Insomnia – Managing Without Medications!

-Insomnia – Managing Without Medications!

Dr Guruprasad Mohanta, Professor,Annamalai university

Insomnia is a common issue with elderly patients. The problems may vary from person to person which range from ‘difficulties falling asleep’ to ‘trouble staying asleep’ to ‘early morning awakening with inability to resume sleep’. This makes people difficult to do the day time functions. Most often the health professionals find a remedy with medications often not realizing the danger of using these medicines. The common medications used for treating insomnia includes benzodiazepine and non-benzodiazepine. They are all associated with serious adverse effects: driving impairment, dizziness, anxiety, depression, suicidal ideation, confusion, memory loss, amnesia, addiction with withdrawal symptoms, falls and hip fractures. However, there are better approaches of managing insomnia without medications. Often sounds surprising but are less expensive, less dangerous and more sensible.

These approaches are: stimulus control, sleep restriction, sleep hygiene education, cognitive therapy, multicomponent therapy, and relaxation therapy. This small write up does not intend to have a review of all the approaches but general guidelines which can be easily adoptable:

·         Go to bed only when you are tired or feel tired. Use bed or bedroom only for sleep not for reading books or watching TV. If you do not get sleep within 15-20 minutes, leave the room and return only when you sleepy. Get up at the same time every morning irrespective of quantum of sleep you had. Avoid napping and if needed take before 3 in the afternoon.

·         Avoid the use of caffeine containing products like tea, coffee; nicotine; alcohol during later part of the day. Avoid heavy meals within 2 hours of bedtime. Do not drink liquids after dinner to prevent night time urination. Make bedroom atmosphere conducive to sleep like good mattress, comfortable temperature.

·         While in bed, relax and have good and pleasant thoughts. Continue your regular physical activities including daily exercise but avoid vigorous exercise close to bedtime.

The above non-pharmacologic treatments are proved to have long term benefits. Our pharmacists may keep this in mind while counselling the patients that non-medication approach are feasible and effective too.

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