I will now discuss the treatment of and cures for insomnia, which is varied. It is important to not forget good sleep hygiene habits, such as not watching a stimulating t.v. program or movie or reading a suspenseful novel right before bedtime. Light reading can be very helpful though, without the t.v. on. Relaxation techniques such as slow deep breathing and visualization of relaxing settings can help. Being in a dark and quiet bedroom is important.
The most common treatment of insomnia is sleeping pills, what I have referred to as the “band-aid approach”. For those with mild insomnia, they may respond to herbal medications such as melatonin, tryptophan, kava-kava, GABA, and other natural relaxants. Sleeping pills such as Ambien, Lunesta, Sonata, Restoril, Halcion and others can be helpful. Some use tranquilizers such as Valium, Klonopin, Ativan, Xanax and others. The prescription medications can certainly help, but can also be habit forming with potential rebound insomnia, meaning that it can then be difficult to sleep without taking one.
As always, I prefer to focus on cures for insomnia by preventing insomnia with non-addictive medications that re-balance the nervous-system properly, such as SNRIs, SSRIs, dopamine and GABA agents. See previous blogs or my book for a more detailed discussion of how these medications work. I try to focus on optimally treating the anxiety disorder, depression or bipolar disorder that leads to the insomnia. For those with less severe insomnia the anti-depressants and GABA agents are the treatment of choice. These would be those with difficulty getting to sleep and those with early morning awakening with difficulty getting back to sleep that I explained in the previous blog. For those with more severe treatment-resistant insomnia, the mood stablizers are the treatment of choice, such as the dopamine agents. The most effective dopamine agent for insomnia is Seroquel, which is one of the most common medications I prescribe, though it may be too sedating the next day for some. Other options in that class are Risperdal, Zyprexa, Saphris, Invega, Abilify and Geodon. Daytime sedation can be a problem if the medication is too strong or the dose is too high.
For unipolar disorder, the SSRIs such as Lexapro, Zoloft and others are the mainstay of treatment for most doctors. However, I don’t prescribe these nearly as much as the SNRIs, such as Pristiq, Effexor XR and Cymbalta, which are often more effective. Pristiq is currently the #1 medication I prescribe. Trazadone/Desyrel is a popular choice for many doctors and patients with chronic or acute insomnia. Stress reduction with a cardiovascular exercise program, meditation, yoga and a well balanced diet are important. Obesity can lead to insomnia due to sleep apnea, so losing weight when needed is crucial. The importance of a good night’s sleep can not be over-emphasized in order to ensure a high quality of life.