Insomnia - Medicine Article

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By:Dr. West Conner

Studies show that insomnia affects approximately 75 million people in the United States. Insomnia can present itself in a couple of different ways; each may require a different medication. One symptom is a difficulty falling asleep but once asleep, the patient stays asleep. Another symptom is difficulty staying asleep, but an ease of getting to sleep.

Most often, insomnia lasts for just a short period of time, a week at most. When the difficulty in sleeping lasts for more than six months, it is considered a chronic condition. The chronic insomnia is troublesome because it can affect your work, your health, and your social relationships.

The treatment for insomnia should begin with what is known as “sleep hygiene.” Sleep hygiene consists of ten philosophies:

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, after trying sleep hygiene, you are still having difficulties, you can try some over-the-counter remedies.

There are many different sleeping pills you can buy at your local store. This is what I recommend:

- find the cheap, generic, store brand diphenhydramine 25 milligrams

It can by found either in the sleeping pill section or in the allergy section. Let me tell you why. Diphenhydramine is the active ingredient in the allergy medication Benadryl. Along with its ability to help with your allergy symptoms, it causes a good amount of drowsiness. So much so that it is the active ingredient in ALL of the following expensive brand name sleeping agents:

Simply Sleep

Sleepinal

Sominex

Tylenol PM

Unisom

Alka-Seltzer PM

Excedrin PM

Goody’s PM

Nytol

Bayer NightTime Relief

Doan’s PM

GoodNight’s Sleep

Legatrin PM

All of these are much more expensive and have the exact same active ingredient as the cheap store brand. Why pay more for the exact same thing?

The next step to try is melatonin. Now many people want to go directly to melatonin because they feel it is a “natural” alternative. Melatonin in made in a laboratory just like any other medication. You can get natural melatonin that is made from the pineal gland of animals but this approach is not recommend due to frequent viral contamination.

The brain secretes melatonin to supposedly tell our body to go to sleep. The scientific community is still discussing the exact dosage and duration of therapy for melatonin. Until they come up with an answer, start with the one milligram dose. If this is not effective, go to two milligrams. If there are still difficulties in getting to sleep, go for the three milligram dose.

Let me tell you about my own personal experience with melatonin. When it first came out many years ago, I tried it to help with my sleeping. I took it the first night, fell asleep, and woke up at 3am, wide awake and couldn’t get back to sleep. Of course the next night I was tired so I took it again. I fell asleep but was wide awake again at 3am and couldn’t get back to sleep. The next night I didn’t take it and slept until morning. The fourth night I took the pill and again woke up at 3am, wide awake. I have never taken it since. Why I woke up at 3am, I don’t know. It was strange but that is what happened to me.

If sleep hygiene, diphenhydramine, and melatonin are not helpful for you, the next step in the doctor’s office. Don’t be intimidated into one of the new, expensive designer sleeping pills. Start cheap.

Your first step should be trazodone. This is actually an antidepressant that causes sedation as a side effect, similar to diphenhydramine. One of the reasons for using an antidepressant like trazodone is the fact that many people with insomnia are also depressed, whether diagnosed or not.

Trazodone is cheap, reliable, and has been used safely for years. The most common dose for getting a good night’s sleep is 50 milligrams. You will never see an advertisement for trazodone because it is an old, dependable drug that is very cheap.

The next step should be temazepam. This is another old reliable medication that has been used for years. Temazepam is in the same family as Xanax and Valium. It provides the right amount of sedation that lasts about eight hours. The medication is classified as a schedule IV meaning it does have some addictive properties. There are not too many people who get “hooked” on temazepam so I would not worry too much about that.

If, after trying these three medications, you are still having difficulties, you and your doctor may want to try other medications in the same family as temazepam. These are called benzodiazepines. They all work basically the same way and cause drowsiness. They differ in how quickly they work and how long the effect lasts.

Your next step is going to be expensive. The pricey brand name drugs are going to be your next option. I would recommend starting with Ambien. It is quite popular and will soon be available in generic form. The manufacturer is now focusing on the new formulation called Ambien CR. They are no longer promoting Ambien because the patent will soon expire. The Ambien CR is nothing more than a controlled release form of the drug. You can get a voucher for a free trial at ambiencr.com.

After this, you have many choices but all are costly. You can try Sonata or Lunesta. A free four day trial of Sonata is available at sonata.com and a free four day trial of Lunesta is available at lunesta.com.

A new medication for sleep is called Rozarem. To make the science easy, it tricks your body into thinking it has a lot of melatonin. This is a new category of medication. They are quite expensive at about $7.00 each.

Most people do not realize how effective the cheap generics are because they don’t see them on TV or hear about them on the radio. These established drugs have been working for many years and there is no reason to begin your therapy with expensive prescription drugs.

The recommendations for sleeping pills follow the rest of my suggestions, start over-the-counter and cheap. Begin with simple, proven, and inexpensive remedies and slowly move up in cost. The newer, brand name drugs are heavily advertised and well known to the general public. This advertising and brand name recognition makes them quite expensive.

Don’t be tempted into the expensive route right away. Your doctor is probably going to want to start you on the newest expensive drug. Most people don’t realize that he or she is being rewarded by the drug companies for prescribing these expensive medications to you.

A good night’s sleep is important. If it really only takes a few cents a night to get it, why pay several dollars?

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Dr. West Conner is the author of the incredibly popular workbook “How To Save Money On Your Prescription Drugs” and the audio CD “Are You Spending Too Much On Your Prescriptions?” He is currently active in assisting clients who are having difficulty affording their prescription drugs. Through his many years of practice, Dr. Conner has developed a number of unique and creative ways to lower prescription costs. Visit www.rxcostcutters.com for more details.