Coping with insomnia

Recently I have mentioned a topic that I could call a little more about today. Since insomnia is one of the most common symptoms in the field of psychiatry to which special attention is paid, I would like to bring you some truths and misconceptions about the habits and medications that are relatively often prescribed to you by your family doctor. Many of you are wondering what are the differences between lorazepam, diazepam, bromazepam, alprazolam, oxazepam, zolpidem and why are some taken more often and some less often? Why does your family doctor warn you to take hypnotics for no longer than a month? Is there an alternative to hypnotics and what habits should we gradually introduce into everyday life in order to improve the quality of sleep?

How do we define insomnia?

  • difficulty falling asleep that lasts an hour or longer
  • difficulty sleeping that occurs more than twice and lasts longer than 15 minutes

We approach insomnia in a way that examines whether there are causes of the same (sudden changes in weather, excessive caffeine consumption, dehydration, conflicts, hormonal oscillations, menopause, restless legs syndrome….) primarily eliminating the cause, not treating the consequences!

Here I want to emphasize the importance of sleep hygiene by which we mean:

  • going to bed at the optimal time so we could fall asleep no later than 11:45 p.m.
  • minimum 7 hours of sleep
  • avoiding intense workouts after 9 p.m.
  • reduce sweets intake
  • limit caffeine intake till 4 p.m. (coffee, tea, Coca-Cola)
  • do not take fluids before going to bed
  • the last meal should be consumed no later than 2 hours before going to bed
  • consuming alcohol in the evening no more than; for women 12g / dl, for men 24g / dl
  • reduce the use of laptops, tablets or cell phones just before bedtime
  • we are encouraged to read books before bed
  • yoga / meditation
  • biofeedback therapy
  • autogenic training
  • cognitive training
  • a light musical backdrop
  • it is advisable to use the bed ONLY for sleep- stimulus control
  • avoiding afternoon sleep longer than 15-20 minutes
  • going to bed at the same time

Hypnotics- truth and myths

Alprazolam causes addiction MYTH

Diazepam is the medicament of choice against sleep disorders MYTH

Lorazepam causes addiction TRUTH

Oxazepam has a short-acting effect MYTH

Zolpidem can be consumed for years MYTH

Clonazepam is the medicament of choice against sleep problems MYTH / TRUTH

Alprazolam is a medicament that does NOT cause addiction and it is very easy to omit it from therapy when the symptoms no longer manifest, no withdrawal syndrome is seen when omitted. It is an excellent remedy of choice for severe fear and sleep disorders. In minimal doses, in most patients in general practice clinics we achieve symptom control, and the reported side effects are minimal.

Diazepam is NEVER prescribed as a medicament for sleep disorders, in high doses has an effect on sleep, but in doses prescribed on an outpatient basis (2, 5 or very rarely 10 mg) they are not sufficient for this purpose and are mainly used for muscle relaxation due to overexertion syndrome and painful conditions of the locomotor system. On the other hand, we use this drug in combination with other psychotropic drugs for severe anxiety, aggression and other neurological diseases.

Lorazepam is addictive after just a few days of therapy. Therefore, we very carefully assess the need for this drug and resort to other options for long-term treatment. Keep in mind that this is one of the fastest addictive drugs and as a result of not taking the drug they have severe withdrawal syndrome. Never use Lorazepam for insomnia as the drug of choice!

Oxazepam has a medium effect, up to 12 hours, which is not short at all!

Zolpidem is one of the most popular hypnotics in general practice clinics, but it is not intended for long-term treatment of insomnia and it is not recommended to take it for longer than 3-4 weeks.

Clonazepam has a mild sedative effect, but its other dominant properties are used to treat completely different conditions in psychiatry. We try to avoid the use of Clonazepam in sleep difficulties.

What to apply in the end?

The options are numerous given the extreme variety of sleep difficulties in individuals. Therapy for sleep disorders can be monotherapy (single drug therapy) that is sought to be resorted to as much as possible, but it can also be polytherapy (therapy with two or more drugs). An important item that can sometimes confuse patients is the existence of antipsychotics or antidepressants in the therapy itself (Doctor… but I am not psychotic / depressed, why do you prescribe me antipsychotics / antidepressants if I have sleep problems?). What would be useful to point out is that such antipsychotics that are introduced into therapy are “antipsychotics with very mild antipsychotic action” which in low doses very successfully treat sleep disorders. It is also valid for antidepressants that are included in sleep difficulties, they are mild antidepressants, and their advantage is that they do not cause addiction, and regulate sleep difficulties in a quality and long-term manner. Dear all who receive such drugs from your psychiatrist or general practitioner (which is very rare) do not feel stigmatized, because knowledge about such drugs in the general population is very scarce! What to do when your doctor recommends short-term medication? The already mentioned short-term treatment of sleep difficulties, which in most cases is carried out by a general practitioner, lasts up to a month. Take in consideration that the treatment is carried out exclusively to calm the problems, but what you need to do is to adopt healthy habits and introduce sleep hygiene into your daily life.

“Simple actions eradicate seemingly unsolvable situations.”

Is there a series of thoughts that burden you in everyday life? Do you devote enough time to balancing your thoughts, set spiritual priorities, and give yourself room for leisure to relieve yourself of the stress of everyday life? Imagine how a lack of free time causes an individual to accumulate everyday difficulties and how these daily difficulties gradually find space in your subconscious and begin to affect the quality of sleep and sometimes the content of dreams? Let’s go back to the simple things we can do for ourselves to improve our health completely free of charge. Pay attention to the list of sleep hygiene measures and try to apply at least 2-3 elements from the list.

I am looking forward to your feedback and questions🙂

Sleep well and stay healthy!

Yours,

dr.Mamich