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Need a good night's sleep?
How to cope with insomnia

Most, if not all of us, have nights where sleep just does not come easily. If you are lucky, the problem solves itself and you can slip back into your normal routine. However, for some it is not that easy. A sleep problem can become so tiring that it affects every aspect of your life. It becomes more difficult to work or socialize. Even leisure time is not enjoyable if you cannot get the sleep you need.

Different people have different troubles with sleeping. Perhaps you cannot fall asleep. Someone else may have no problem getting to sleep, but wake shortly and then toss and turn. Still others may think they have had enough sleep, but for some reason do not feel rested at all.

Finding the cause

You may not be sleeping well for many reasons. For instance, the slightest sound may interrupt your sleep or too much light may disturb you. Everyone has different reasons for not sleeping well, but certain things often cause problems:

• prescription medications
• non-prescription medications
• herbal products
• certain brands of multi-vitamin
• changes in your sleeping environment
• stress
• and poor sleep habits.

Prescription medications are a good place to start looking for a cause, but not everyone is affected the same way. Sometimes both drowsiness and insomnia can be listed as side effects for the same medication!

Interactions between medications can also affect sleep. Different medications may not cause a problem by themselves, but taken together may cause problems. Medications are complicated by nature, so talk to your doctor or pharmacist about how they affect sleep.

Over-the-counter medications are especially tricky. Products that look absolutely identical to the untrained eye can have very different ingredients. Cough and cold preparations are a particular problem. Some cause insomnia, others drowsiness. As there are many different formulations and brand names, you may think you are buying one thing when you are actually buying something else. Manufacturers have been known to change the main ingredients of a product without changing the package!

Certain pain medications include caffeine, as this may make them work slightly better. A keen eye is needed to find which versions have caffeine and which do not. Since it is very hard to tell if a product will affect your sleep, talk to a professional.

Herbal products (especially combination products) may also contain ingredients that can keep you awake. Yerba Mate is an ingredient in some herbal weight loss products. Although it may not say so on the package, the main active part of this herb is caffeine.

Multivitamins are becoming more and more popular. However, be careful which one you choose. Some products contain caffeine as a ‘metabolism booster.’ Your pharmacist can help you choose a caffeine-free version.

Changing your usual sleeping environment or feeling stressed can affect sleep patterns. Certain diseases or medical conditions, such as those causing pain, can also be part of the problem. Some things can be changed to improve sleep. This is always the best solution. However, the issues affecting your sleep may be hard to find or change. Practicing good sleep ‘hygiene’ (habits) is a wise first step.

Tips for a good night’s sleep

• Avoid caffeine for four to six hours before bedtime.
• Avoid large meals before bed, or going to bed hungry.
• Alcohol can cause you to wake later in the night.
• Napping before bedtime will make sleeping through the night more difficult.
• Exercising just before bed may wake you up.
• Regular exercise during the day can improve sleep at night.
• If possible, stick to regular times for going to bed and waking up.
• Only use the bedroom for sleep and intimacy.
• Find a routine that helps you wind down before bedtime.

Herbal products

Most pharmacies have a selection of sleeping aids. But which one is right for you? Melatonin and valerian are two of the most popular herbal products.

Not all herbal products are created equal. Herbal products do not have to follow the same rules as prescription medication. One product may use a different formulation and may work differently. In Canada, approved herbal products should have an NPN (Natural Product Number). This assures you the product is made using good manufacturing practices and has a certain amount of data to support its use. Ask a trusted health professional for advice.

Melatonin is one of the most well known products. It is produced naturally in the body. While it seems to play an important role in sleep rhythms, the exact mechanism is still not known. Trying it for a short period of time seems to be safe for most people. However, if it has not worked within a week or so, it probably will not work at all.

Be aware that there are different formulations of melatonin. Some products need to be dissolved under your tongue. As these work quickly, they are the best choice if you have trouble falling asleep. Other tablets take a longer time to start working but last longer into the night. They are a good choice if you often wake in the middle of the night.

Valerian seems to work best for those who have trouble getting to sleep. It may take a few days to a few weeks of everyday use to start working. However, there is little information on its long-term safety. Until more is known, it is best not to take valerian longer than four weeks at a time. It has been known to affect the liver in rare cases. Always check with your pharmacist if you are taking other medications. Valerian may interact with them.

St. John’s Wort has been used by many people for mild depression and insomnia. Unfortunately, it interacts with many other medications and only seems to work for insomnia related to mild depression.

The best advice – always check with a trusted health care professional before deciding which product is right for you.

Over-the-counter medications

For many years pharmacies have had non-prescription medicines available for use as sleeping aids. These all use a class of drug called antihistamines. In fact, apart from one product, they all use the same antihistamine called diphenhydramine. The exception is doxylamine, but as it is still an antihistamine the effect is the same.

Although these medications are usually used for allergies, one side effect is drowsiness. This makes them useful as sleep aids, but they can have other side effects. Dry mouth, grogginess in the morning, constipation, blurred vision, and being unable to urinate are most common. Be aware that they can make certain health conditions worse and are not recommended for the elderly. Side effects can be worse in older people.

These medications can help you fall asleep, but do not work very well if you wake up in the middle of the night. Your quality of sleep will not be as good as with regular sleep. They are best used only to bring sleep back to a more regular pattern. Use them sparingly. If they are not effective after three nights, or you still need them after two weeks, they are not right for you. Talk to your doctor about more effective treatments.

Prescription options

Sometimes nothing you do seem to work. After some discussion, you and your doctor may decide to try a prescription sleeping aid. These medications are usually stronger than non-prescription items. You may have heard about people becoming ‘addicted’ to sleeping pills. When taken for less than four weeks and used only two to three times per week, these medications are unlikely to create dependence. However, if you have taken sleeping pills for a long time, do not stop suddenly without first talking with your doctor or pharmacist.

Side effects from prescription sleep aids are also stronger. As they can cause drowsiness and unsteadiness, falls are a serious concern. Talk about this with your doctor before trying such medications.

Together, prescription medication and good sleep habits can bring a poor sleeping pattern back in line. It will take some time and work on your part to get the best results.

Trouble sleeping can be frustrating. Look honestly at your sleep habits and see if they can be improved. Even small changes may help. Talk to a trusted health care provider. With the right advice and some effort, you can stay clear of problems and finally get a good night’s sleep.