Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
There are numerous prescription medications to treat insomnia. Generally, it is advised that they should not be used as the only therapy and that treatment is more successful if combined with non-medical therapies. In a study, it was noted that when sedatives were combined with behavioral therapy, more patients were likely to wean off the sedatives than if sedatives were used alone.
The most commonly used sleeping pills are listed in the following sections
including over-the-counter medications and natural sleep aids.
Prescription Sleep Aids
Benzodiazepine sedatives: Six of these sedative drugs have been used to treat insomnia. There are reports of subjective improvement of quality and quantity of sleep when using these medications.
Examples include temazepam
(Restoril), flurazepam (Dalmane), triazolam
(Halcion), estazolam (ProSom, Eurodin), lorazepam
(Ativan), and clonazepam
(Klonopin).
Nonbenzodiazepine sedatives:
Examples include eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien or Intermezzo).
Ramelteon (Rozerem) is a prescription drug that stimulates melatonin receptors.
Ramelteon promotes the onset of sleep and helps normalize circadian rhythm disorders. Ramelteon is approved by the
US Food and Drug Administration (FDA) for treatment of insomnia characterized by difficulty falling asleep.
Some antidepressants
(for example, amitriptyline
[Elavil, Endep] and trazodone
[Desyrel]) have been used for the treatment of insomnia in patients with co-existing depression because of some sedative properties. Generally, they may not be helpful for insomnia in people without depression.
Over-the-Counter (OTC) Medications
Antihistamines with sedative properties [for example,
diphenhydramine
(Benadryl) or doxylamine] have also been used in treating insomnia as they may induce drowsiness, but they do not improve sleep and should not be used to treat chronic insomnia.
Melatonin:Melatonin is secreted by the pineal gland, a pea-sized structure at the center of
the brain. Melatonin is produced during the dark hours of the day-night cycle (circadian rhythm). Melatonin levels in the body are low during daylight hours. The pineal gland responds to darkness by increasing melatonin levels in the body. This process is thought to be integral to maintaining circadian rhythm. At night, melatonin is produced to help your body regulate your sleep-wake cycles. The amount of melatonin produced by your body seems to decrease as you get older.
Melatonin supplements may be beneficial in patients with circadian rhythm problems.
Herbal Remedies for Insomnia
Valeriana officinalis
(Valerian) is a popular herbal medication used in the United States for treating insomnia with possibly some benefit in some patients with chronic insomnia.
St. Johns Wort and chamomile have not shown any real benefit in treating insomnia.
Other natural herbal sleeping aids such as, dogwood,
kava kava, and
L-tryptophan, may be associated with potential adverse effect when used for insomnia.
Benzodiazepines have been shown to be useful. Melatonin, a hormone secreted by the pineal gland that regulates our sleep-wake cycles,
has also been used.
Insomnia from shift changes
Behavioral therapy has been useful in modifying the
insomnia and symptoms of sleep deprivation in shift workers.
A person should shift their schedules forward in a
clockwise direction, from days to evening, then evenings to night shift, and allow sufficient
time to adapt (at least one week) between shift changes.
Bright light is a potent stimulus to circadian
rhythm. Bright light is being examined as a rhythm synchronizer.
Shift workers should stress the importance of good sleep habits with regular bedtime and awakening.
Supplemental naps may be necessary to ensure work
time alertness.
Discuss the use of naps with a doctor.
Some people promote using short-acting sedatives in the first few days following a shift change, but not everyone agrees.
Insomnia from Acute Stresses
Stress may be positive or negative, and concerns
about sleep may vary. Many stressors will go away with support and
reassurance.
Education about the importance of good sleep habits
is also helpful.
Some people may need short-term treatment with
medications. A doctor will often work toward the lowest
effective dose with a short-acting
sedative to achieve proper sleep.
General recommendations for prevention of insomnia include the following:
Work to improve your sleep habits.
Learn to relax. Self-hypnosis,
biofeedback
and
relaxation breathing are often helpful.
Control your environment. Avoid light, noise, and
excessive temperatures. Use the bed only to sleep and avoid using it
for reading and watching TV. Sexual activity is an exception.
Establish a bedtime routine. Fix wake time.
Avoid large meals, excessive fluid intake, and
strenuous exercise before bedtime and reduce the use of stimulants including
caffeine and nicotine.
If you do not fall asleep within 20 to 30 minutes, try a
relaxing activity such as listening to soothing music or reading.
Limit
daytime naps to less than 15 minutes unless directed by your doctor.
It is generally preferable to avoid naps whenever
possible to help consolidate your night's sleep.
There are certain sleep disorders, however, that will benefit from naps. Discuss this issue with your doctor.
Insomnia is defined as repeated difficulty with the initiation, duration, maintenance, or quality of sleep that occurs despite adequate time and opportunity for sleep that results in some form of daytime impairment.
