Insomnia: An Overview and Some Alternative Approaches

It is unbelievable how many patients in my practice suffer from insomnia and are taking sleeping medications. I thought I’d share with you some alternatives which may help you to get a restful sleep.

Many sleeping medications make you sleep but don’t allow you to really rest. They take away your dream/REM pattern which is necessary to get the feeling of rest. Those who fall asleep easily and sleep through the night are the lucky ones.

By definition, insomnia is “difficulty initiating or maintaining sleep, or both” and it may be due to inadequate quality or quantity of sleep. It is typically followed by functional impairment while awake. The pattern of insomnia often is related to the etiology.  Insomnia affects 1 in 3 people.

1. Onset insomnia: Difficulty falling asleep at the beginning of the night, often associated with anxiety disorders.
2. Middle-of-the-night insomnia:  Insomnia characterized by difficulty returning to sleep after awakening in the middle of the night or waking too early in the morning, also referred to as nocturnal awakenings, encompasses middle and terminal insomnia.
3. Middle insomnia: Waking during the middle of the night, difficulty maintaining sleep. Often associated with pain disorders or medical illness.
4. Terminal (or late) insomnia: Early morning waking. Often a characteristic of clinical depression.

Insomnia can be caused by many medications such as  psychoactive drugs or stimulants, including certain medications, herbs, caffeine, cocaine, ephedrine, amphetamines, methylphenidate, MDMA (also known as ecstasy), methamphetamine and modafinil. Some antibiotics can also cause chronic insomnia such as Levaquin® (levofloxin).

It is easy to understand that anxiety, stress (emotional, financial or sexual) and fear can cause you difficulty sleeping. We also know that jet lag or working night shifts can impact your sleep at some times of the day and cause excessive sleepiness at other times of the day.

If chronic insomnia exists specific medical conditions should be ruled out such as  hyperthyroidism or rheumatoid arthritis. Insomnia may be a symptom of magnesium deficiency, or low magnesium levels, but this has not yet been proven. A healthy diet containing magnesium may help to improve sleep in individuals without an adequate intake of magnesium.

Insomnia in women seems to be linked at least partly to lower estrogen levels, which is a potential reason why women often tend to develop insomnia at menopause. Estrogen helps with the uptake of magnesium into the soft tissues. If estrogen levels are low, magnesium deficiencies and conditions they can cause such as insomnia, heart palpitations, anxiety and fibromyalgia may become more problematic. Make sure you have seen your gynecologist to discuss estrogen replacement strategies.

As mentioned, insomnia can be caused by many other diseases, side effects from medications, or psychological problems. To be able to treat insomnia effectively, it is critical to find out all medical and psychological conditions before starting any medications. Obviously it is necessary to assure that there is an appropriate sleep hygiene which basically means no noise or other environmental factors leading to sleep disruptions.

Please discuss medication therapies with your oncologists.

However you might consider to explore some alternative options which you need to share with your treating physician. For example, when I am traveling I usually take 3 mg of melatonin to avoid jet lag, which seems to work for me. Melatonin is available over the counter but also in prescription form known as Rozerem® (ramelteon). These drugs seem to lack the potential for abuse and dependence. This class of drugs has a relatively mild side effect profile and lower likelihood of causing morning sedation. While these drugs show good effects for the treatment of insomnia due to jet lag, the results for other forms of insomnia are less promising.

There are a number of herbal mixtures which have been suggested to have some modest effects including valerian, chamomille, hops, and passion-flower. Valerian has undergone multiple studies and appears to be modestly effective.

There is more you can try by changing the way you arrange your lifestyle. These include changing your sleep area or schedule, watching what and when you eat and drink, and being more active. It’s also important to keep regular bedtimes and wake times seven days a week and to try to avoid taking naps during the day.

A Harvard Medical School study found that yoga improved the study participants overall quality of sleep, including helping people to fall asleep easier and stay sleeping for longer periods. A study published in the Journal of the American Geriatrics Society found that elderly adults with moderate sleep complaints improved self-rated sleep quality through a low to moderate intensity Tai chi program conducted for six months.