Medical treatments for insomnia
Over the counter drugs include
diphenhydramine (Sominex®, Nytol®, Excedrin PM®) and doxylamine (Unisom®).
The prescription medications most commonly used to treat insomnia include zolpidem (Ambien®), zaleplon (Sonata®),
estazolam (ProSom®), flurazepam (Dalmane®), temazepam (Restoril®), and triazolam (Halcion®). Though these agents are
beneficial, they often become less effective over time.
Behavioral or psychological counseling may be recommended for people with poor sleep habits
or emotional disorders. People with insomnia are typically advised to avoid stimulants such as
caffeine (found in coffee,
tea, and soda) and over the counter cold
and allergy products containing
pseudoephedrine.
Dietary changes that may be helpful for insomnia
Caffeine is a stimulant.1 The
effects of caffeine can last up to 20 hours,2 so some people will have disturbed
sleep patterns even when their last cup of coffee was in the morning. Besides regular coffee, black tea, green
tea, cocoa, chocolate, some soft drinks, and many over-the-counter pharmaceuticals
also contain caffeine.
Doctors will sometimes recommend eating a high-carbohydrate food before bedtime, such as a
slice of bread or some crackers. Eating carbohydrates can significantly
increase levels of a neurotransmitter (chemical messenger) called serotonin,3 which
is known to reduce anxiety and promote
sleep.
Food allergy may also contribute to
insomnia. In a trial involving eight infants, chronic insomnia was traced to an allergy to
cow’s milk. Avoidance of milk resulted
in a normalization of sleep patterns.4
Lifestyle changes that may be helpful for insomnia
A steady sleeping and eating schedule combined with caffeine avoidance and counseling sessions using
behavioral therapy has reduced insomnia for some people, as has listening to relaxation
tapes.5
The effect of exercise on sleep has not been well studied. However, some healthcare
practitioners recommend daily exercise as a way to reduce stress, which in turn can help with
insomnia.
A naturopathic therapy for insomnia is take a 15- to 20-minute hot Epsom-salts bath before
bedtime. One or two cups of Epsom salts (magnesium sulfate) in a hot bath are thought to act
as a muscle relaxant.
Smokers are more likely to have insomnia than nonsmokers.6 As with many other
health conditions, it is important for people with insomnia to quit smoking.
Nutritional supplements that may be helpful for insomnia
Melatonin is a natural hormone that
regulates the human biological clock. The body produces less melatonin with advancing age,
which may explain why elderly people often have difficulty sleeping7 and why
melatonin supplements improve sleep in the elderly.8
Warning: Melatonin is a potent hormone and its long-term safety is
not established. Melatonin should only be taken with medical supervision.
Middle-aged adults (average age, 54 years) with insomnia also have lower melatonin levels,
compared with people of the same age without insomnia.9 However, there is not much
research on the use of melatonin for sleep problems in middle-aged people.
Double-blind trials have shown that melatonin facilitates sleep in young adults without
insomnia,10 but not in young people who suffer from insomnia.11 However,
one trial found that children with sleep disturbances stemming from school phobia had improved
sleep after taking 1 mg of melatonin per night for one week, then 5 mg per night for one week,
then 10 mg per night for a third week.12
The results of one double-blind trial also indicate that a controlled release melatonin
supplement providing 2 mg per day improves sleep quality in people with
schizophrenia.13
Normally, the body makes melatonin for several hours per night—an effect best
duplicated with controlled-release supplements. Trials using timed-release melatonin for
insomnia have reported good results.14 Many doctors suggest taking 0.5 to 3 mg of
melatonin one and a half to two hours before bedtime. However, because melatonin is a potent
hormone, the long-term effects of which are unknown, it should be taken only with the
supervision of a doctor.
The amino acid, L-tryptophan, has been used
successfully for people with insomnia,15 presumably because it is converted to the
chemical messenger, serotonin. According to one preliminary trial, L-tryptophan
supplementation was 100% effective at promoting sleep in people who awaken between three to
six times per night, but not effective at all for people who only awaken once or twice, nor in
people who doze on and off throughout the night in a state blurred between sleep and
wakefulness.16 However, L-tryptophan is no longer available over the counter in the
United States. A related compound that occurs naturally in the body, 5-Hydroxytryptophan (5-HTP), is also converted into serotonin and
might, therefore, be helpful for insomnia. In a double-blind trial of people without insomnia,
supplementation with 5-HTP (200 mg at 9:15 p.m. and 400 mg at 11:15 p.m.) increased
rapid-eye-movement (REM) sleep, presumably indicating improved sleep quality.17 In
a preliminary trial of people with
fibromyalgia, supplementing with 100 mg of 5-HTP three times a day improved sleep
quality.18 However, additional research is needed to determine whether 5-HTP is
safe and effective for people with insomnia.
Some people have difficulty sleeping because of a problem known as period limb movements
during sleep (PLMS) or another condition called
restless legs syndrome (RLS). In a preliminary trial, people with PLMS or RLS who suffered
from insomnia had a significant improvement in sleep efficiency after supplementing with magnesium (about 300 mg each evening for four to
six weeks).19
In two small preliminary tr
Herbs that may be helpful for insomnia
Herbal remedies have been used safely for centuries for insomnia. In modern herbal
medicine, the leading herb for insomnia is
valerian. Valerian root makes getting to sleep easier and increases deep sleep and
dreaming. Valerian does not cause a morning “hangover,” a side effect common to
prescription sleep drugs in some people.22 23 A double-blind trial found
that valerian extract (600 mg 30 minutes before bedtime for 28 days) is comparable in efficacy
to oxazepam (Serax®), a commonly
prescribed drug for insomnia.24 In a separate double-blind trial, the same amount
of valerian extract was found to improve subjective assessments of sleep quality and certain
aspects of brain function during sleep as well.25 A concentrated (4–5:1)
valerian root supplement in the amount of 300–600 mg can be taken 30 minutes before
bedtime. Alternately, 2 to 3 grams of the dried root in a capsule or 5 ml tincture can be
taken 30 minutes before bedtime.
A combination of valerian and lemon balm
has been tested for improving sleep. A small preliminary trial compared the effect of valerian
root extract (320 mg at bedtime) and an extract of lemon balm (Melissa officinalis)
with that of the sleeping drug triazolam
(Halcion®).26 The effectiveness of the herbal combination was similar to that
of Halcion, but only the Halcion group felt hung over and had trouble concentrating the next
day. A double-blind trial found that a combination of valerian and lemon balm, taken over a
two-week period, was effective in improving quality of sleep.27
Another double-blind trial found a combination of 360 mg valerian and 240 mg lemon balm
taken before bed improved reported sleep quality in one-third of the
participants.28
Combining valerian root with other mildly sedating herbs is common both in Europe and the
United States. Chamomile, hops,
passion flower, lemon balm, American scullcap, and catnip are commonly recommended by
doctors.29 These herbs can also be used alone as mild sedatives for those suffering
from insomnia or nervous exhaustion. Chamomile is a particularly good choice for younger
children whose insomnia may be related to gastrointestinal upset. Hops and lemon balm are
approved by the German government for relieving sleep disturbances.30
Bitter orange has a history of use as a
calming agent and to counteract insomnia. There is no clinical trial data to support its
efficacy in this regard. The usual amount of tincture used is 2 to 3 ml at bedtime.
Corydalis contains several ingredients, one
of which has been shown to influence the nervous system, providing pain relief and promoting relaxation. People with
insomnia were able to fall sleep more easily after taking 100–200 mg per day of a
corydalis extract (called dl-tetrahydropalmatine, or DHP), according to a preliminary
report.31 People taking the extract reported no drug hangover symptoms, such as
dizziness or vertigo.
The volatile oil of
Holistic approaches that may be helpful for insomnia
can be triggered by psychological stress. Dealing with stress, through counseling
or other techniques, may be the key to a better night’s rest. Many trials have shown
that psychological intervention can be helpful for insomnia.35 A combined program
of counseling, sleep restriction methods (i.e., the only time spent in bed is when sleeping),
and control of stimuli that might interfere with sleep, significantly increased sleep time in
a group of people with insomnia.36
Acupuncture may be helpful for insomnia,
possibly by increasing production of calming neurotransmitters such as serotonin and other
substances.37 A preliminary trial found one acupuncture treatment daily for seven
to ten days resulted in complete recovery of normal sleep in 59% of patients and partial
recovery in 21%.38 A controlled trial treated patients with either acupuncture or
fake acupuncture (insertion of needles at non-acupuncture points). The patients receiving true
acupuncture had significant improvements in a laboratory measure of sleep quality compared to
the placebo group.39 The treatment of insomnia with auricular (ear) acupuncture may
provide similar benefits to people with insomnia, according to a preliminary
trial.40 However, double-blind trials are necessary to conclusively determine the
value of acupuncture in treating insomnia.
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Copyright © 2004 Healthnotes, Inc. All rights reserved.
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The information presented in Healthnotes is for informational
purposes only. It is based on scientific studies (human, animal, or in
vitro), clinical experience, or traditional usage as cited in each article.
The results reported may not necessarily occur in all individuals. For many of
the conditions discussed, treatment with prescription or over the counter
medication is also available. Consult your doctor, practitioner, and/or
pharmacist for any health problem and before using any supplements or before
making any changes in prescribed medications.
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