Medications are used to treat insomnia

The main classes of medications used to treat insomnia are the sedatives and hypnotics, such as the benzodiazepines and the non-benzodiazepine sedatives.

Several medications in the benzodiazepine class have been used successfully for the treatment of insomnia, and the most common ones include:

• quazepam (Doral),
• triazolam (Halcion),
• estazolam (ProSom),
• temazepam (Restoril),
• flurazepam (Dalmane), and
• lorazepam (Ativan).

Another common benzodiazepine, diazepam (Valium), is typically not used to treat insomnia due to its longer sedative effects.

Non-benzodiazepine sedatives are also used commonly for the treatment of insomnia and include most of the newer drugs. Some of the most common ones are:

• zaleplon (Sonata),
• zolpidem (Ambien or Ambien CR, Zolpimist), and
• eszopiclone (Lunesta).

Melatonin, a chemical released from the brain which induces sleep, has been tried in supplement form for treatment of insomnia as well. It has been generally ineffective in treating common types of insomnia, except in specific situations in patients with known low levels of melatonin. Melatonin may be purchased over-the-counter (without a prescription).

Ramelteon (Rozerem), which is an insomnia drug that acts by mimicking the action of melatonin, is a newer drug. It has been used effectively in certain group of patients with insomnia.

There are also other medications that are not in the sedative or hypnotic classes, which have been used in the treatment of insomnia. Sedative antihistamines, diphenhydramine (Benadryl) have been used as sleep aids because of their sedative effects; however, this is not a recommended use of these or other similar drugs due to many side effects and long-term drowsiness the following day.

Some anti-depressants [for example, trazodone (Desyrel), amitriptyline (Elavil, Endep), doxepin (Sinequan, Adapin)] can be used effectively to treat insomnia in patients who also may suffer from depression. Some anti-psychotics have been used to treat insomnia, although their routine use for this purpose is generally not recommended.

A doctor or sleep specialist is the best person to discuss these different medications, and to decide which one may be the best for each specific individual. Many of these drugs have a potential for abuse and addiction and need to be used with caution. None of these medications may be taken without the supervision of the prescribing physician.

The Benefits of Naps

By Dr. Gregg D. Jacobs
July 27, 2004

Many people feel a mid-afternoon slump in mood and alertness, especially after a poor night of sleep. Many believe that this slump is caused by eating a heavy lunch. However, in reality, this occurs because we were meant to have a mid-afternoon nap.

Several lines of evidence, including the universal tendency of toddlers and the elderly to nap in the afternoon and the afternoon nap of siesta cultures, have led sleep researchers to the same conclusion: nature intended that we take a nap in the middle of the day. This biological readiness to fall asleep in the mid-afternoon coincides with a slight drop in body temperature and occurs regardless of whether we eat lunch. It is present even in good sleepers who are well rested. Sleep researchers have also discovered that the afternoon dip in mood and alertness is associated with poorer performance, particularly after a night of sleep loss, and a simultaneous increase in sleepiness-related accidents. In fact, deaths from all causes show a secondary peak in the afternoon after a nocturnal peak, presumably from sleepiness-related accidents

Other evidence for a biological propensity for a mid-afternoon nap includes: sleepiness increases in the mid-afternoon; the afternoon nap is the last to be given up by children; older adults revert to afternoon naps; and, adult naps are almost always taken in the afternoon;

A mid-day nap is an integral part of the daily routine of many cultures, particularly those near the equator. This suggests that napping may have been part of an evolutionary mechanism to get us out of the hot midday sun. However, because the urge for a nap is appreciably weaker than the need to sleep at night, it can be suppressed (or masked by caffeine) but at the cost of increased sleepiness and reduced mood and performance. Also, because naps conflict with work schedules, they are becoming less common in industrialized societies (with the exception of college students and the elderly, who have more regular opportunities to nap). Unfortunately, this decline in napping may be causing poorer afternoon alertness and performance.

Research on napping suggests that an afternoon nap as short as ten minutes can enhance alertness, mood, and mental performance, especially after a night of poor sleep. Several studies also suggest that polyphasic sleep in the form of 30 minute naps taken regularly (every 4 hours) is the only way to reduce nocturnal sleep below 5-6 hours and still maintain performance. Studies on solo yacht racers indicate that winner’s average about five hours of sleep in the form of brief naps throughout the 24 hour day. In one study, subjects were allowed 20 minutes of rest/nap every 6 hours during a 64 hour work period. Results suggested that baseline levels of cognitive functions were maintained.

If you have an opportunity for an afternoon nap, particularly after a poor night of sleep, take one; you will feel more alert and energetic afterwards. Following a mid-afternoon nap, performance may temporarily deteriorate due to grogginess. However, once sleep inertia dissipates (usually 5-20 minutes), mood, energy, and subjective alertness improve beyond baseline; in sleep-deprived individuals, objective alertness and performance also improve. In non-sleep deprived individuals, improvements in performance have also been documented when measured 1.5 to 12 hours after a nap, particularly when naps are scheduled in preparation for all-night work shift. Naps should be limited to 45 minutes and avoided after 4:00 p.m.;otherwise, one may enter deep sleep, which may cause grogginess for a period of time after the nap and reduce the pressure for sleep that night.

Interestingly, there is no evidence that nap benefits are tied to a specific sleep stage. Also, there is evidence that simply resting in the mid-afternoon can improve mood. Sleep itself may not be the crucial factor in the positive effects of afternoon naps on improving mood; what may be important is an afternoon period of relaxation common to both resting and napping.

In summary, napping is normal and beneficial in terms of reducing sleepiness and increasing performance. Optimum human performance appears best served by at least biphasic sleep and perhaps polyphasic sleep.

Can Meditation Help Cure Insomnia?

There are many things you can do to try and cure insomnia, from watching your diet and what you drink, exercising, maintaining good sleep patterns and sticking to a routine. As well as both natural and prescription medications that deal with the condition. However a new study suggests there may be another way to cure this, it has no side effects and doesn’t cost a penny – meditation.

What does meditation mean to you? Perhaps it conjures up images of a Buddha type person, sitting under a tree, or perhaps you view it as taking a break from your every day worries and clearing the mind. Meditation is actually a simple yet highly effective task that anyone can participate in once you get the hang of it.

Roughly 9% of all Americans (that’s over 20 million people) practice mediation and that figure is on the increase. If you think about it we all spend time exercising the body, so why not exercise the mind?

So what does this all have to do with helping insomnia sufferers? Well a recent study by Ramadevi Gourineni, the director of an insomnia study programme at Illinois Northwestern memorial hospital, conducted a study into the matter. She took 11 patients – all who suffered from chronic insomnia symptoms. the groups were divided into two and one group was taught the importance of health, diet, stress and environmental issues and how to apply them to deal with their insomnia. The others were taught a ‘Kriya Yoga’ meditation which involves focusing and calming the mind. After the results were compiled, she found that the group who practised meditation had a greater overall increase in their sleeping patterns, including total sleep time and better overall sleep quality.

This indicates that perhaps meditation is beneficial for the reduction of sleep related issues. By clearing out thoughts and worries we can feel more focused and refreshed throughout the day, and ready for sleep at night. And meditation has many other positive aspects including increasing oxygen flow throughout the body, reducing stress, helping the mind focus and boosting serotonin levels, so give it a try – after all you have nothing to lose and hopefully a lot to gain.

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