Ask the Specialty Pharmacy Expert – Christine Pothier
A good night’s rest doesn’t come easy for everybody. Interestingly, as many as 1 in 3 people may have symptoms related to insomnia, which is a term associated with difficulty sleeping.
There are many factors that may contribute to insomnia. Emotional and physical discomforts (like death or illness of a loved one, or noise, light and temperature disturbances, respectively) are the primary causes of sleep disturbances. Other secondary causes include: psychiatric conditions, cardiovascular disease, chronic pain, breathing disorders, hormonal changes, gastrointestinal disorders, and many others and drugs (both legal and illicit).
If left untreated, insomnia can contribute to impaired job performance, increased sick days taken, increased risk of traffic and workplace accidents, reduced quality of life, and possible increased risk of medical problems like depression, high blood pressure, diabetes, and cardiac events.
Non-drug therapies should always be considered when trying to get a better night’s sleep. It is best to go to sleep only when tired, use the bedroom only for sleep and intimacy, have a fixed bedtime and awakening time, and avoid caffeine, alcohol, and heavy, spicy, or sugary foods within 4-6 hours before bedtime. Watching television, using a computer, or staring at a cell phone screen can negatively affect sleep. Getting regular exercise can improve sleep as long as it is not within 2 hours of bedtime. Cutting down on noise and light and having the bedroom at an ideal temperature will make sleeping easier. Having a relaxing bedtime ritual can signal the brain that it is time to get some rest – some ideas include: having a warm bath, reading, or stretching. Avoid watching your alarm clock and if you find yourself in bed for 15-20 minutes and still not being able to fall asleep you should get up, go into another dimly-lit room, and read quietly until you get sleepy again.
When non-drug therapies alone do not give adequate sleep it may be time to try a nonprescription sedative. The non-herbal over-the-counter product used for sleep is diphenhydramine, an antihistamine with sedative properties. Doses of 12.5-50 mg about 30-60 minutes before bedtime may improve sleep onset, night awakening, and duration/quality of sleep. Diphenhydramine likely works best to help those having trouble falling asleep. However, it can sometimes cause side effects like morning drowsiness, dizziness, and grogginess. Other side effects make it unsuitable for certain people – check with your Live Well Pharmacist.
Melatonin is a hormone normally produced by the brain that when taken as a supplement may improve sleep. It is generally well-tolerated especially when used short-term, but side effects can include fatigue, headache, dizziness, irritability, and abdominal cramps. Doses generally vary from 3-10 mg depending on the dosage form. Taking melatonin one hour or so before your intended bedtime will maximize its benefits.
Another natural herbal product with limited evidence used for insomnia is valerian. The recommended dose is 400-900 mg taken 30-60 minutes before bedtime. However, side effects may include morning ‘hangover’, dizziness, nausea, and headache.
If a nonprescription sedative isn’t helping after 3 nights, if it is needed for more than 14 nights in a row, or if it is causing bothersome side effects, it is best to talk to your physician. Always discuss with your health care provider which medications you take and which medical conditions you have been diagnosed with. For personalized recommendations come in and talk to a Live Well Pharmacist today