Insomnia Treatment Options

Sleeplessness is defined as difficulty initiating or maintaining sleep or not feeling rested following sleep. Up to 30% of the general population reports experiencing rest disturbances. In clinical settings, as much as 50% of patients complain of sleep-related problems. According towards the International Classification of Sleep Disorders, you will find 11 kinds of sleeplessness. The three most common are adjustment sleeplessness, psychophysiologic sleeplessness, and sleeplessness secondary to a mental disorder.

Adjustment sleeplessness is associated with an identifiable stressor. This type of insomnia is more typical in females and older adults; it’s generally short-term, lasting from days to weeks. Adjustment sleeplessness ceases with resolution of or adaptation to the stressor.

Psychophysiologic sleeplessness is characterized by the patient’s preoccupation with his or her rest problem, which causes increased wakefulness at bedtime. Patients with this kind of insomnia typically report sleeping better away from home.

Sleeplessness secondary to a mental problem might be caused by major depressive disorder, dysthymic disorder, bipolar problem, cyclothymic problem, and most anxiety disorders. A comprehensive background ought to consider rest latency, number and time of rest interruptions, time of morning awakening, and frequency and duration of naps. To increase the accuracy with the history, the patient should keep a diary of rest habits.

Treatment depends on the cause and duration with the sleeplessness. Nonpharmacologic treatment strategies ought to be implemented for short-term and chronic sleeplessness. Nevertheless, pharmacologic remedy may be indicated for some individuals with short-term insomnia. Patients with chronic insomnia ought to be evaluated for a possible medical, psychiatric, or pharmacologic trigger.

Nonpharmacologic treatment includes good rest hygiene and lifestyle modifications. The patient should go to bed only when sleepy and use the bed only for sleeping and sexual activity. If still awake after 20 minutes, the patient should get out of bed and return to bed only when sleepy. A regular sleep schedule ought to be established, and the patient should wake up at the same time each morning. Caffeine and nicotine should be avoided or consumption stopped in the late afternoon. Alcohol should be avoided close to bedtime. Fluids should be limited within the evening to avoid night trips to the bathroom. Relaxation techniques are beneficial.

Pharmacologic options include antihistamines, antidepressants, zolpidem, zaleplon, and ramelteon. Antihistamines aren’t as efficient as benzodiazepines, and their use is often limited by anticholinergic side outcomes. Antidepressants such as amitriptyline, doxepin, and trazodone are frequently prescribed for rest difficulties. But some antidepressants might contribute to insomnia. Trazodone is an effective treatment for patients with insomnia induced by other antidepressants. Zolpidem is comparable in effectiveness to benzodiazepines but doesn’t produce the anxiolytic and muscle relaxant outcomes of these drugs. Zaleplon is really a great alternative for patients with prolonged sleep latency. The newest pharmacologic agent is ramelteon, a nonscheduled melatonin agonist indicated for difficulty with sleep onset.

Benzodiazepines reduce sleep latency and number of awakenings, resulting in increased total rest time. However, their use may be restricted by tolerance, anterograde amnesia, and rebound sleeplessness. These drugs should not be prescribed for individuals with a history of substance abuse, pregnant individuals, or individuals with rest apnea. Tolerance and dependence might be minimized by utilizing the lowest efficient dose and limiting therapy to brief durations. To minimize withdrawal effects, taper the medications and warn the patient of possible rebound sleeplessness upon discontinuation.

Remedy options vary and depend on the trigger and the duration of the insomnia. Good rest hygiene and pharmacologic therapy can effectively treat most cases.

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