Insomnia




Insomnia is described as randomly delay of sleep greater than 30 minutes, difficulty in maintenance of sleep or abridged duration of sleep. Insomnia can be classified based on cause or by duration. There are non-prescription drugs and non-pharmacologic intervention that can be considered in treating insomnia.

Classification based on cause: A. Primary Insomnia is a condition in which a person experiences constant insomnia with no medical condition or psychiatric condition accounted for. The source or cause of this condition is unknown but it can be treated. B. Secondary Insomnia can be due to substance abuse, medical condition, psychiatric disorder, lifestyle habits such as use of caffeine, or situational stress.

Classification of Insomnia by duration: A. Transient Insomnia is a self-limiting insomnia that can lasts to less than 1 week. It is due to acute situational stress or circadian issues like working in shift or jet lag. B. Short-term Insomnia is related to situational stress to work, medical or psychological issues, or family matter. It can last from 1 week to 4 weeks. If this kind of insomnia is not attended properly, it can lead to chronic insomnia. C. Chronic Insomnia is a kind of insomnia that requires proper assessment since it could be due to medical disorder. It is more likely associated to psychiatric problem mainly depression.  
Most of people are guilty of doing self-medicating in the effort to correct the condition. They often consider drinking alcohol just to get into sleep. As of the often, there are no data supporting the safe and effective use of complementary therapy as sleep aids. So before taking any medication for insomnia, it is better to consult a doctor first.

OTC medicines (sleep aids)
1. Diphenhydramine is a drug that blocks histamine making the person relieved from allergic cough and colds. It is also as sleep aid such as Unisom Sleep Gels, Simply Sleep, and Compoz (these brand names are available in US). Unfortunately, in some countries, this drug is not directly promoted as sleep aids. You can ask your local pharmacist about it.
Dosage: For person aged 13 or older, 25 mg- 50 mg per night can induce sleep. Greater than 50 mg dose will not give more beneficial effect but will only enhance the chance of experiencing adverse effects. A dose of 1 mg/kg/night may be given to children aged 6 to 12 but must be of doctors’ order. Diphenhydramine is not recommended for children below 6 years old. There is a decrease of efficacy if use more than 10 consecutive days.
Diphenhydramine has anticholinergic adverse effects. It can cause dryness of mouth, urinary retention, constipation, blurred vision, and decrease in perspiration. It is contra-indicted to person suffering from cardiovascular disease, dementia, glaucoma and benign prostatic hypertrophy.

2. Melatonin is another drug recommended for person suffering from insomnia specifically in circadian issues like jet lag and work shifts. Melatonin is a nocturnal neuro-hormone secreted by pineal gland which is decreases production as people age.  There are also some factors that decrease production of melatonin namely, alcohol, tobacco and some medication such as steroids, non-steroidal anti-inflammatory drugs, calcium channel blockers, fluoxetine, and benzodiazepines.
Dosage: It may be dosed as 0.3 mg – 5 mg during the day or at night, depending on the desired effect. The dose of greater than 1 mg may improve sleep efficiency but have not shown the capacity to offer quality sleep restoration.

3.Doxylamine is also anti-histamine drug which induces sleep by blocking the histamine and muscarinic receptors. It acts in the same manner as of the diphenhydramine. The usual dose of doxylamine is 25mg per night.

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