Pharmacological Approach for Insomnia
For those of you who have exhausted all other options, there is always surgery/medication which I find generally expensive and unnecessary compared to the more simple, tried-and-tested home remedies. Be sure that this is the last stop for you!
In many cases, insomnia is caused by another disease, side effects from medications or a psychological problem. It is important to identify or rule out medical and psychological before deciding on the treatment for the insomnia. Simple home remedies and adjustments to your sleep environment should be your first steps before proceeding on to pharmacological approaches. Below is a list of treatments for insomnia should the home remedies fail to work for you. These however cost quite a sum of money and I can personally attest to the equally effective home remedies listed on this site!
Hypnotism
Hypnotism has proven to be quite effective in the short term treatment of insomnia though users generally develop a resistance to it. The effects also wear off due to tolerance.
Cognitive Behavior Therapy
A recent study found that cognitive behavior therapy is more effective than hypnotic medications in controlling insomnia. In this therapy, patients are taught improved sleep habits and relieved of counter-productive assumptions about sleep. The effects of cognitive behavior therapy have sustained and lasting effects on treating insomnia long after therapy has been discontinued. The long lasting benefits of a course of CBT show superiority over pharmacological hypnotic drugs. Even in the short term when compared to short term hypnotic medication such as zolpidem (Ambien), CBT still shows significant superiority. Thus CBT is recommended as a first line treatment for insomnia.
Medications
Many insomniacs rely on sleeping tablets and other sedatives to get rest. All sedative drugs cause psychological dependence where the individual cannot psychologically accept that they can sleep without drugs. This is also the cause of rebound insomnia, (see “Causes of Insomnia” in the navigation bar above). Certain classes of sedatives such as benzodiazepines and newer non-benzodiazepine drugs can also cause physical dependence which manifests in withdrawal symptoms if you do not carefully wane yourself off the drug. Hypnotic medications also have a number of side effects such as day time fatigue, motor vehicle crashes, cognitive impairments and falls and fractures. Elderly people are more sensitive to these side effects.
Benzodiazepines
The most commonly used class of hypnotics prescribed for insomnia is the benzodiazepines. These drugs can lead to tolerance, physical dependence and the benzodiazepine withdrawal syndrome upon discontinuation, especially after consistent usage over long periods of time. Benzodiazepines while inducing unconsciousness, actually worsen sleep as they promote light sleep whilst decreasing time spent in deep sleep such as REM sleep. A further problem is with regular use of short acting sleep aids for insomnia, day time rebound anxiety can emerge.
Non-Benzodiazepines
Nonbenzodiazepine sedative-hypnotic drugs, such as zolpidem, zaleplon, zopiclone and eszopiclone, are a newer classification of hypnotic medications. They similar to the benzodiazepine class of drugs. These drugs appear to cause both psychological dependence and physical dependence though less than traditional benzodiazepines and can also cause the same memory and cognitive disturbances along with morning sedation.
Antidepressants
Some antidepressants such as amitriptyline, doxepin, mirtazapine, and trazodone can often have a very strong sedative effect, and are prescribed off label to treat insomnia. The major drawback of these drugs is that they have antihistaminergic, anticholinergic and antiadrenergic properties which can lead to many side effects. Some also alter sleep architecture. As with many benzodiazepines, the use of antidepressants in the treatment of insomnia can lead to physical dependence; withdrawal may induce rebound insomnia and actually further complicate matters in the long-term.
Melatonin and Melatonin antagonists
The hormone and supplement melatonin is effective in several types of insomnia. Melatonin has demonstrated effectiveness in inducing sleep and regulating the sleep/waking cycle. One particular benefit of melatonin is that it can treat insomnia without altering the sleep pattern which is altered by many prescription sleeping tablets. Another benefit is it does not impair performance related skills. Melatonin is often used by frequent travelers who have to quickly adjust to time zones without many side effects. Melatonin pills can be prescribed by your doctor.
Sexual Activity
In several cases, sexual intercourse has been found to heavily reduce stress patterns. However, this might be problem because your insomnia might be the cause of a reduced sex drive. Work on improving quality of sleep and everything else will fall into place.
