Overcome Sleepless Nights | Say Goodnight to Insomnia

Patient complaining of Chronic insomnia which affect 30% of us population, initial treatment focus is on non medication treatment like cognitive behavioral therapy which improve negative though pattern, stimulus control, and relaxation techniques, other non pharmacological treatment include exercise, mindfulness an acupuncture. if this not successful then recommend medication.  Here are some

Common treatments for chronic insomnia:

 

  1. Cognitive Behavioral Therapy for Insomnia: This is often considered the first-line treatment for chronic insomnia. CBT-I focuses on changing behaviors and thoughts that contribute to insomnia. It typically involves techniques such as stimulus control, sleep restriction, relaxation training, and cognitive therapy.
  2. Lifestyle Changes: Making changes to your lifestyle and sleep habits can also help improve insomnia. This can include practicing good sleep hygiene (such as maintaining a regular sleep schedule, creating a relaxing bedtime routine, and optimizing your sleep environment), limiting caffeine and alcohol intake, exercising regularly (but not too close to bedtime), and managing stress through techniques such as mindfulness or relaxation exercises.
  3. Addressing Underlying Conditions: Sometimes, chronic insomnia may be caused or exacerbated by underlying medical or psychological conditions, such as anxiety, depression, sleep apnea, or chronic pain. Treating these underlying conditions may help improve sleep.
  4. Alternative Therapies: Some people find relief from chronic insomnia through alternative therapies such as acupuncture, yoga, or herbal supplements like valerian root or chamomile. However, the evidence supporting the effectiveness of these treatments varies, and it’s important to use them under the guidance of a healthcare provider.
  5. Sleep Studies: In some cases, a sleep study (polysomnography) may be recommended to evaluate for sleep disorders such as sleep apnea, restless legs syndrome, or periodic limb movement disorder, which may be contributing to insomnia.
  6. Medications:
    In some cases, medications may be prescribed to help with insomnia. These can include Over-the-counter sleepaids
  7. Melatoninreceptor agonists like :  recommended for sleep onset

             Melatonin 1-3 mg and rozerem 8 mg  half life 2.5-3.5 hr

  1. benzodiazepinesFDA approved for insomnia :recomanded for sleep onset and maintenance

            Estazolam (1-2mg) half life 15hr, flurazepam (15-30mg) half life 74 hr, quazepam  (7.5-15mg) half life 55hr,                             Temazepam  (7.5-30mg) half life 11hr,  Triazolam  (0.125-0.25mg) half life 4 hr

  1. Non-benzodiazepinesedative-hypnotics, or Z-drugs:
    recommended for sleep onset and maintenance
    Eszopiclone(lunesta) (1-3mg) half life 6h, zaleplon (5-10mg) half life 1h, zolpidem (5-10mg) half life 2.6 h, zolpidem extend release (6.25-125mg) half life 2.8 h
  2. Orexin recptor anatgonist:
    recommended for sleep onset and maintenance

             daridorexant(Quviviq) (20-25mg) half life 8 h, lemborexant (dayvigo) (5-10mg) half life17 h,                                                   suvorexant (Belsomra) (5-20mg) half life 15 h

  1. Tricyclic antidepressant:
    recommended for sleep maitenece limited use     amitriptyline (25-150mg) half life 30 h, doxepin (3-6 mg) half life 15 h, mirtazapine (7.5-15mg) half life 30 h, nortriptyline (25-150mg) half life30 h,trazodone (50-100mg) half life 10h
  2. Anticonvulsant:
    gadapentin (300-600mg) half life 6 h, pregabalin (lyrica) (50-300 mg) half life 6 h
  3. Antipsychotic:
    Olanazapine (zyprexa) (2.5-20mg) half life 30 h, Quetiapine (50-400mg) half life 6h, Risperidone (0.25-6mg) half life 20 h
  4. Antihistamin:
    diphenhydramine (25-50mg) half life 8.5 h,doxylamine recomanded for sleep onset (25mg) half life 10 h, hydroxyzine (50-100mg) half life 20 h

However, long-term use of these medications is generally not recommended due to the risk of dependence and other side effects. like daytime sedation, ataxia, fall, cognitive impairment, respiratory depression, rebound insomnia , and antegrade amnesia. It’s essential to work closely with a healthcare provider to develop a personalized treatment plan for chronic insomnia, as what works for one person may not work for another. Additionally, addressing any underlying causes or contributing factors is crucial for long-term management of insomnia.

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