Insomnia

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Insomnia

About Insomnia

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Overview

Insomnia is defined as having difficulty falling asleep or staying asleep, which can lead to sleepiness and other problems during the daytime. Normal sleep is generally considered getting 7 to 9 hours a night, although this varies from person to person; some might feel fine with as little as 4 hours of sleep while others might need up to 10. Older people may often sleep less, but might nap more during the day.

Insomnia can be mild to severe, and the sleep issues vary from person to person. Some people only have trouble falling asleep, while others fall asleep easily but awake during the night, and still others have trouble both falling asleep and staying asleep. These sleep disturbances can lead to daytime fatigue and feeling irritable and anxious.

Insomnia can range from short-term—a night or two for up to two weeks—to chronic, which is difficulty sleeping several nights a week for at least a month. Some people fall in between and have intermittent bouts of insomnia.

Most of us have experienced short-term insomnia at some point in our lives. It can be caused by a number of things—stress, jet lag, or poor sleep habits. It can last up to a couple of weeks but usually passes in a few days.

Intermittent short-term insomnia is more bothersome. People with this type are prone to bouts of insomnia from time to time. The episodes might last a few days to a few weeks, sometimes triggered by events, or arising spontaneously.

Chronic insomnia—trouble getting to sleep at least three nights a week for at least a month, and usually much longer—is even more serious. If your insomnia has persisted for this long, you should see your doctor for an evaluation. He or she might help you identify an underlying cause, and possibly order blood or other tests such as a sleep study.

Common Symptoms

  • Difficulty falling asleep–tossing and turning for an hour or more
  • Waking up during the night and not being able to get back to sleep
  • Feeling unrefreshed upon waking
  • Daytime fatigue, irritability, poor concentration or anxiety

What Causes it?

If your problems sleeping are because of pain, hot flashes, heartburn, frequent urination, or waking up short of breath, your insomnia might be due to an underlying condition. Asthma, bladder and prostate problems, fibromyalgia, heart failure, gastroesophageal reflux disease (GERD), menopause, and sleep apnea can all interfere with sleep. Other conditions, such as hyperthyroidism and Parkinson and Alzheimer disease, are also associated with sleep disorders. Treating the condition might help relieve your insomnia.

Medications that can interfere with sleep include allergy and cold medicine, beta-blockers, certain pain relievers, steroids, and asthma medicine, such as theophylline. In addition, alcohol, caffeine, and tobacco or other nicotine products can trigger insomnia.

Am I at Risk?

Insomnia is quite common. Up to 40 percent of adults have difficulty falling or staying asleep within any given year, and up to 15 percent say they have chronic insomnia, according to the National Heart, Lung, and Blood Institute (NHLBI).

Insomnia can affect people of any age, including children. But women are more likely to suffer from it than men. Older people are also more likely to have trouble sleeping. This is usually because they are more likely to have other illnesses (or just aches and pains) that disrupt sleep, or to be taking medicines that make getting a good night’s rest difficult.

African-Americans also face a heightened risk of insomnia, according to the NHLBI. Compared to Caucasians, African-Americans, in general, take longer to fall asleep, don’t sleep as well, and tend to take more naps.

Several other factors are also associated with an increased risk of insomnia. They include:

  • High level of stress
  • Depression or sudden changes in life that cause significant distress, such as divorce or death of someone close
  • Working at night
  • Traveling to different time zones
  • Illnesses or disorders that interfere with sleep
  • A sedentary, inactive lifestyle

Consumer Reports Best Buy Picks

Zolpidem (generic of Ambien)

Cost: $16-$17 for 7 pills

Our choice of zolpidem is based not just on its price advantage, but also because the evidence shows it helps people fall asleep and stay asleep, and next day drowsiness is unusual (see the effectiveness table below). Thus, if you are getting a first-time prescription for one of the new sleeping pills, or if you have been taking one, we urge you to talk with your doctor about trying generic zolpidem.

The other forms of zolpidem—sustained-release (Ambien CR), dissolvable tablet (Edluar), and the oral mist spray (Zolpimist)—are more expensive and offer little if any advantage to make the higher cost worth it.

Edluar and Zolpimist are designed to act more quickly than other forms of zolpidem, but there is very little evidence directly comparing these newer drugs with the other insomnia drugs. Edluar has been shown to help people fall asleep more quickly than regular zolpidem tablets. But it does not appear to offer any other advantages.

Other Prescription Drugs Evaluated

  • Lunesta (eszopiclone)
  • Rozerem (ramelteon)
  • Sonata (zaleplon)
  • Ambien, Ambien CR, Edluar, Zolpimist (zolpidem)

Three of the four newer sleeping medications—zolpidem (Ambien and generic), eszopiclone (Lunesta and generic), and zaleplon (Sonata and generic)—work the same way, by affecting a chemical in the brain called gamma-aminobutyric acid, or GABA. The remaining medicine, Rozerem, works differently. It affects the receptor in the brain for the hormone melatonin.

Zolpidem CR contains the same medicine as Ambien but stays active in the body for a longer period. The dissolvable tablet, Edluar, and the oral spray, Zolpimist, also contain the same medication as Ambien, but those are designed to work more quickly.

Two other medications—doxepin (Silenor) tablets and low-dose zolpidem (Intermezzo) dissolvable tablets—are approved by the Food and Drug Administration for treating insomnia. Neither were included in the analysis that forms the basis of our report, so their effectiveness or safety have not been as thoroughly evaluated as the other sleeping pills.

Intermezzo is a low dose of zolpidem, but it has been studied only against a placebo, so it’s unclear how it compares with regular-strength zolpidem. Intermezzo’s side effects are the same as regular-strength zolpidem.

Is it Effective?

Over-the-Counter Options

If those don’t work, you could consider taking an over-the-counter sleeping aid. However, some medical experts recommend against using those medications because there's little good quality research showing that they're effective for relieving insomnia and they carry a risk of side effects.

Nevertheless, they may be worth a try. Common ones include antihistamines, such as diphenhydramine (Benadryl, Nytol, Sominex, and generic) and doxylamine (Unisom and generic). Diphenhydramine is also contained in combination products such as Advil PM and Tylenol—though we suggest steering clear of PM products that have acetaminophen in them unless you are also experiencing pain or fever.

Although some people find them helpful in the short-term, nonprescription antihistamines should not be used over a long period for chronic insomnia because they can cause next-day drowsiness, daytime sleepiness, confusion, constipation, dry mouth, and urinary retention.

Are there Non-Drug Options?

Insomnia sufferers may get relief by treating an underlying illness or stopping a medication that might be causing the insomnia. But don’t stop or switch a medication without talking to your doctor first. Studies have found that improving your sleep habits can also help relieve chronic insomnia.

Poor sleep habits that may be contributing to your insomnia

  • Watching TV in bed
  • Computer work in bed
  • Drinking alcoholic or caffeinated drinks at night
  • Taking medicine late at night
  • Big meals late at night
  • Smoking at night
  • Lack of exercise
  • Exercise late at night
  • Busy or stressful activities late at night
  • Varying bedtimes
  • Varying wake-up times 
  • Spending too much time in bed tossing and turning
  • Late-day napping
  • Poor sleep environment

Cognitive behavioral therapy

One group of nondrug treatments—collectively known as cognitive behavioral therapy or CBT—has proved to be quite effective in treating insomnia. This involves getting help from a therapist to learn a new set of behaviors regarding sleep. For example, you might be prohibited from watching TV in bed, or be directed to get up at the same time every day. Or you might have your actual time in bed restricted while you “relearn” to associate being in bed with sleep.

You might also learn relaxation techniques and mental tricks to help you get to sleep. Generally, CBT involves three to six one-hour sessions with a trained therapist, plus directions for at-home activities.

Studies have found behavioral therapy to be effective—it helps 70 to 80 percent of people with chronic insomnia—and it appears to be at least as effective as sleeping pills. In some studies, a combination of the two has helped people the most.

For many people, behavioral therapy can provide a long-term solution for insomnia, as opposed to sleeping pills that treat only the symptoms but don’t address the underlying issues. If you see a primary-care doctor or therapist for chronic insomnia and they prescribe pills without mentioning behavioral therapy as an option, you should mention it. If they don’t know anything about it, finding a physician who does.

Source

Consumer ReportsSleeping Pills for Insomnia: Which Ones Work Best? Consumer Reports Best Buy Drugs compares the effectiveness, safety, and price of the most common insomnia medications. Published May 2014.

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