Sleep. We all want it but can never seem to get
enough of it.
“I keep
waking up in the middle of the night, what do you recommend for sleep?”
“I haven’t
slept in three days, what can I take?”
“I have
insomnia, what’s good for sleep?”
These are just some of the questions community
pharmacists face every day, but are we clear on what insomnia is and what the
options are?
What exactly is insomnia?1
- Dissatisfaction with sleep quality or quantity, this could be 1 or more of the following:
- Difficulty in falling asleep (sleep latency)
- Difficulty staying asleep
- Early morning awakening without being able to return to sleep
- Sleep disturbance must cause functional impairment or distress
- It occurs at least 3 nights per week for at least 3 months
- It cannot be substance related (e.g. Medication or drug of abuse)
So, what
can we recommend?
Pharmacotherapy
Over the counter pharmacotherapy is limited to
antihistamines, namely, diphenhydramine (Nytol, Sleep-Eze, Unisom, ZzzQuil and
any generics). The dosing ranges from 12.5 – 50 mg, optimally 50 mg, 30 to 60
minutes before bedtime. However, this is only a temporary solution and should
only be used for a short, intermittent (less than 4 times weekly) basis.
Other pharmacotherapy measures require a prescription
and include benzodiazepines and nonbenzodiazepine GABA agonists.
Natural Health Products
There are two common natural health products
marketed for insomnia – melatonin and valerian.
Melatonin (N-acetyl-5-methoxytryptamine) has
been reported to increase total sleep time, relieve or prevent daytime fatigue
associated with jetlag, reduce sleep onset latency, help reset the body’s
sleep-wake cycle and improve overall sleep quality. Although the absolute
benefit of melatonin compared to placebo was less significant when compared to
other pharmacological treatments, melatonin may still play a role due to it’s
side effect profile.2
Valerian (Valeriana
officinalis) has been reported to improve sleep quality but most of the
studies had significant issues with methodology and numerous variations in
dosing, preparation and length of treatment.
Clinical Tip: Always refer to a physician if any over-the-counter product is required for over 7 consecutive days.
Nonpharmacologic treatment is the first line
option because it is a safe and effective alternative to pharmacologic therapy.
This comprises of psychological and behavioural including stimulus control
therapy, relaxation training and cognitive behavioural therapy (CBT). A combination
of these techniques can be found below!
Top 10
tips for battling insomnia1 - Avoid napping during the day
- Maintain a regular schedule – go to bed and get up at a consistent time every day (including weekends)
- Implement a winding down ritual before bed using relaxation techniques like stretching, taking a warm bath
- Use your bedroom only for sleep and sex. Avoid watching television and eating in the bedroom.
- Make your bedroom the most comfortable place to sleep by ensuring it’s an ambient temperature and cutting down on light and noise
- Pick a comfortable mattress and pillows!
- Exercise regularly (aim for the late afternoon and avoid 2 hours before bedtime)
- Avoid alcohol, caffeine, nicotine and eating heavy meals before bed
- Reduce your fluid intake before bed to avoid sleep disruption
- Try creating a sleep diary!
I hope you were able to gain some insight from my blog posts – I know I’ve learnt a lot but it’s time for me to hit the hay. Goodbye and good night rxBriefCase!
Cheers,
Ingrid
References
- Procyshyn, R., Barr, A., CTMA [Internet]. Ottawa (ON): Canadian Pharmacists Association; c2018 [updated 2017 06; cited 2018 06 07]. Insomnia. Available from http://www.myrxtx.ca. Also available in paper copy from the publisher.
- Ferracioli-Oda, E., Qawasmi, A., & Bloch, M. H. (2013). Meta-Analysis: Melatonin for the Treatment of Primary Sleep Disorders. PLoS ONE, 8(5), e63773. http://doi.org.myaccess.library.utoronto.ca/10.1371/journal.pone.0063773
