Sleep Concerns

Sleep can be elusive for many reasons and we at Remedy are always happy to discuss any sleep concerns you may have.  There are several situations that might interrupt your sleep such as waking up at night to urinate, joint pains, or obstructive sleep apnea, but some people struggle with sleep with no specific trigger.  In evaluating patients, I find it helpful to think through their sleep habits and ask if they find it difficult to fall asleep, stay asleep, or both.  Some people are “night owls” and sleep well on vacations and weekends but cannot fall asleep when it is convenient during the work week.  Some struggle to relax their mind and falling asleep any time is challenging.  

Often, we encourage people to focus on their “sleep hygiene” as a first treatment.  The major steps for sleep hygiene include: going to bed and getting up at the same time every day, sleeping only long enough to feel rested and then getting out of bed, avoiding caffeinated beverages after noon, avoiding alcohol in the late afternoon/evening, avoiding smoking, keeping your bedroom dark, cool, and quiet, getting plenty of physical activity but limiting heavy exercise right before bed, and avoiding screens that give off light at least 30 minutes before bed.  Many patients find calming activities like meditation or stretching can help them wind down before bed. There are apps such as Calm or Headspace available on smart phones to help guide you through meditations. If you are doing all these modifications and sleep is still difficult, some people with chronic persistent insomnia may benefit from cognitive behavioral therapy for insomnia.  Most people do not immediate think about seeing a therapist to work through their insomnia, but it can be a helpful medication-free option to try.  

In terms of medication treatment, there are several non-prescription options including supplements like melatonin or over the counter medications like diphenhydramine (Benadryl) or doxylamine (Unisom). Melatonin (1-3mg 1-2 hours prior to desired bedtime) is relatively mild in its effect but can help those struggling to fall asleep.  Sleep clinics encourage people to avoid high doses of melatonin chronically as this can throw off your body’s own melatonin production and sleep/wake cycles.  However, small doses here and there for a bad night can be reasonable. Diphenhydramine and doxylamine can be helpful, but do have potential side effects of dry mouth, dizziness, and rarely urinary retention. These are not my favorites for those age 70yo or older as these patients are more susceptible to the side effects.  But if you are having a rough night of allergies and finding it difficult to sleep, diphenhydramine may be a great option.  There are several prescription sleep medications, but none are perfect.  Some are costly and others may have side effects such as dizziness. However, these medications can be worth potential risks for those who are really struggling. 

I know how important sleep is and how challenging missing out on sleep can be. I am happy to review any of the above medications or issues with you more in depth if this is an issue you face.  

References

1) Qaseem A, Kansagara D, Forciea M, Cooke M, Denberg TD. “Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline from the American College of Physicians.” Annals of Internal Medicine. 19 July 2016

2) Neubauer DN. “Pharmacotherapy for insomnia in adults.” Available on UpToDate. Updated Sep 14, 2021.