Strategies For Overcoming Insomnia, From Better Sleep Habits To Choosing The Right Medication
Prevention and Treatment “I’m so tired, I just can’t get to sleep.” It’s a common complaint for the 3.3 million Canadians who have difficulty with sleep.
Aside from a lack of energy, there are many other far reaching and serious consequences. Research links a lack of sleep and non-restorative sleep to everything from obesity, depression and even early death. The reality is that it’s not always a question of quantity, but rather sleep quality.
Insomnia is a widespread problem that needs to be addressed in a meaningful and concerted way, according to Dr. Colin Shapiro, director of the Sleep and Alertness Clinic & Sleep Research Laboratory at Toronto Western Hospital.
Do you have insomnia?
It’s not unusual to have the occasional bad night. That is not insomnia. Doctors look for a recurring pattern of sleeplessness — three nights over a month, for example — to make a diagnosis. Insomnia may manifest by: trouble falling asleep, frequent waking at night, or early morning wakening. It’s important to note that patients don’t necessarily need to exhibit all three phases of sleeplessness.
Watch for changes in mood, important warning signs of insomnia. Those who suffer from insomnia are irritable and have a higher risk of depression — four times greater than those who are well rested.
“Sleeplessness is not something you should dismiss. It’s a potentially dangerous condition with serious implications for overall health.”
When to see a doctor
It’s time to book an appointment when sleep disrupts your functionality and quality of your life. “Far too many people wait too long to seek medical help,” says Dr. Shapiro. “Sleeplessness is not something you should dismiss. It’s a potentially dangerous condition with serious implications for overall health.”
Strategies for better sleep
An important component to managing insomnia is what experts call “sleep hygiene.” They include positive habits such as: avoiding naps during the day, establishing consistent bedtime routines, and avoiding heavy meals before turning in.
Cognitive Behavioural Therapy for Insomnia (CBT-I) is a drug-free option designed to replace habits contributing to sleep disruption with these more positive ones.
Drug treatment options
Sleep strategies and CBT-I may not be enough to fully manage your sleep difficulties. Your doctor may suggest medication. But not all medicines are equal.
Over the counter preparations are available. “Taking over-the-counter drugs are a big mistake,” says Dr. Shapiro. “They don’t do what they are supposed to do — namely provide good quality sleep.” Self-medicating with alcohol is common, but not a wise tactic for the same reason.
The preferred type of medications have been formulated specifically to help provide fast onset sleep and reduce the anxiety some insomniacs have when trying to get to sleep. In Canada, patients may be prescribed benzodiazepines, a class of drugs that became available in the 1960s and has been widely used to treat insomnia. The introduction in the 1990s of a newer class called Z-drugs, including zoplicone (Imovane), offered key advantages over benzodiazepine medications. The newest addition to that group is zoplidem (Sublinox), which became available in 2011.
“The newer drugs available may give a better quality of deep sleep,” says Dr. Shapiro. “And patients have less dependence and less withdrawal with these. Improvement can happen within a day or two of use. In three to five weeks, the quality of sleep improves another notch.”
Recently, Health Canada issued an advisory for zoplicone (Imovane), about the risk about next day impairment. It was suggested that patients wait at least 12 hours before driving or undertaking activities requiring full mental alertness. However, the recommendation for zoplidem (Sublinox) is eight hours, making it less likely to cause problems with next day functioning.
When discussing your insomnia with your doctor, it is important to talk about your most distressing symptom and the goal of your therapy. “Determining that goal is an important guide to choosing the right drug treatment for patients,” says Dr. Shapiro. The ideal sleep medication should allow you to wake the next day feeling refreshed and alert without any lingering effects of the medication, such as grogginess.
“We are a society of insomniacs,” says Dr. Shapiro. “On average, we are getting one hour less sleep than was the case 25 years ago. Clearly there’s a problem. It needs to be addressed and addressed well.” If you are experiencing recurring sleep disruption, talk to your doctor about treatment options.