May is Better Sleep
Month
Who has a sleep
disorder?
Sleep disturbances are among the most common complaints
brought to physicians. Around 70 million Americans have some form of sleep
disorder, and 60% of these patients report that their sleep disorder is chronic.
Women, seniors, night shift workers, and those with pre-existing diseases are
more likely to have sleep disturbances than others. However, less than 5% of
people with sleep disorder seek medical attention. It is important to address
sleep disorder because it can lead to daytime drowsiness, decreased
productivity, mood changes, and overall poor quality of life.
Why is sleep
important?
A lack of sufficient sleep can lead to decreased physical
and mental functioning during the day time. Sleepiness is a major cause of
motor vehicle accidents and is also a leading cause of errors made in the
workplace. It has been shown that being awake for 24 hours can be equivalent to
a 140 lb person having 4 alcoholic drinks.
Poor quality sleep or insufficient sleep can also lead to
increased risk of heart attack or infection, slower healing, changes in
metabolism, and worsening of other health conditions.
How do I know if I
have a sleep disorder?
There are 3 common types of sleep disorder: insomnia, obstructive
sleep apnea, and circadian rhythm disturbances.
Insomnia is the
most common of these 3 types of sleep disorder. Insomnia includes being unable
to fall asleep, difficulty maintaining sleep, or not feeling refreshed after
sleep. Those who have insomnia symptoms for over 1 month are considered to have
chronic insomnia.
Insomnia can be caused by anxiety, stress, and other
emotional factors. Insomnia can also be caused by other diseases, such as
thyroid disorder, cancer pain, arthritis, gout, breathing discomfort in heart
failure, severe heartburn, or asthma. Certain medications might also contribute
to sleep disturbances. Below is a table of common medications that may cause
insomnia.
MEDICATIONS
THAT MAY CAUSE INSOMNIA
|
|
Over-the-Counter Medications
|
·
Cold medications containing pseudoephedrine
·
Pain medications containing caffeine (Excedrin
Migraine, Midol Complete)
·
Some allergy medications
·
Stimulant laxatives (Senna, Bisacodyl)
·
Diet pills
|
Prescription Medications
|
·
Some antidepressants (fluoxetine, bupropion)
·
Stimulants
·
Anticonvulsants (phenytoin, lamotrigine)
·
Thyroid medications
·
Diuretics that may increase night-time
urination (hydrocholorthiazide, furosemide)
·
Corticosteroids (prednisone,
methylprednisolone)
|
Recreational Drugs
|
·
Tobacco products containing nicotine
·
Alcohol
·
Cocaine
·
Amphetamines or methamphetamines
|
Obstructive sleep apnea is another
common disorder and is found in 15 million Americans. Obstructive sleep apnea
is caused by interruptions in breathing, leading to too little oxygen during
sleep. Thyroid disorder and acromegaly are diseases thought to be linked to sleep
apnea. Obesity, male sex, and being middle-aged also puts you at risk for
developing this disorder.
Sleep cycle (circadian rhythm) disturbances are
another common form of sleep disorder. Sleep cycle disturbances can occur due
to jet lag or shift-work changes. Jet lag is a sleep disturbance that happens
after travel between different time zones and can last up to 14 days after
travel especially if time zone
changes are greater than 8 hours or when traveling eastward. Shift-work sleep disorder can be
caused by rotating between morning and night work shifts.
It is also important to look at how long your sleep
disturbance lasts. Sleep disturbances are said to be transient (or temporary) if the disturbance lasts 2 to 3 days and short-term if it is resolved within 3
weeks. Chronic sleep disorder may
last for over 4 weeks.
Can I treat my sleep
disorder?
There are a number of ways to address sleep disorder.
Life-style modifications and over-the-counter medications can aid in improving
sleep. However, those with obstructive sleep apnea and chronic insomnia should
seek the help of a physician for prescription-only medication and for further
counseling.
Lifestyle changes that may improve sleep:
·
Keep a regular schedule for when you sleep and
wake.
·
Sleep only enough until you feel rested, and
then get up.
·
Go to bed 30 minutes later than when you usually
go to bed to induce sleepiness before lying down.
·
If you are unable to fall asleep within 15 to 20
minutes of lying down, leave the room and return only when you feel sleepy.
·
Avoid napping throughout the day.
·
Make sure that your sleep environment is
comfortable and free of clutter and noise.
·
Place your clock so that it is not visible while
you are sleeping.
·
Avoid watching television or using computers on
the bed. Try to reserve the bed for sleep only.
·
Do not exercise within 2 hours before bedtime.
However, light, regular exercise 4 to 5 hours before bed is recommended.
·
Avoid foods containing stimulants in the evening,
including coffee, caffeinated tea, caffeinated sodas, dark chocolate, and
alcohol.
Medications for Insomnia
If lifestyle changes are not effective in improving sleep, a
medications may be needed. These ages vary in safety and effectiveness. The choice
of a medication depends on each person’s individual sleep profile.
MEDICATIONS
TO TREAT INSOMNIA
|
|
Over-the-Counter Medications
|
Helps you fall asleep:
-
Diphenhydramine
and doxylamine are safe and
effective to use on a short-term basis (less than 7 days).
Helps you stay asleep for
longer:
There are no over-the-counter drugs are approved for this use.
|
Herbal Medications
|
Helps you fall asleep:
-
Melatonin
is a supplement that can be found at most pharmacies. It is a hormone
naturally found in the body that regulates the sleep cycle. It is effective in
certain individuals with disturbed sleep due to school schedules, work
schedules, and jet lag.
-
Valerian is another commonly used
over-the-counter herbal. However, it has been found to decrease time to sleep
onset by only 1 minute, so its effectiveness is limited.
-
Alcohol
is commonly self-prescribed for sleep. While it has been shown to decrease
time to sleep onset, it also increases sleep disturbances throughout the
night and may lead to dependence.
Helps you stay asleep for
longer:
There are no supplements that are effective to extend the amount of
time you stay asleep.
|
Prescription Medications
|
Helps you fall asleep AND stay
asleep for longer:
Benzodiazepines are a class
of drugs prescribed for sleep. While they are effective, they also have the
potential for addiction.
-
Short-acting benzodiazepines (estazolam,
flurazepam, temazepam, triazolam) can help you fall asleep faster.
-
Long-acting benzodiazepines (flurazepam and
quazepam) can help you fall asleep and stay asleep for longer.
Nonbenzodiazepines (zaleplon,
zolpidem, eszopiclone) are another commonly prescribed group of drugs. They can help you fall asleep, wake
up less often, and stay asleep for longer.
A melatonin agonist (ramelteon)
can decrease the time it takes to fall asleep and can also extend sleep
duration.
|
Where can I find more
information?
There are many resources for additional information on sleep
disorders. Below are a few helpful
websites.
·
Center for Disease Control: http://www.cdc.gov/features/sleep/
·
The Sleep Foundation: http://www.sleepfoundation.org/
·
Mayo Clinic: http://www.mayoclinic.com/health/insomnia/DS00187
Written by:
Bonnie Vu
Doctor of Pharmacy Candidate
College of Pharmacy, University
of Illinois at Chicago
UIC Pharmacy
May 2013
