strategies include attention to sleep hygiene, stimulus control, behavioral interventions, sleep-restriction therapy, paradoxical intention, patient education and relaxation therapy.[21]
EEG biofeedback has demonstrated effectiveness in the treatment of insomnia with improvements in duration as well as quality of sleep.[22]
Stimulus control therapy is a treatment for patients who have conditioned themselves to associate the bed, or sleep in general, with a negative response. As stimulus control therapy involves taking steps to control the sleep environment, it is sometimes referred interchangeably with the concept of sleep hygiene. Examples of such environmental modifications include using the bed for sleep or sex only, not for activities such as reading or watching television; waking up at the same time every morning, including on weekends; going to bed only when sleepy and when there is a high likelihood that sleep will occur; leaving the bed and beginning an activity in another location if sleep does not result in a reasonably brief period of time after getting into bed (commonly ~20 min); reducing the subjective effort and energy expended trying to fall asleep; avoiding exposure to bright light during nighttime hours, and eliminating daytime naps.[citation needed]
A component of stimulus control therapy is sleep restriction, a technique that aims to match the time spent in bed with actual time spent asleep. This technique involves maintaining a strict sleep-wake schedule, only sleeping at certain times of the day and for specific amounts of time to induce mild sleep deprivation. Complete treatment usually lasts up to 3 weeks and involves making oneself sleep for only a minimum amount of time that they are actually capable of on average, and then, if capable (i.e. when sleep efficiency improves), slowly increasing this amount (~15 min) by going to bed earlier as the body attempts to reset its internal sleep clock. Bright light therapy, which is often used to help early morning wakers reset their natural sleep cycle, can also be used with sleep restriction therapy to reinforce a new wake schedule. Although applying this technique with consistency is difficult, it can have a positive effect on insomnia in motivated patients.
Paradoxical intention is a cognitive reframing technique where the insomniac, instead of attempting to fall asleep at night, makes every effort to stay awake (i.e. essentially stops trying to fall asleep). One theory that may explain the effectiveness of this method is that by not voluntarily making oneself go to sleep, it relieves the performance anxiety that arises from the need or requirement to fall asleep, which is meant to be a passive act. This technique has been shown to reduce sleep effort and performance anxiety and also lower subjective assessment of sleep-onset latency and overestimation of the sleep deficit (a quality found in many insomniacs).[23]
Cognitive behavior therapy
A recent study found that cognitive behavior therapy is more effective than hypnotic medications in controlling insomnia.[24] In this therapy, patients are taught improved sleep habits and relieved of counter-productive assumptions about sleep. Common misconceptions and expectations that can be modified include: (1) unrealistic sleep expectations (e.g., I need to have 8 hours of sleep each night), (2) misconceptions about insomnia causes (e.g., I have a chemical imbalance causing my insomnia), (3) amplifying the consequences of insomnia (e.g., I cannot do anything after a bad night's sleep), and (4) performance anxiety after trying for so long to have a good night's sleep by controlling the sleep process. Numerous studies have reported positive outcomes of combining cognitive behavioral therapy treatment with treatments such as stimulus control and the relaxation therapies. Hypnotic medications are equally effective in the short term treatment of insomnia but their effects wear off over time due to tolerance. The effects of cognitive behavior therapy have sustained and lasting effects on treating insomnia long after therapy has been discontinued.[25][26] The addition of hypnotic medications with CBT adds no benefit in insomnia. The long lasting benefits of a course of CBT shows superiority over pharmacological hypnotic drugs. Even in the short term when compared to short term hypnotic medication such as zolpidem (Ambien), CBT still shows significant superiority. Thus CBT is recommended as a first line treatment for insomnia.[27]
Many insomniacs rely on sleeping tablets and other sedatives to get rest, with research showing that medications are prescribed to over 95% of insomniac cases.[28] Certain classes of sedatives such as benzodiazepines and newer nonbenzodiazepine drugs can also cause physical dependence which manifests in withdrawal symptoms if the drug is not carefully tapered down. The benzodiazepine and nonbenzodiazepine hypnotic medications also have a number of side effects such as day time fatigue, motor vehicle crashes, cognitive impairments and falls and fractures. Elderly people are more sensitive to these side effects.[29] The non-benzodiazepines zolpidem and zaleplon have not adequately demonstrated effectiveness in sleep maintenance. Some benzodiazepines have demonstrated effectiveness in sleep maintenance in the short-term but in the longer term is associated with tolerance and dependence. Drugs are in development which may prove more effective and safer than existing drugs for insomnia.[30]
In comparing the options, a systematic review found that benzodiazepines and nonbenzodiazepines have similar efficacy which was not significantly more than for antidepressants.[31] Benzodiazepines did not have a significant tendency for more adverse drug reactions.[31] Chronic users of hypnotic medications for insomnia do not have better sleep than chronic insomniacs who do not take medications. In fact, chronic users of hypnotic medications actually have more regular nighttime awakenings than insomniacs who do not take hypnotic medications.[32] A further review of the literature regarding benzodiazepine hypnotic as well as the nonbenzodiazepines concluded that these drugs caused an unjustifiable risk to the individual and to public health and lack evidence of long term effectiveness. The risks include dependence, accidents and other adverse effects. Gradual discontinuation of hypnotics in long term users leads to improved health without worsening of sleep. Preferably hypnotics should be prescribed for only a few days at the lowest effective dose and avoided altogether wherever possible in the elderly.[33]
Benzodiazepines
The most commonly used class of hypnotics prescribed for insomnia are the benzodiazepines. Benzodiazepines bind unselectively to the GABAA receptor.[31] These include drugs such as temazepam, flunitrazepam, triazolam, flurazepam, midazolam, nitrazepam and quazepam. These drugs can lead to tolerance, physical dependence and the benzodiazepine withdrawal syndrome upon discontinuation, especially after consistent usage over long periods of time. Benzodiazepines while inducing unconsciousness, actually worsen sleep as they promote light sleep whilst decreasing time spent in deep sleep such as REM sleep.[34] A further problem is with regular use of short acting sleep aids for insomnia, day time rebound anxiety can emerge.[35] Benzodiazepines can help to initiate sleep and increase sleep time but they also decrease deep sleep and increase light sleep. Although there is little evidence for benefit of benzodiazepines in insomnia and evidence of major harm prescriptions have continued to increase.[36] There is a general awareness that long-term use of benzodiazepines for insomnia in most people is inappropriate and that a gradual withdrawal is usually beneficial due to the adverse effects associated with the long-term use of benzodiazepines and is recommended whenever possible.[37][38]
Non-benzodiazepines
Nonbenzodiazepine sedative-hypnotic drugs, such as zolpidem, zaleplon, zopiclone and eszopiclone, are a newer classification of hypnotic medications. They work on the benzodiazepine site on the GABAA receptor complex similarly to the benzodiazepine class of drugs. Some but not all of the nonbenzodiazepines are selective for the α1 subunit on GABAA receptors which is responsible for inducing sleep and may therefore have a cleaner side effect profile than the older benzodiazepines. Zopiclone and eszopiclone like benzodiazepine drugs bind unselectively to α1, α2, α3 and α5 GABAA benzodiazepine receptors.[39] Zolpidem is more selective and zaleplon is highly selective for the α1 subunit, thus giving them an advantage over benzodiazepines in terms of sleep architecture and a reduction in side effects.[40][41] However, there are controversies over whether these non-benzodiazepine drugs are superior to benzodiazepines. These drugs appear to cause both psychological dependence and physical dependence though less than traditional benzodiazepines and can also cause the same memory and cognitive disturbances along with morning sedation.
Alcohol
Alcohol is often used as a form of self-treatment of insomnia to induce sleep. However, alcohol use to induce sleep can be a cause of insomnia. Long-term use of alcohol is associated with a decrease in NREM stage 3 and 4 sleep as well as suppression of REM sleep and REM sleep fragmentation. Frequent moving between sleep stages occurs, with awakenings due to headaches, polyuria, dehydration and diaphoresis. Glutamine rebound also plays a role as when someone is drinking, alcohol inhibits glutamine, one of the body's natural stimulants. When the person stops drinking, the body tries to make up for lost time by producing more glutamine than it needs. The increase in glutamine levels stimulates the brain while the drinker is trying to sleep, keeping them from reaching the deepest levels of sleep.[42] Stopping chronic alcohol use can also lead to severe insomnia with vivid dreams. During withdrawal REM sleep is typically exaggerated as part of a rebound effect.[43]
Opioids
Opioid medications such as hydrocodone, oxycodone, and morphine are used for insomnia which is associated with pain due to their analgesic properties and hypnotic effects. Opioids can fragment sleep and decrease REM and stage 2 sleep. By producing analgesia and sedation, opioids may be appropriate in carefully selected patients with pain-associated insomnia.[12]
Some antidepressants such as amitriptyline, doxepin, mirtazapine, and trazodone can often have a very strong sedative effect, and are prescribed off label to treat insomnia.[44] The major drawback of these drugs is that they have properties which can lead to many side effects, for example; amitriptyline and doxepin both have antihistaminergic, anticholinergic and antiadrenergic properties which contribute to their side effect profile, while mirtazapines side effects are primarily antihistaminergic, and trazadones side effects are primarily antiadrenergic. Some also alter sleep architecture. As with benzodiazepines, the use of antidepressants in the treatment of insomnia can lead to withdrawal effects; withdrawal may induce rebound insomnia.
Mirtazapine is known to decrease sleep latency, promoting sleep efficiency and increasing the total amount of sleeping time in patients suffering from both depression and insomnia.[45][46]
The hormone and supplement melatonin is effective in several types of insomnia. Melatonin has demonstrated effectiveness equivalent to the prescription sleeping tablet zopiclone in inducing sleep and regulating the sleep/waking cycle.[47] One particular benefit of melatonin is that it can treat insomnia without altering the sleep pattern which is altered by many prescription sleeping tablets. Another benefit is it does not impair performance related skills.[48][49]
Melatonin agonists, including ramelteon (Rozerem) and tasimelteon, seem to lack the potential for misuse and dependence. This class of drugs has a relatively mild side effect profile and lower likelihood of causing morning sedation. While these drugs show good effects for the treatment of insomnia due to jet lag,[50] the results for other forms of insomnia are less promising.[51]
Natural substances such as 5-HTP and L-Tryptophan have been said to fortify the serotonin-melatonin pathway and aid people with various sleep disorders including insomnia.[52]
Antihistamines
The antihistamine diphenhydramine is widely used in nonprescription sleep aids such as Benadryl. The antihistamine doxylamine is used in nonprescription sleep aids such as Unisom (USA) and Unisom 2 (Canada). In some countries, including Australia, it is marketed under the names Restavit and Dozile. It is the most effective over-the-counter sedative currently available in the United States, and is more sedating than some prescription hypnotics.[53]
While the two drugs mentioned above are available over the counter in most countries, the effectiveness of these agents may decrease over time and the incidence of next-day sedation is higher than for most of the newer prescription drugs. Anticholinergic side effects may also be a draw back of these particular drugs. Dependence does not seem to be an issue with this class of drugs.
Cyproheptadine is a useful alternative to benzodiazepine hypnotics in the treatment of insomnia. Cyproheptadine may be superior to benzodiazepines in the treatment of insomnia because cyproheptadine enhances sleep quality and quantity whereas benzodiazepines tend to decrease sleep quality.[54]
Atypical antipsychotics
Low doses of certain atypical antipsychotics such as quetiapine, olanzapine and risperidone are also prescribed for their sedative effect but the danger of neurological, metabolic and cognitive side effects make these drugs a poor choice to treat insomnia. Over time, quetiapine may lose its effectiveness as a sedative. The ability of quetiapine to produce sedation is determined by the dosage. Higher doses (300 mg - 900 mg) are usually taken for its use as an antipsychotic, while lower doses (25 mg - 200 mg) have a marked sedative effect, e.g. if a patient takes 300 mg, he/she will more likely benefit from the drug's antipsychotic effects, but if the dose is brought down to 100 mg, it will leave the patient feeling more sedated than at 300 mg, because it primarily works as a sedative at lower doses.
Eplivanserin is an investigational drug with a mechanism similar to these antipsychotics, but probably with less side effects.
Some insomniacs use herbs such as valerian, chamomile, lavender, hops, and passion-flower. Valerian has undergone multiple studies and appears to be modestly effective.[55][56][57].
Insomnia may be a symptom of magnesium deficiency, or low magnesium levels, but this has not yet been proven. A healthy diet containing magnesium can help to improve sleep in individuals without an adequate intake of magnesium.[58]
insomnia. otc sleep aids. sleeping pills
