Frequently Asked Questions about Insomnia and Sleep Aids

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What should patients try before taking a sleep aid?

1. If, as in many cases, the insomnia is of recent onset and associated with stressful life experiences, it will likely resolve as the stress passes.

2. Sleep Hygiene is always the first approach if the insomnia does not resolve spontaneously. For example, this includes eliminating caffeine intake for at least 6 hours before attempting to initiate sleep.  For more sleep hygiene tips, click here.

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How are sleep aids chosen as appropriate for patients?

Usually the duration of the medication is matched to the pattern of the insomnia.  This is often a trial-and-error process.

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Are sleep aids addictive? What are the safety concerns?

1. Older prescription sleep aids still in use for treating insomnia are potentially addictive and toxic in overdose, and can lose effectiveness with regular use.  Others induce as much daytime as nighttime sedation, which affects waking performance and can contributes to automobile accidents, particularly when combined with alcohol.

2. Over-the-counter sleep aids often include sedating antihistamines. These agents have limited effectiveness and often induce next day sleepiness after nighttime use, potentially leading to car accidents and poor school and work performance.  In the elderly, these agents can lead to confusion and falls.

3. Newer prescription agents are safer, more effective, and less addictive.  Still, safety concerns include:
a. These agents induce sleep and should not be taken during waking activities. – In some situations (driving, going to a party, or talking on the phone) these agents can induce cognitive confusion and memory impairment.
b. All sleep aids should be used with caution in individuals with a history of addiction and addictive personalities.
c.  In the elderly, due to the danger of nighttime falls, these agents should be used cautiously and at lower doses.

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Are some insomnia symptoms easier to treat than others?

Many insomnia symptoms are readily treated with interventions such as encouraging, teaching, and reinforcing healthy behaviors, as well as eliminating maladaptive behaviors that contribute to sleep difficulties.  A simple example: removal of technology from the bedroom and eliminating computer use one hour before sleep.  This is an example of identification of an issue, education on why it’s likely an unhelpful physiologic behavior, and teaching a change. The next step is execution.

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What are some new developments in sleep aids?

There are currently some medications working their way through the research process that target new and specific chemicals/hormones or receptor sites and hold promise.  Other non-prescription approaches include is the commercial development of other 'aids' that may contribute in some way to sleep improvement; for example, new bed designs, natural supplements and additives/scents.

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