At some point we have all experienced some form of sleeplessness, lying in bed, unable to fall asleep or having trouble staying asleep. The last time this happened to me I was in bed contemplating my day ahead and worrying about traveling to a different location for work. I had gotten into bed at what I thought was a reasonable time. But there I lay intermittently looking at the time on my cell phone. Midnight became two, then four in the morning while listening to my husband blissfully snoring beside me.
My anxiety about my day turned into frustration. How was I going to function fully and stay awake after a sleepless night? Maybe if I prayed to God to quiet my mind and empty out all the thoughts that were running through my head I would be able to sleep. Why was I still awake at 5 am, a few hours before I had to get up! I thought back to all the things I ate and drank and finally, I remembered it was the tea! I had ran out of my decaffeinated tea which was the only type of tea I drink regularly and made the mistake of drinking a large cup of hot caffeinated tea a few hours before bedtime. Now I was regretting it! Yes, I am one of those people who doesn’t tolerate caffeine well. In fact a few gulps of Coca Cola or coffee will not only give me insomnia but also heart palpitations as well. It is unfortunate because I actually like the taste of a cold Coca cola but have learned to avoid it and on the rare occasions that I do crave a soda, I reach for something decaffeinated like Sprite, Ginger Ale or 7-up.
Anyway, I digress. Back to where I lay miserable and pissed off that I had to get up shortly having not slept the entire night. Needless to say I had trouble staying awake most of the day and that really sucked!
Insomnia is a very common condition affecting millions of people, which is why I don’t think there is a person in the U.S. that hasn’t heard of Ambien, a commonly prescribed medication for insomnia. Don’t get me wrong, this is not an endorsement for Ambien because I am one of those people who believes that this medication has been overly prescribed, leaving so many patients dependent on it – but that’s a whole other story.
WHAT CAUSES INSOMNIA?
Some causes may seem obvious but it is amazing how many of these things we overlook!
- Stress – Job stress, financial stress, your children, your spouse,your health…
- Caffeine– in tea, coffee, soda/pop, some energy drinks and even chocolate.
- Pain from a headache, a tooth that needs to be extracted, sprain joints..etc
- Sleeping in the day or napping – no wonder you can’t sleep at night!
- Going to bed too early
- Depression
- An Underlying Medical problem
- Manic disorder – often insomnia is a significant symptom among people with Bipolar disorder.
- Alcohol abuse – despite making you drowsy and appearing to help you fall asleep it interferes with the normal sleep cycle.
- Stimulants– like cocaine or those found in some cough medicines and many of the prescribed diet aids!
- Heavy smoking– so you are thinking “I don’t smoke a lot” well your body may feel differently especially when done close to bedtime.
- Sedative-Hypnotics (benzodiazepines): medicines like Xanax often prescribed for anxiety may help you fall asleep but for those who try to quit taking it withdrawal symptoms may present a problem. In this case withdrawal symptoms can make it hard to sleep.
- Room temperature being too hot or too cold
- Eating high Carbohydrate foods close to bedtime like sweets or sugar loaded foods which take time for your body to burn.
WHAT CAN BE DONE FOR INSOMNIA OR DIFFICULTY SLEEPING?
Believe it or not there are several things you can do to help your predicament.
SLEEP HYGIENE
- Go to bed when you are sleepy!
- Avoid watching television in your bedroom it should be reserved for sleep & sex. All that television provides you not only with visual stimulus but emotional stimulus that keeps your mind racing.
- Make sure the room is dark, draw the blinds or wear an eye mask. I love them at home or when I travel.
- Stop drinking excessive amounts of caffeine or at least cut down and definitely not close to bedtime.
- Stop smoking!
- Cut back on drinking liquids close to bedtime so that your sleep is not disrupted by going to the bathroom too often.
- Avoid alcohol your liver will thank you too!
- Start a routine exercise program. Start small.
- Take a hot bath with lavender oil & Epsom salt & soak for 20 minutes.
- Instead of a high carb sugary snack too close to bedtime consider yogurt or avocado rich in magnesium which helps with sleep. Low magnesium levels can contribute to insomnia.
- Consider taking a short-term over the counter Melatonin.
- Get off the phone! Why are you talking to people who stress you out right before bedtime?
- Listen to some calming music or read a relaxing book
- Learn some relaxation techniques and meditation.
If all or most of the above doesn’t seem to work then certainly see your PMD for medical options. There are a number of medicines used to assist in sleeping but they all have potential side effects you should consider or be aware of:
Benzodiazepines like Lorazepam, Temazepam, Zolpidem are supposed to be used short-term but unfortunately many patients become dependent on them. I cannot tell you how many times I have had to advise patients to cut back or wean off. Clearly these medicines can be very addictive if used daily or in the long-term. Also in long-term use it can cause memory problems or amnesic episodes. In the elderly population they should be used with caution and dosages should be adjusted because they can cause excessive drowsiness, poor balance and falls! Those with liver problems also may need to avoid this class of drugs or have dosages adjusted.
Antihistamines like Diphenhydramine (Benadryl) or hydroxyzine are another alternative for insomnia and are non-habit forming. The trouble is they can cause confusion or problems urinating in the elderly.
Trazodone is what they call an “atypical antidepressant” and is non-habit forming. Works well as a sleep aid even though it is also often prescribed as an antidepressant. I have often prescribed this in the elderly or those with substance abuse problems. In terms of side effects it can cause Priapism which is a prolonged painful erection of the penis. It is rare and obviously only an issue in men but requires medical attention.
I hope these notes and tips are helpful to you. Please feel free to share it with anyone you think may benefit! Guess who won’t make the mistake of drinking caffeinated tea again! Remember this should not replace your medical doctor’s recommendations. Don’t forget to see your doctor for a routine checkup or regarding symptoms of concern.
Karim
March 15, 2017I’m tired all the time