How to get Better Sleep

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. Some antidepressants (amitriptyline, trazodone, doxepin) can help you fall asleep faster and can also be used to relieve chronic pain which may interfere with sleep.

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