INSOMNIA: Difficulty Sleeping a few days a week
If you have insomnia, you are not alone. By some estimates, 10% of the general population suffers from insomnia[1]. Let’s discuss ways to improve your sleep. Here you’ll learn some quick tips, sleep habits and then an overview of the types of medications (herbal and non-herbal) commonly used to treat insomnia. Of course, talk to your physician first about these and all symptoms.
Powerful tips for sleeping better at night [2]
1) Renovate your bedroom: Your bedroom should be a “Sleep Temple.” It should primarily be used for sleeping so that your mind will associate this room with restful sleep. Avoid watching TV, movies, doing paperwork, etc. This room should be kept dark in the evening.
2) Avoid stimulants like caffeine and nicotine, especially in the afternoon. Avoid alcohol at night. Although this can make you feel sleepy, it often leads to restless sleep and can make you feel more tired in the morning.
3) Do something relaxing every night before sleep. This also helps to build a routine to let your mind know it’s time to go to sleep. For example, reading, cleaning, drinking a warm cup of milk or herbal tea (keep it small so you don’t have to pee in the middle of the night), etc.
4) Get on a sleep schedule. Your brain works best when it has a schedule. Try to sleep and wake up at the same time every day (even on weekends) to get your sleep-wake cycles back to normal.
5) Exercise during the day, but not within 2 hours of going to sleep. The best exercises to help with sleep is running / jogging and weight lifting. If you have questions or concerns about exercising, speak to me about it.
6) What to do when it's 1:00 am and you haven't slept? Get out of bed, leave the bedroom, and do something relaxing such as reading a book (no Stephen King novels!) or a magazine, straightening up the kitchen or whatever relaxes you. Only when you are sleepy should you head back to sleep. No working!
7) Remind yourself that loosing sleep will make the day a bit tougher but will not ruin your day, or cause terrible harm. You may be a bit cranky, and emails may be returned a bit slower, but you will get through it. Train yourself to stop worrying about the next day.
HERBAL SUPPLEMENTS FOR INSOMNIA
Behavioral changes such as going to sleep the same time every night (even weekends), lowering the lights 2 hours before sleep, daily exercise and keeping the TV and computer out of the bedroom are the best long term strategies for insomnia. However, there are a number of natural remedies which may help as well. Stick to supplement brands that are USP verified, such as Nature Made.
Ask you physician if you have questions about these products, and do not use before discussing with your physician if you have kidney or liver problems.
1) Melatonin: This is an over the counter supplement traditionally used for jet lag, that can help with "resetting" your brain as to when to become sleepy. Start with 3mg 1-2 hour before going to sleep. Best associated with low light environment, so turn the lights low 1-2 hours before you want to go to sleep.
2) Valerian: You can find this in most health food stores. Use as supplement.
3) Hops: Use as a supplement, not as a strong IPA (as in, do not drink San Diego beer as a sleeping aid). This is generally combined with Valerian.
4) Chamomile: Taken as tea or capsule. As opposed to regular tea, to get the medicinal effects, make a strong pot of tea. First, take 3 tea bags and steep with lid on mugs to maximize volatile oils. It's the oils that help you sleep If you are allergic to rage weed, you may be allergic to chamomile
5) Consider making “golden milk” nightly. Both the ritual of making this, and the ingredients, help transition you to sleep. Here's the Recipe: 1 cup of low fat or fat free milk. 2 pinches of Cardamon. 2 pinches of Cinnamon. 1 pinch Tumeric. Heat milk with spices until it boils. Let milk cool for a few minutes. Add 1sp honey to taste (Note, the above links to Dr. Weil. I do not like to recommend the advice of "famous" docs like Dr. Weil and Dr. Oz, as they often hype any scientific study, true or false, in order to get higher ratings and thus income from advertising. However, this recipe looks good.)
NON-HERBAL MEDITATIONS
(check with me or another physician before taking any medication)
1) Chlorpheniramine Maleate. The brand name is "Chlor-Trimeton." Note: Many chain pharmacies (CVS, Walgreen's...) sell generic versions that is 1/4th the cost of the name brand . This is a medication for allergies, but can also help you sleep. Try the lowest possible dose first, often 4mg.This medication may make you sleepy the next day, so take at least 8 hours before you need to wake up and of course don't drive the next day if you feel sleepy. If you are over 65, discuss with me before taking.
2) Ambien (zolpidem) is a prescription medication to help with insomnia, prescribed only by your doctor. It should be used only after you have already tried Melatonin and Chlorpheniramine and adhered to the “tips” above. While this is a powerful sleep aid, your body can get used to Ambien and it becomes less effective over time. Some people report strange behaviors such as sleep walking or sleep eating, and also not remembering things well after taking Ambien. So, make sure you are in bed ready to sleep when you take it. Ambien can be habit forming (though less so than Xanax) and shouldn't be mixed with alcohol. It is not generally recommended for patients over 65.
3) Ambien-like medications: There are other prescription medications out there (Sonata, Lunesta) that are marketed aggressively on TV. They all work similarly to Ambien, and carry similar risks. Many, if not most, of all sleep issues can be helped with behavioral changes. Medications to treat insomnia are a temporary measure and should only be used for a few days a week, if not a few days a month (or ever!)
[1] http://www.cdc.gov/features/dssleep/
[2] Morin CM, Hauri PJ, Espie CA, Spielman AJ, Buysse DJ, Bootzin RR. Nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine review. Sleep. 1999;22(8):1134–1156.