April, 2011 – Insomnia


Ask the Docsask-the-docs


By Heather Loguidice, ARNP



Everyone, at one point in their lives, has experienced difficulty either falling asleep or staying asleep.  According to the National Sleep Foundation, about 20% of Americans report that they get less than 6 hours of sleep each night. One of the most common complaints I hear about from my patients is poor sleep. We live in a 24/7 society that offers 24 hour cable TV, the internet, restaurants, and even shopping.  It is no wonder that most of us have a hard time “shutting our brain off” in order to fall asleep.


Most people require 7 to 8 hours of sleep each night in order to function optimally and feel well. Insomnia can lead to poor work performance, driving accidents, increased anger and depression. Recently, heart disease, hypertension, diabetes, and obesity have all been linked with chronic sleep loss. Many people do not realize that sleep is just as important for overall health as diet and exercise.


Insomnia is considered to be primary when it is not due to any other health condition. Secondary insomnia means that a person is having sleep problems because of something else, like depression, pain, heartburn, or asthma.


Insomnia can also vary in how long it lasts and how often it occurs. It can be short term (acute) or it can last a long time (chronic). It can also be episodic. Acute insomnia can last from one night to a few weeks. Insomnia is considered to be chronic when it lasts at least 3 nights per week for a month or longer.


Acute insomnia is typically related to stress, particularly life altering events such as a job loss, divorce, death of a loved one, or a move. Other common causes of acute insomnia include illness, emotional or physical discomfort, jet lag, certain medications, such as Sudafed and antihistamines, and environmental factors like noise, light, and temperature.


Chronic insomnia is usually associated with depression/anxiety, chronic pain, and chronic stress.


Treatment of insomnia varies depending on the duration and cause. A sleep diary can be helpful in formulating a treatment plan. Sometimes, medication will be prescribed for a short time to help reset your body’s inner sleep clock. Secondary insomnia is best controlled by treating the underlying health problem or eliminating the aggravating factor, such as decreasing caffeine, nicotine, and alcohol.


There are many natural sleep aids available on the market. These herbal remedies and supplements are not regulated by the FDA for quality, dosing, and formulation. Therefore, it is difficult to test their safety and effectiveness.


A common natural sleep aid is melatonin. Melatonin is a hormone produced by the pineal gland in your brain. It helps to regulate the body’s circadian rhythm. Studies have shown that melatonin decreases the time it takes to fall asleep, increases drowsiness, and may increase the duration of sleep. It has also been used successfully to reduce the feelings of jet lag. Studies show that 0.1 to 0.3 mg is a safe dose for short term use (3 months or less). It has not been studied for long term use.


Valerian is another popular herbal extract used for insomnia. Studies have shown mixed results in relation to valerian usage. Some did not show any benefit over placebo. Valerian is recommended for short term use of 4 to 6 weeks only.


Chamomile is a popular herbal sleep remedy that has been used for centuries. It is available as a tea or as a tincture. It generally causes a calming effect and may help people feel relaxed. It is considered safe for short and long term use.


Kava, also known as kava-kava, is an herbal remedy for anxiety and insomnia. It is not recommended and has been linked to at least twenty cases of liver failure in Europe. Kava is still available in the United States, so it is important to read the ingredient labels on all herbal products. Do not take the product if it contains kava.


Good sleep habits can help to correct and prevent insomnia. Here are some tips to help you get a good night’s sleep:

          Try to go to sleep at the same time each night and get up at the same time each morning. Avoid taking naps.

          Avoid caffeine, nicotine, and alcohol late in the day. These are all stimulants.

          Get regular exercise, but don’t exercise within four hours of bedtime. Exercise can also act as a stimulant.

          Avoid heavy meals within four hours of sleep. A light snack at bedtime is OK.

          Your bedroom should be dark, quiet, and not too warm or too cold.

          Read a book, listen to music, or take a bath prior to sleep.

          Do not watch TV in bed. Do not work from your bed.

          Make a to-do list before you go to sleep so your mind can rest.


I wish all of you many good nights of sleep.  If you would like further information or need to be evaluated for insomnia, please contact us at Family Medical and Wellness Center (561) 721-1953.