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Insomnia is a very common complaint among older adults. The condition affects more than 70 million Americans. Some symptoms include difficulty falling asleep, difficulty staying asleep, difficulty with early morning awakening, or not feeling rested by a “good night’s sleep.” Occasionally, insomnia lasts for a short time and can be easily managed. Other times it is a chronic condition, lasting more than six months. This chronic insomnia is more troublesome and can affect work, social relationships, and health. Many people with insomnia are also diagnosed with other conditions such as depression, anxiety, allergies, or pain.
Insomnia treatment begins with what is known as “sleep hygiene.” This includes regular sleep and wake times. You should avoid eating, drinking, or exercising before bedtime. The room should be cool, comfortable, and dark.
Philosophy of Sleep Hygiene
1. keep a regular sleep schedule
2. exercise regularly but avoid exercise before bed
3. go to bed when sleepy
4. do relaxing and enjoyable activities before bed
5. keep the bedroom quiet and comfortable
6. do not eat a large evening meal
7. if you are not sleeping within 20 minutes, get up and return to bed when you are sleepy
8. if you must take a nap, limit it to 30 minutes
9. avoid alcohol, caffeine, and nicotine
10. have your pharmacist check your medications for stimulating drugs
If the “sleep hygiene” methods are not working, then it may me necessary to begin using medication.
If you are still having difficulty getting a good night’s sleep, you should talk to your pharmacist or doctor. The cause of your insomnia will need to be determined and you may need medication to help you sleep. Even if medication is used for insomnia, “sleep hygiene” principles should still be followed and can provide added benefit.
The best medication should act quickly and for a short period of time. This eliminates the “hangover effect” some people experience.
There are many other products that might be used for insomnia. Melatonin has been shown to be helpful in treating insomnia due to melatonin deficiency in elderly patients. It may also improve sleep quality but probably will not increase the length of sleep time. Kava kava and valerian root are also commonly used for the treatment of insomnia. Kava kava has not been shown to be effective in the treatment of chronic insomnia. It is also known to be potentially dangerous to the liver. Valerian root may be helpful in helping one get to sleep as well as improving the quality of sleep.
There are a number of treatment options available for the treatment and management of insomnia. It is important to diagnose and attempt to treat the root or underlying cause first. After that, the practice known as “sleep hygiene” should be practiced. If “sleep hygiene” is not effective, then the use of prescription medication may be warranted.
The cheapest treatment is, of course, “sleep hygiene.” If you try this approach and are unsuccessful, I would recommend over-the-counter diphenhydramine, while still practicing “sleep hygiene.” There are many different types available. The next step would be to visit your doctor for a prescription. As is my usual recommendation, begin with the lowest priced medication.
For insomnia treatment, I would recommend trazodone first. Trazodone represents approximately 40% of all insomnia prescriptions. It is very cheap at less than $10 a month. If that is ineffective, go with temazepam. It is also very popular and cheap. It is, however, a controlled substance which means there is a possibility of addiction.
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