Pharmacy/Insomnia

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Question
Hi Gisella, I'm a sufferer of insomnia I basically take anything in the cupboard to help me sleep. I've taken codeine based drugs, serapax and Xanax but I've been told that these are addictive?! I've also tried herbal alternatives but they just don't do the trick. Do you have any suggestions? What should I ask my doctor to prescribe? Are they likely to help me out?

Answer
Dear Jenny,
Thanks for your question.  Insomnia is a common problem.  For most of us, it occurs sporadically and is not usually a cause for concern, but for many others, it occurs frequently and can be problematic.  I feel for you.  Let's see if we can sort this out.  

I think it's important to start from the basics.  What is the route of the problem?  Why is it that you can't get a full night's sleep?  For example, are you in pain or discomfort?  Is there something on your mind? Feeling cold/hot or generally uncomfortable?  Is your environment not conducive to sleep; too noisy, too much light etc etc?  Do you have any other medical conditions, as some of these may impact on sleep?  What other medications are you on?  Some medications may cause insomnia.  Be sure to discuss this matter with your family doctor.  There may be an underlying cause to your insomnia, which may easily be mitigated.  A far more simple solution may exist, rather than having to resort to potentially harmful or addictive pills.

Medications that are prescribed for insomnia, whether it be difficulty getting to sleep, waking early, or for disrupted sleep, are referred to as hypnotics, and include those you mention.  Yes, these are invariably addictive, both physically and psychologically, and are designed for short-term use on an as needed basis.  The reality, however, is that some people may require these regularly.  It is important to work together with your physician and as hard as possible to avoid this.  These medications have other concerns to consider, such as drowsiness, which of course, is what you're after, but be aware of the potential grogginess the following day.  This may affect work, general performance and driving ability.  Tolerance may also develop, which may necessitate a dose increase.  If you must take these, be sure to take the dose prescribed strictly as directed.  Large loses may be fatal.  It is best to avoid alcohol concurrently, as this could potentiate the drowsiness.  And avoid driving or performing complex functions.  Note also that other medications you may be on may interact with hypnotics or increase side effects.  Codeine is not usually prescribed for sleep, unless there is underlying pain.  It also has the added problem of constipation.  So, Jenny, the bottom line is to avoid these medications if at all possible, otherwise be sure to use the lowest dose for the shortest possible time.

You must also consider proper sleep habits or 'sleep hygiene'.  Avoid caffeine (coffee, tea etc), surgary beverages and high energy drinks before bed.  Smoking (nicotine) is best avoided.  Exercise and vigorous physical activity may be very stimulating before bed.  However, it is important to note that exercise in general is great as it uses up a lot of energy and allows your body to tire naturally.  The adrenaline sometimes keeps people up.  If this is the case, try exercising in the morning or during the day.  Avoid napping during the day.  Try to wind down before bed time, perhaps taking a warm bath or practicing meditation.  Try a glass of warm milk, although the jury's still out on whether this is truly effective.  You mention that herbals haven't worked for you.  What have you tried?  Consider products containing valerian or melatonin.  Remember, that only because these products are "natural" does not mean they do not have side effects or the potential to interact with other medications you may be on.  Be sure to ask your pharmacist first.  Sedating antihistamines may also be of use short term.  These also have a range of side effects, contraindications and drug interactions.  Again, speak to your pharmacist.  And lastly, Jenny, the worst thing you can do when you can't fall asleep is just lie in bed in frustration.  Allow yourself 10-15min in which to fall asleep.  If it hasn't happened by then, turn on your lamp, sit up and engage in some sort of light activity eg, read a book.  Do this until you feel the urge to sleep.  Do not just lay there.  The anxiety that this generates may potentiate your insomnia and generally reinforces negativity associated with sleep.  Allow your body to tire.  Eventually it will become exhausted.

I hope this helps.

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Gisella Campanelli

Expertise

I am able to answer questions relating to pharmaceuticals, therapeutic regimes and primary health care. This includes offering advice on drug indications, dosages, and disease state management. I can also identify side effects, drug interactions and contra-indications, and offer recommendations on ways to mitigate these. I can diagnose minor illnesses and suggest appropriate over-the-counter remedies and/or preventive healthcare tips. I can recognize cardinal symptoms which would otherwise require referral to a medical practitioner.

Experience

I am a registered pharmacist in Australia, and I have practiced in a hospital pharmacy for over thirteen years. My clinical specializations lie within the areas of psychiatry and general medicine (including gastroenterology, respiratory, endocrinology, neurology, infectious diseases, gerontology, dermatology). I self-managed the training program for pharmacy interns in preparation for their final registration exams, and I have worked for the Pharmacy Board of Australia as an examiner and exam writer.

Education/Credentials
I hold a Bachelor of Pharmacy from the Victorian College of Pharmacy, Monash University, and I am board-registered to practice within Australia. I also hold a Master's degree in an unrelated field (art conservation).

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