Jeff Prescott, PharmD, Jacqueline Palmer, PharmD Candidate

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When insomnia begins to negatively impact a patient's quality of life, pharmacists can explain the nonpharmalogic and pharmalogic treatment options.

What are some things that patients do not realize that affect their sleep?

	Insomnia is a condition in which you are unable to sleep or unable to get restful sleep. It affects anywhere from 30% to 50% of adults. There are different kinds of insomnia. Some people with insomnia have trouble falling asleep, and some have trouble staying asleep. Others simply don’t feel refreshed when they wake up in the morning.

	Not getting enough sleep makes you feel tired during the day, affects your mood, makes you more likely to miss work or school, and makes it hard to function or remember things. Insomnia puts you at risk for other physical and mental health problems. It can also raise your chances of having an accident at work or while driving. Driving a car after not getting enough sleep can be dangerous as driving while intoxicated.

	Those at higher risk for insomnia include:

	• People with a chronic physical or mental illness

	• People who work overnight or rotating shifts

	Insomnia can have many different causes. Finding out why you have trouble sleeping is the key to fixing it. Insomnia can be due to stress or changes in your sleep cycle. Sometimes insomnia can be a symptom of another disorder. For example, people with chronic pain or certain mental health conditions have insomnia rates as high as 50% to 75%. Your doctor will need to rule out some of these possible causes.

	You should seek treatment when insomnia begins to have a negative impact on your life. If you feel tired or are unable to function during the day, it might be time to talk to your doctor. The goals of treating insomnia are to:

	• Increase your energy, attention, and memory during the day

	The first step to getting better sleep is to make lifestyle changes. For many people, these can be effective. Begin by improving your sleep habits. Good sleep habits include:

	• Limiting caffeine, alcohol, and cigarettes, especially closer to bedtime.

	• Doing something that relaxes you just before you go to bed.

	• Avoiding exercise, heavy meals, or lots of liquids within 2 hours of bedtime.

	• Avoiding doing work, reading, or watching television in bed. Try to keep your bed a place only for sleeping.

	• Getting up and doing something else if you can’t sleep, then trying to sleep again at a later time.

	• Trying to make your bedroom as comfortable as possible.

	Sometimes even after changing your sleep habits, insomnia may continue to be a problem. At that point, you might want to consider medication. There are many drugs that can help with insomnia. Some are available only with a prescription and some are available over-the-counter (OTC). OTC products may be helpful for short-term treatment of insomnia, but should not be used on a regular basis. You should always ask your doctor or pharmacist before using any medication to help you sleep.

What are some common misconceptions by patients about sleep medications?

	Many of the OTC products used for insomnia are herbal remedies. There is little scientific data supporting use of these herbs for insomnia, and some of these products have serious side effects. For example, valerian and kava are 2 herbal products that should be used with caution. Not only is there a lack of evidence to show they actually help people sleep, there have been cases of liver damage in patients taking these herbal products.

	Melatonin is a popular OTC product for insomnia. It is a hormone found naturally in our bodies that regulates the sleep cycle. Melatonin has the most benefit in the elderly population. Chamomile is another herbal remedy found in bedtime teas. Many people who drink it say it makes them feel calm and relaxed.

	Although all of the products mentioned to this point have been used to improve sleep, there are only 2 active ingredients that have been studied and approved for use as OTC sleep aids. These drugs are diphenhydramine and doxylamine, and they are available as both single ingredients and in combination with other drugs (such as pain relievers). You might recognize these drugs from other products, as they are commonly featured in cough, cold, and allergy treatments, because they are also antihistamines. These products can be useful to help you get to sleep, but may make your sleep less restful. These drugs have the opposite effect on some people, especially children and the elderly, who can become more on edge after taking them.

	Sometimes OTC medications are not effective, or you may suffer from chronic insomnia. In these cases you may want to consider prescription medications. Your doctor might prescribe a type of drug called a sedative-hypnotic. These drugs are meant to calm you and help you fall asleep. Sedative-hypnotics include zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata). These are shortacting agents that work best to get you to sleep quickly. Ramelteon (Rozerem) is a prescription medication that works like melatonin. This might help regulate a person’s sleep cycle. Some antidepressants and antianxiety medications can also improve sleep, but should only be used at your doctor’s discretion. The Table lists the various drugs used for insomnia.

	Remember that all of the medications used for insomnia are meant to make you tired. You should not drive or do anything else requiring a lot of concentration after taking any of these drugs. You also should not combine different types of sedatives, as this can make you excessively sleepy. Some of these medications take a while to wear off and may cause a “hangover-like” effect the next morning. This can cause you to still feel sleepy when you wake up, even if you took them the night before. Be careful if you have to drive or focus on something important in the early morning. Make sure you will be able to get at least 8 hours of sleep before taking any of these medications.

	Insomnia may be disrupting your life, but there are possible solutions. Your doctor may need to do certain tests to verify if some other health condition could be causing your insomnia. Keep your doctor or pharmacist involved in your treatment. Making the right decisions in treating insomnia will help you get more restful sleep and function better during the day. PT

Dr. Prescott is vice president, clinical and scientific affairs, for 

. Ms. Palmer and Ms. Wade are PharmD candidates at the Ernest Mario School of Pharmacy at Rutgers University in Piscataway, New Jersey. 

Jeff Prescott, PharmD, Jacqueline Palmer, PharmD Candidate

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