Almost everyone, at one time or another, experiences difficulty in falling asleep. Lack of sleep or poor quality sleep, if prolonged, can have a signifi cant impact on daily activities.

     Insomnia is not a disease but a symptom with many different causes including emotional and physical disorders and medication use. Insomnia is a common condition among young and old: 10-15 per cent of the adult population may suffer from chronic insomnia and up to 50 per cent suffer from occasional (or temporary) insomnia.

     Difficulty in falling asleep often occurs with emotional disturbances like tension, stress, anxiety, depression or fear. Individual sleep needs can vary from 6-10 hours per night amongst healthy individuals, so insomnia cannot be diagnosed strictly on how long a person sleeps. It is thought to have more than a single cause and treatment depends on the cause and severity.

     Sleeping less than four hours or more than nine hours per night has been associated with a higher death rate. As we age, we require less sleep and our sleep cycles change. Older people experiencing age-related sleep changes usually don’t need treatment because the changes are normal. They may find going to bed later or getting up earlier helpful.

     Insomnia that lasts days to weeks occurs in about 20 per cent of the population, more commonly in women. Stressors such as moving, a new job, or money problems can cause insomnia, with trouble falling asleep and frequent awakenings during the night as common complaints. This should end when the patient resolves the stressors. If it lasts more than three months then the patient should be reassessed.

     Sometimes sleeplessness is due to medications which have side effects that cause insomnia such as: anti-depressants (like buproprion); blood pressure medications (like metoprolol); corticosteroids (like prednisone); and stimulants (like caffeine, pseudoephedrine)to name a few. This can be confusing because clinical trials often report both drowsiness and insomnia from the same drug due to individual responses. Suddenly stopping or decreasing a drug which causes drowsiness may result in withdrawal or rebound insomnia.

     Some medications, which are useful in mild to moderate insomnia, are available without a prescription such as the sedating antihistamine: diphenhydramine (commonly known as Benadryl) which is the active ingredient in many sleep-aids (like Sleepeze or Sominex) and works for up to eight hours.

     Dimenhydrinate (or Gravol) is also a sedating antihistamine used for motion sickness but may be safer as it works for up to four hours.

   

The main goals in treatment are to reduce or eliminate the excessive daytime symptoms and improve quality of life. To help your physician in assessing your insomnia, keep a sleep diary to track:
• time you go to bed
• time of rising
• night time awakenings
• timing and quantity of: meals, alcohol use, caffeine intake, medications
• exercise
• descriptions of sleep quality each day

Your physician may feel that a prescription medication is necessary.
A few guidelines to follow are:
• Use lowest effective dose
• Use medication intermittently (i.e. “if needed” dosing) to a maximum of 2-4 times per week
• Discontinue insomnia medication gradually to prevent rebound insomnia which can occur if stopped too abruptly.


Changing one's behavior may be useful in dealing with insomnia:
• Have a regular bedtime and wake-up time
• Go to bed only when you are sleepy
• Use the bed only for sleep and sexual activity
• Avoid use of stimulants like caffeine and nicotine (cigarettes) within 4-6 hrs of retiring
• Talk to your doctor or pharmacist about scheduling medication that can cause insomnia 4-6 hrs before retiring when possible
• Do not drink alcohol to help you fall asleep because it causes fragmented sleep
• Avoid heavy meals before going to bed but do not go to bed hungry!...have a light snack
• Minimize noise, light and extreme temperatures in bedroom (may need to use earplugs, window blinds, fans, etc.)
• Exercise regularly during the day and avoid strenuous exercise within 3 hours of retiring
• Increase exposure to natural light and bright light during the day and early evening
• Develop relaxing rituals like reading, listening to music, a hot bath, etc before bed
• Sleep only enough to feel refreshed... do not over-sleep
• If unable to fall asleep within 15 to 20 minutes, get out of bed and do something relaxing, and then try again.

  
Herbal remedies including chamomile, hops, melatonin, passion flower and valerian have been promoted as sleep aids but data for most of these is insufficient to guarantee reliable results.

     Non-drug measures to improve sleep (called “sleep hygiene measures”) are good habits for everyone to follow. Talk to your pharmacist or physician about how to improve your sleep if you are suffering from insomnia.