Q: I have been using melatonin for a couple of weeks to treat my insomnia but it’s not helping. What else can I try?
When it comes to sleep, we often think of eight hours as being the magic number. However, the length of time people actually need to sleep in order to wake up feeling rested varies from person to person, and as we age our body tends to need less sleep. Therefore, total sleep time is not the focus when making an insomnia diagnosis.
People with insomnia have difficulty falling asleep, difficulty staying asleep or they wake up early in the morning and are unable to get back to sleep. This occurs at least three nights per week and interferes with their daytime functioning. This would include feeling tired during the day, lacking motivation or energy, trouble concentrating, mood swings and headaches.
Certain things tied directly to our lifestyle can sometimes be the source of our insomnia, and making small lifestyle changes may be enough to make it go away. If you are eating late at night, consuming caffeine or alcohol in the evening, using electronic devices before bed, not doing enough physical activity during the day or exercising at night you may be causing yourself to have poor sleep.
To set yourself up for the best chance of successful sleep, it is important to practice good sleep hygiene, which includes creating an ideal space and environment for sleep. A consistent bedtime routine is also important where all the things you do to prepare for sleep are done in the same order each night to trigger your body to prepare for sleep. There are plenty of online resources to help you with tips on sleep hygiene, bedtime routines and methods to help reduce stress before bed.
Short-term or acute insomnia lasts less than three months. Acute insomnia is often the result of temporary stressors in our lives that eventually improve on their own. This may include adjusting to a new sleep environment, a new time zone, shift work, or going through a stressful event such as job loss or surgery.
Melatonin supplements can be helpful in treating acute insomnia caused by jetlag or shift work. Melatonin is naturally produced by our body at night to help regulate our sleep-wake cycle, therefore using a supplement can help your body adjust back to your regular bedtime. If your insomnia is due to something other than an adjustment to your schedule, you may find melatonin ineffective.
Diphenhydramine is an antihistamine commonly used to treat allergies but is also marketed under many different brands as an over-the-counter sleep aid because it has the side effect of causing drowsiness. This would typically be my recommendation for short-term treatment of acute insomnia when melatonin has not helped, but you will want to check with your pharmacist first to ensure it is safe for you to use with your other medications and medical conditions.
If your insomnia has lasted for longer than three months, then you have moved from acute insomnia to chronic insomnia, and you should book an appointment with your doctor or nurse practitioner for an assessment. Chronic insomnia is often associated with other medical conditions such as chronic pain, restless leg syndrome, thyroid disorders, asthma, COPD, Alzheimer’s disease and mental health issues. It can also be related to certain medications such as stimulants for treating ADHD, steroids, decongestants, weight loss supplements and antidepressants.
Depending on the assessment, your sleep disorder could be treated by treating a completely different issue, or you could be prescribed one of many medications that can help with sleep. Hypnotic medications such as zopiclone, zolpidem and various benzodiazepines such as lorazepam, clonazepam and temazepam are commonly used to induce sleep. When hypnotics are not appropriate, or if you have co-existing mental health issues, you may see your prescriber choose trazodone, mirtazapine or quetiapine. If pain is an issue, you may receive a prescription for something that helps with both sleep and chronic pain such as amitriptyline, nortriptyline or gabapentin.
Certain medications used for sleep carry the potential for tolerance, dependency and addiction. Please be sure to discuss this with your prescriber or your pharmacist before starting any medications for sleep.
Erin Thompson (BSc, BScPharm) is a graduate of Dalhousie University and a community pharmacist practicing at Shoppers Drug Mart in Quispamsis N.B. Her opinions expressed in this column are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment.