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What Is The Best Medication For Chronic Insomnia

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Acute Insomnia: Symptoms Causes And Treatment

What are the Different Types of Insomnia and Their Symptoms?

Not all forms of insomnia are created equal. This sleep disorder varies drastically from one person to the next. While some people suffer for years at a time, others experience trouble sleeping short term. This is the difference between chronic and acute, or transient insomnia.

Each type of insomnia has its own set of causes and symptoms, but one thing they all have in common is the ability to interfere with your everyday life. Mood swings, an inability to focus, and depression are just a few of the negative ways that insomnia can impact your life.

Understanding exactly what acute insomnia is can help you not only recognize it but take the necessary steps to combat it and return to a happy, healthy way of life.

Lets take a closer look at exactly what acute insomnia is, its causes, and how to overcome it.

Transform Your Room Into A Haven Of Peace

Your bedroom should be the quietest space in the house. If you live in a town or other noisy surroundings, and loud sounds wake you up several times each night, try wearing earplugs.

Apps and devices that play white noise can also help you sleep better. When a sound wakes you up in the night, it isnt the sound itself that wakes you up, but the sudden shift in noise that jar you. White noise creates a masking effect, blocking out those sudden changes that exude light sleepers.

This is the reason why the majority of bedpartners prefer the constant white noise of a CPAP machine rather than their spouses crescendo-decrescendo snoring sounds, Clete A. Kushida, director of the Stanford Center for Human Sleep Research, writes in an email to Popular Science.

But having your bedroom the quietest place in your home does not do if your frame is noisy. Just imagine how annoying it would be if every time your partner changes the position your frame started creaking. It would be impossible to get a full-resting night. Heck, you would have exactly the identical problem even if you sleep alone!

Cure For Chronic Insomnia

If your chronic insomnia is caused by an underlying medical condition, such as acid reflux or pain, treating the condition may cure your insomnia.

Chronic health conditions that cause insomnia can be managed with changes in treatment, in turn managing or preventing insomnia. Talk to your doctor about changing medications or treatment plans if a drug youre taking is causing insomnia.

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What Are The Consequences Of Chronic Insomnia

Insomnia symptoms have significant immediate and long-term consequences affecting both our days and nights. Insomnia is responsible for exhausting night and day symptoms such as fatigue, lower energy, lack of concentration, mood swings, increased risk of work and car accidents, as well as a long-term negative impact on health caused by sleep loss.

The cumulative long-term effects of sleep deprivation and insomnia have been associated with a wide range of deleterious long-term health consequences including an increased risk of hypertension, obesity, depression, etc.

Insomnia is also a societal issue. The economic burden of insomnia is very high worldwide. Insomnia is taken seriously more and more by insurance companies. Many industries and several countries are now addressing it as a public health matter. In Quebec alone, a study published in 2009 estimated the total annual cost of insomnia at $6.6 billion, mostly attributed to insomnia-related work absences and reduced productivity. Society pays too. The economic burden of not treating insomnia is thought to be higher than the cost associated with providing effective treatment such as CBTi.

The general public and healthcare providers alike need to learn more about sleep, including sleep disorders such as insomnia, to make life better for everyone.

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Acute Or Short Term Insomnia

Insomnia Medication , Treating Insomnia

This ones like the above but can last for several weeks. This can be caused by:

  • A longer illness, maybe causing frequent nightly toilet visits
  • Stressed or upset about a bigger or recurring problem
  • Bereavement after the death of someone close to you

While the causes are bigger ones than listed in transient insomnia, they are still fairly short term so your problem should in time disappear.

The best thing you can do if youre suffering with short term insomnia is to keep to good sleep practices, such as sticking to sleep patterns as best as possible and avoiding stimulants in the evening.

Short term sleep problems are usually caused by temporary changes in your mindset. This may though lead to future problems with your sleep timing. If problems with your timing continue, you may start negatively associating your sleep environment with staying awake, creating a cycle of insomnia. This is one of the reasons why its always best to cure your insomnia before it has chance to take hold and develop.

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Treatment Options For Insomnia

KALYANAKRISHNAN RAMAKRISHNAN, MD, and DEWEY C. SCHEID, MD, MPH, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

Am Fam Physician.;2007;Aug;15;76:517-526.

;Patient information: See related handout on insomnia, written by the authors of this article.

The American Academy of Sleep Medicine defines insomnia as unsatisfactory sleep that impacts daytime functioning.1 More than one third of adults report some degree of insomnia within any given year, and 2 to 6 percent use medications to aid sleep.2 Insomnia is associated with increased morbidity and mortality caused by cardiovascular disease and psychiatric disorders and has other major public health and social consequences, such as accidents and absenteeism.3 Risk factors for chronic insomnia include increasing age, female sex, psychiatric illness, medical comorbidities, impaired social relationships, lower socioeconomic status, separation from a spouse or partner, and unemployment.4

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Exercise, cognitive behavior therapy, and relaxation therapy are recommended as effective, nonpharmacologic treatments for chronic insomnia.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, see page 483 or .

Sample And Inclusion Criteria For Chart Review

This study contained 4 inclusion criteria: insomnia ranked as the primary reason for seeking treatment despite nightly use of prescription medication for sleep, minimum duration of medication use of 6 months, completion of overnight diagnostic polysomnography or split-night protocol with at least 2 hours of diagnostic sleep data, and at least 18 years of age. shows nearly half the clinic population of 2,236 patients ranked insomnia as their primary problem, but only 301 patients reported both residual insomnia and nightly sleep medication use. Each individual patient’s medications were reviewed to determine whether or not their reported nightly agent was in fact being used to treat sleep problems. For example, 3 patients were excluded because the only nighttime medication was lithium, a drug not typically used for insomnia. Additional exclusions were duration of use less than 6 months, no polysomnography testing, or age less than 18 years. And, as anticipated from our introduction, no patients presented to our sleep medical facility with a self-reported optimal response to nightly use of prescription medication for sleep.

Selection Criteria for Patient Inclusion

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For Better Sleep Opt For Healthy Habits Not Pills

Research has shown that changing your lifestyle and sleep habits is the best way to combat insomnia. Even if you decide to use sleeping pills or medications in the short term, experts recommend making changes to your lifestyle and bedtime behavior as a long-term remedy to sleep problems. Behavioral and environmental changes can have more of a positive impact on sleep than medication, without the risk of side effects or dependence.

The Right Amount Of Sleep Per Night

New Help for Chronic Insomnia

Adults need 7 or more hours of sleep per night for the best health and wellbeing, according to the Centers for Disease Control and Prevention. Short sleep duration is defined as less than 7 hours of sleep per 24-hour period. So practice good sleep hygiene, and to protect your health, don’t miss these Signs You’re Getting One of the “Most Deadly” Cancers.

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Herbal And Dietary Supplements

Many herbs and dietary supplements have been promoted as sleep aids.19 There is insufficient evidence of benefit except for melatonin and valerian.

Melatonin, a hormone produced by the pineal gland that is involved in sleep regulation, improves insomnia caused by circadian schedule changes .20; Melatonin has been approved by the U.S. Food and Drug Administration to treat circadian rhythm sleep disorder in blind children and adults, but it is unregulated and preparations vary greatly in strength. At higher doses, it causes sleep disruption, daytime fatigue, headache, dizziness, and irritability . Little information is available about the safety of long-term use.

note: CNS stimulation includes insomnia, nervousness, euphoria, irritability, tremors, nightmares, hallucinations, and convulsions. CYPxxx is antagonized or potentiated by inducers and inhibitors of the cytochrome P450 system, isoforms 1A2, 2C9, 2D6, 3A .

FDA = U.S. Food and Drug Administration; CNS = central nervous system; SSRI = selective serotonin reuptake inhibitor.

*Prices for monthly starting dosages. Estimated cost to the pharmacist based on average wholesale prices in Red Book. Montvale, N.J.: Medical Economics Data, 2007. Cost to the patient will be higher, depending on prescription filling fee. Prices are rounded to the nearest dollar.

Common adverse effects of nonbenzodiazepine hypnotics: headache, dizziness, and nausea; use caution with narcotics; additive effects with alcohol and CNS depressants.

Restless Legs Syndrome And Periodic Leg Movement Disorder

Restless Legs Syndrome is a common neurologic condition marked by the urge to move, particularly the legs, which occurs primarily at rest in the evening or bedtime. The essential criteria for making the diagnosis include: 1) The urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs; 2) The urge to move or unpleasant sensations begin or worsen with rest or inactivity; 3) The urge to move or unpleasant sensations are partially or totally relieved by movement; 4) The urge to move or unpleasant sensations are worse in the evening . Sleep disruptionand complaints of decreased quality of life is present in 3/4 of the patients with the syndrome . A majority of RLS patients will have repetitive periodic limb movements on polysomnogram. The RLS/PLMD has a genetic basis and increases with age so that in the geriatric population over 30% of individuals may meet criteria for the diagnosis. RLS/PLMD is also more common in children with AD/HD, patients in renal failure, individuals with low serum ferritin levels , and in patients taking some medications such including antidepressants, antiemetics and antihistamines .

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Pharmacologic Treatment Of Insomnia

The pharmacologic treatment of insomnia has made great advances in the last 2 decades. In the early 19th century, alcohol and opioids were used as sleeping medications. In the late 19th century, chloral hydrate was used . Barbiturates were used from the early 20th century until the early 1960s, when benzodiazepines were first approved by the US Food and Drug Administration for the treatment of insomnia.

In 2017, the American Academy of Sleep Medicine released an updated guideline for the pharmacologic treatment of chronic insomnia in adults.

Benzodiazepines include long-acting forms , intermediate-acting forms , and short-acting forms . The long-acting agents are rarely used today for insomnia because of daytime sedation, cognitive impairment, and increased risk of falls in elderly patients.

Benzodiazepines were commonly used until the 1980s, when tolerance, dependence, and daytime side effects were recognized as major limitations of these agents, particularly those with long elimination half-lives. Temazepam is still used for a short-term course , at a dose of 15-30 mg at bedtime.

In the 1990s, antidepressants were widely used for primary insomnia, and they continue to be widely used, despite the fact that few randomized, controlled trials have demonstrated their efficacy in treating primary insomnia. At present, sedative-hypnotics remain the most commonly prescribed sleep medications.

Barbiturates Opiates And Antidepressants

Insomnia Medication  Medications for Insomnia

Barbiturates function as GABAA brain receptor agonists, decreasing sleep-onset latency and suppressing REM sleep. They are effective in short-term insomnia but lose the ability to induce and maintain sleep beyond this period.21 Longer-term use is associated with tolerance, physical and psychological dependence, and increased adverse effects . Barbiturates should rarely be used as sleep aids.

Opiates fragment sleep and decrease REM and stage 2 sleep. By producing analgesia and sedation, opiates may be appropriate in carefully selected patients with pain-associated insomnia.

Some antidepressants produce sedation by blocking acetylcholine, norepinephrine, and serotonin presynaptic receptors. Compared with placebo, antidepressants decrease sleep-onset latency and wakefulness after sleep onset .4,13,14,16,22 They also increase total sleep time, sleep efficiency, and sleep quality but suppress REM sleep.4 Antidepressants are an effective treatment option in patients with insomnia and coexisting depression. Trazodone is the most commonly prescribed sleep aid, but there is insufficient evidence to support its use in the absence of depression.

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Treatment For Insomnia In Older Adults

For the management of chronic insomnia in seniors, the first step often focuses on sleep education and improved sleep hygiene. A doctor will consult with the patient about how to create and maintain a bedroom environment that is conducive to healthy sleep. The optimal bedroom should be dark and quiet, with a temperature lower than 75 degrees Fahrenheit . The bed should only be used for sleeping rather than other activities like working and playing video games. An air conditioner may be helpful during hotter times of the year. Doctors will also promote regular exercise and balanced meals, and discourage stimulants like caffeine and tobacco.

Other non-pharmacological treatments can help alleviate insomnia symptoms for seniors without prescription medication. These include:

If these non-pharmacological interventions are not effective, then the doctor may consider sleep medications. Choosing appropriate insomnia medication for elderly patients requires a lot of care and consideration. Some medications, such as benzodiazepines and non-benzodiazepines , produce hypnotic effects and can increase the risk of falling for older people. These drugs also carry a high tolerance, dependence, and withdrawal risk, and doctors should take their patients other prescriptions into account in order to prevent negative drug interactions.

You should always speak with a doctor before attempting any pharmacological or non-pharmacological insomnia treatments.

Cognitive Behavioral Therapy Is The Gold

If improving sleep hygiene and other lifestyle changes alone dont help with your sleep, the next step is cognitive;behavioral therapy to improve sleep and reverse chronic insomnia. Aouad says its a better option than medication.

Medication will help you as long as its in your system, so thats a day or two, she says. While there are some appropriate uses for prescription sleep aids , they can come with extremely dangerous side effects, and they tend to be highly addictive. The benefits of cognitive behavioral therapy, a specific type of counseling to help with the anxiety around sleep that comes with chronic insomnia, have been shown to far outlast medication, Aouad explains.

According to a study published in May;2012 in the journal;BMC Family Practice, cognitive behavioral therapy is better at improving sleep efficiency than common drugs, and led;to an extra 30 to 60 minutes in sleep time when the two treatment strategies were compared.

Cognitive behavioral therapy focuses on teaching techniques to help you relax, control your breathing and mood, slow down your racing mind, and get to sleep. Really, the basis of it is providing education, talking about sleep drive and teaching people things like stimulus control and avoiding anything stimulating around bedtime, Aouad says. Think of it as reteaching your body how to sleep.

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What Are The Types Of Over

Any adult can buy OTC sleep medications at a store. OTC sleep aids often contain an antihistamine. This drug treats allergies, but it can also make you drowsy.

Some people take melatonin or valerian supplements to help them sleep. Melatonin is a hormone your body naturally produces that promotes sleep. Valerian is an herb that supposedly aids relaxation and sleep.

Although these sleep aids are easily accessible, you should check with your healthcare provider before taking them. Drugs in over-the-counter sleep aids can interfere with other medications or make health conditions worse.

Efficacy Of Cbt Versus Sedative

Best Treatment for Insomnia in Older Adults

Several randomized trials comparing CBT against hypnotics for primary insomnia have been published. Morin and colleagues compared temazepam with CBT in older patients and found similar short-term effects, but there was continued efficacy after discontinuation of therapy in the CBT group only. A study by Jacobs et al comparing zolpidem with CBT showed continued efficacy for the patients treated with CBT.

A European study by Sivertsen and colleagues showed that CBT was superior to zopiclone . In fact, zopiclone was found to be no different from placebo on 3 of 4 outcome measures. CBT, on the other hand, reduced total awake time by 52%, improved sleep efficiency, and increased slow-wave sleep. At 6 months, sleep efficiency was still improved with CBT. The limitation of this study was that it consisted of 44 older individuals using zopiclone.

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Cognitive And Behavioural Treatments

If changing your sleeping habits doesn’t help, your GP may be able to refer you for a type of cognitive behavioural therapy ;that’s specifically designed for people with insomnia .

The aim of;CBT-I is to change unhelpful thoughts and behaviours that may be contributing to your insomnia. It’s;an effective treatment for many people and can have long-lasting results.

CBT-I;may;include:

  • stimulus-control therapy which aims to help you associate the bedroom with sleep and establish a consistent sleep/wake pattern
  • sleep restriction therapy limiting the amount of time spent in bed to the actual amount of time spent asleep, creating mild sleep deprivation; sleep time is then increased as your sleeping improves
  • relaxation training aims to reduce tension or minimise intrusive thoughts that may be interfering with sleep
  • paradoxical intention you try to stay awake and avoid any intention of falling asleep; it’s used if you have trouble getting to sleep, but not maintaining sleep
  • biofeedback sensors connected to a machine are placed on your body to measure your body’s functions, such as muscle tension and heart rate; the machine produces pictures or sounds to help you recognise when you’re not relaxed;

CBT-I is;sometimes carried out by a specially trained GP. Alternatively, you may be referred to a clinical psychologist.

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