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I can't sleep: The latest on combating insomnia

I am high maintenance when it comes to sleep. Conditions have to be perfect: dark, quiet, not too hot, not too cold. If I stay up too late, I may miss my bedtime window and not be able to sleep. If I go to bed too early, I may be awake for hours. Interruptions provoke an unfiltered rage because I know I may not be able to get back to sleep, meaning I'll be tired in the morning, grumpy and volatile all day, and unproductive at work. Sleep is key to my wellbeing and relationships, but getting a good night sleep can be a major challenge.


Studies show I'm not alone. Insomnia affects nearly 1/3 of adults, and stress (think Covid-19) and chronic disease can make it worse.


Poor sleep can also contribute to health problems, increasing the risk for weight gain, diabetes, and possibly mood disorders, reduced immune function, heart problems and even decreased life expectancy. Adequate, restful sleep is important.


So, what's an insomniac to do? Here's the lowdown on treatment options and sleep meds:


Before turning to medication, make sure you practice good sleep hygiene:

  • Go to bed and wake up at the same time daily.
  • Limit alcohol, especially near bedtime
  • Avoid caffeine within about 6 hours (or more) of sleeping
  • Avoid daytime naps
  • If you can't sleep for more than 15 minutes, get out of bed, go to a different room, and do a quiet activity (no screens!) until you feel tired enough to try again.

Try meditation. Try breathing or relaxation exercises. This guided meditation was recommended by a physician friend.

Talk to your doctor if you take medications that can impact sleep (stimulants, some antidepressants, some blood pressure medications, steroids, and others). 


Know that most sleep meds only increase sleep by 15-30 minutes. 


Weigh risks and costs of medications:

  • "Z-drugs" [zolpidem (Ambien), etc.] cost <$1 but may cause serious injury or death from sleepwalking, sleep-driving, etc. They usually shouldn't be used long-term.
  • Ramelteon (Rozerem) is similar to melatonin, but costs about $6/dose.
  • Belsomra, Dayvigo are newer medicines to help people fall and stay asleep, but they can cause side effects and interact with other meds.
  • Antihistamines (Benadryl, etc.) have side effects (confusion, urinary retention, etc.) and limited benefits.
  • Benzodiazepines (Ativan, Xanax, etc.) are too risky and addictive; they should be avoided.
  • Other meds (trazadone, doxepin, mirtazepine) may be helpful in certain circumstances.

Consider supplements (but have realistic expectations)

  • Melatonin (usually 3-6 mg) may help some people fall asleep. 
  • Valerian could be considered, but chamomile and kava are unlikely to help.

I also wear ear plugs and use a white noise app – both help a lot.


Finally, emerging evidence shows diet and sleep are intimately connected. Studies show sugar, saturated fat, and processed carbs can interfere with sleep. Plants, fiber, unsaturated fat may improve sleep.


Here's to sleeping better in 2021! Hopefully we won't have as much to keep us up worrying. Please add your own suggestions in the Comments section below.  



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