Insomnia

What causes insomnia ?

• jet lag (particularly travel from west to east)
• an unsuitable sleeping space, for example one that is too noisy, bright or cold)
• medications
• recreational drugs
• nicotine, alcohol and caffeine
• pain
• an inactive lifestyle
• stress
• grief
• pregnancy

Insomnia may be a symptom of another disorder, such as depression or anxiety, restless leg syndrome or sleep apnea.

Another thing that makes insomnia worse is worrying about insomnia.

What are the symptoms of insomnia ?

The symptoms of insomnia are difficulty falling asleep and staying asleep, and waking too early in the morning.

As a result of lack of sleep, you may feel tired during the day and find yourself dozing. You may also feel anxious, irritable and unable to focus. Some people get headaches from lack of sleep. People with some long-term conditions may find their illness flares up if they don’t get enough sleep.

What to do if you think you have insomnia

Try the lifestyle tips outlined in the treatment section. But if lifestyle changes have not worked and your insomnia has been going on for months, see your doctor. They can give advice about lifestyle changes and check out any underlying conditions that might be causing insomnia.

You can buy over-the-counter remedies for sleeplessness. Talk to your pharmacist and doctor about these. You can use them for one to two weeks.

See a doctor about your insomnia if you have experienced it several times a week for three months.

How does a doctor diagnose insomnia ?

The doctor will talk with you about your sleep and tiredness. An insomnia diagnosis typically features one or some of the following sleep problems happening at least three times a week and interfering with your waking life:

• difficulty falling asleep
• difficulty staying asleep
• waking too early and not being able to get back to sleep

The doctor will ask you to keep a sleep diary. They may also ask about any meds you’re taking, including herbs and recreational drugs, as well as your use of tobacco, caffeine and alcohol.

When investigating insomnia your doctor will check you over to see if you have depression or anxiety, or any other underlying condition that has insomnia as a symptom.

They might refer you to a sleep clinic which can run an overnight polysomnography test on you. You’ll sleep overnight at the clinic, wired up to measure different stages of sleep.

How will a doctor treat my insomnia ?

Your doctor will investigate possible causes of your insomnia by asking you about your general health and lifestyle. They may ask you to keep a sleep diary, which will help to identify possible causes of your insomnia.

They will treat any conditions that might be causing insomnia, for example arthritis, allergies, depression or back pain. But sometimes insomnia needs separate treatment from these disorders.

Then your doctor will give advice on sleep hygiene and some lifestyle changes for you to try.

Your doctor will try sleep medication if your insomnia is very bad or if other treatments have not worked.

Lifestyle changes to treat insomnia

Sometimes improving the way you go to bed can relieve insomnia – this is known as sleep hygiene. Here are some pointers to improve sleep hygiene.

Exercise during the day, not at bedtime. An active lifestyle will help you sleep, but exercising within four hours of your bedtime might make it harder for you to fall asleep.

Make your sleeping space comfortable, dark and quiet. Think about blackout curtains, an eye mask or ear plugs, and check that your mattress and bedding are right for you. The ideal sleeping room temperature is on the cool side – about 18 °C.

Manage your exposure to light to relieve insomnia. Getting some natural light early in the day can help insomnia; and keeping bright lights – including screens on phones, devices and TVs – out of the bedroom may be helpful for some people who have insomnia.

Avoid stimulants before bed. Tobacco use, tea and coffee can keep you awake. Alcohol can help you to fall asleep, but it results in shorter, lighter sleep, which can make insomnia worse. Try not to use them in the six hours before you go to bed.

Get a good sleep routine. Going to bed and getting up at the same time every day will help you develop healthy sleep patterns. Start your sleep routine about an hour before you want to go to sleep. Use a series of activities to prepare yourself for sleep, for example, cleaning your teeth, listening to calming music and reading a book.

Don’t nap. If you have a bad night, don’t nap to catch up. Keep to your regular sleeping hours.

Relax for an hour before bed. Read before bed, or take a bath. Avoid using bright screens.

Eat earlier in the day to prevent insomnia. Eating a large meal late at night can make it harder to fall asleep. The last meal of your day should not be fatty or spicy as these types of food can keep you awake.

Practice relaxation to prevent insomnia. Stress and anxiety can lead to insomnia so practising relaxation techniques can be helpful.

Are my meds causing my insomnia?

Some medications for other conditions can cause insomnia. Talk to your doctor or a pharmacist about the meds you are taking. Ask if insomnia is a possible side-effect. Your doctor or pharmacist may be able to adjust your prescription or your dose so it is easier for you to fall and stay asleep. If you think your meds are making it hard for you to sleep, ask for a medicines review.

Cognitive behavioural therapy for insomnia

According to Sleep On It Canada, one of the best treatments for insomnia is cognitive behavioural therapy for insomnia (CBTi). It has a 70-80% success rate within a few weeks. It focuses on the psychological and behavioural factors that contribute to chronic insomnia. You can get CBTi courses online, but many people do better with direct guidance from a therapist.

Treating insomnia with medications

Doctors prescribe insomnia medications if lifestyle changes have not helped. Sleeping pills are usually for short-term use.

Your doctor may prescribe immediate relief insomnia meds to help you fall asleep. Other types of sleeping pill are intended to help you fall asleep again if you wake in the night. Some insomnia meds come in an extended release form, which have a first layer that dissolves fast to help you fall asleep, and then a middle layer that dissolves slowly to help you stay asleep. Your doctor will decide which format of sedative or hypnotic is best for you.

Most sleeping pills are taken ‘as needed’ and only when you are ready to go to bed. Ask your doctor or pharmacist for clear instructions about when you should take your sleeping meds.

There are several medications commonly used to treat insomnia. These include benzodiazepines such as temazepam and hypnotics such as zopiclone.

Benzodiazepines

Examples of benzodiazepines prescribed for insomnia are temazepam, triazolam, lorazepam and diazepam. Some people find that they become dependent on benzodiazepines, and have to go through withdrawal when they stop taking them. Ask your doctor or pharmacist for advice about withdrawing from benzodiazepines.

Other meds that treat insomnia

Some other meds that are used to treat insomnia include hypnotics such as zopiclone and zolpidem.

Sleep medication and tolerance

Many people find that sleep meds get less effective over time. This is known as tolerance. Doctors tend not to prescribe sleep medication for long periods to avoid tolerance.

Can I drive or ride a bike if I take sleeping pills?

You should not drive, cycle or operate heavy machinery until the effects of your sleeping pills have worn off. Some sleeping meds can impair your reactions, affect your eyesight, or make you feel confused. This can make it unsafe to do safety-critical tasks that require concentration. Ask your doctor how long your sleeping meds will affect you.

Will my sleeping pills cause memory loss?

Some types of sleeping pill are linked to memory loss. People have taken their meds and then engaged in activities such as phone calls that they later can’t remember. If this happens to you, tell your doctor, as it means the medication is not suitable.

Can I drink alcohol with my sleep meds?

Avoid drinking alcohol if you are taking sleeping pills. Alcohol is a sedative, and it can amplify the effects of a sleeping pill. Some people who combine alcohol with sleeping pills find that the amplified sedation affects their breathing.

Will recreational drugs interact with my sleeping pills?

It is likely that recreational and street drugs will interact with sleeping pills. The combination of cannabis and sleeping pills, or opiates with sleeping pills could depress your breathing, or make it very hard for you to wake up.

How do I get medications for insomnia ?

There are some insomnia meds that are available over the counter. Ask your pharmacist about these. But most sleeping pills are only available on prescription. To get temazepam, triazolam and zopliclone, you will have to consult your doctor. They will prescribe any sleeping meds that you need. You can then take the prescription to a pharmacy, such as NX Pharmacies, and they will fill it.

In Canada you can depend on NX Pharmacies for your insomnia meds. We serve all areas of Canada and can fill your prescription of insomnia medication. We can help with renewals and refills. Our discretion is assured, and you can depend on us for authentic Health Canada-approved medications.

Even if you’ve been successfully managing your insomnia for years, you can still benefit from the support of a doctor or pharmacist.

If something changes with your insomnia , talk to your GP. And if your meds stop working, or you start to get uncomfortable side-effects, ask for a medicines review. Your pharmacist may also be able to advise on managing side-effects of your insomnia meds.