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Suggest Treatment For Insomnia

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Posted on Mon, 5 Jan 2015
Question: I am a 19 year old male. I have never found it easy falling to sleep at night, generally taking between 1 and 2 hours and regularly wake up feeling exhausted. In January last year this got more severe and It started taking around 3 hours to fall asleep, After almost 2 weeks is started using Kalms and found that on the first night they worked reasonably and I was asleep within an hour, this however returned to 2 hours within a week. I stopped taking the tablets and found that the time I took to fall asleep had returned to the normal (1 to 2 hours).

However, in early April it got even worse than before in just a week, on a couple of occasions I went without sleep after lying in bed for over 5 hours . I sought medical attention over the Easter Holiday and was prescribed quite strong sleeping tablets for two weeks. These worked well and I found that I for the first time that I could remember, I was waking up feeling refreshed during that two weeks.

Since then, it appeared to have returned to normal. However in the last week the time has increased up to 4 hours. I have also found myself waking up very late, often early afternoon (mostly on weekends), which is something I have never done. I sought medical attention again and was prescribed more sleeping tablets, this time considerably weaker.

I feel that the Doctor who prescribed them was just rushing the appointment as it was their last appointment of the week . I would rather not take more sleeping tablets, as while they do have a temporary effect, they apparently don't work in the long term. I really need a solution to this as it had a definite effect on my grades last year (currently studying at university) and I am worried that this will keep getting more severe
doctor
Answered by Dr. Chintan Solanki (39 minutes later)
Brief Answer:
No need to worry,your problem is curable

Detailed Answer:
Hi XXXXXXX

Thanks for writing to us. You are suffering from insomnia. You did not mention the medicines name you have taken.

Insomnia can be of two types.

Primary: Only sleep disturbance is the problem and no other major psycholohical or physical disturbance. In which treatment with medicines for sleep is needed.

secondary:There is some physical problem e.g headache or psychological problem e.g. depression and due to that sleep disturbance is there. In this, main approach is treatment of underlying problem.Medicines for sleep may or may not been needed.

In both types some measures can be helpful for sound sleep.

-taking a cup of warm milk before 15 mnt going to bed is helpful in 30-40% patients.

-do exercise regularly. Walk for half an hour will also be fine.

-do not use your bed for other work than sleep.

-do not take heavy dinner or fatty/spicy food at night.

-take bath before going to bed

-read subjects which you do not like while you go for sleep.

Hope I have given useful answer to your query.
Please revert back to me with medicine details and any other information (stress in life or any physical problem)if you think you have secondary type of insomnia.

Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Chintan Solanki (1 hour later)
Unfortunately, I do not know the name of the sleeping tablets I was prescribed on the first occasion, all I know about it was that it was quite a powerful sleeping tablet and I was warned that it was possibly addictive and so was limited to a 2 week period. On the most recent occasion, I have been prescribed Promethazine HCl. I do not suffer from any other medical issues that I know of.

All three times where it has become more severe have been while I have been at University and around the exam periods, however I do not feel stressed and do not stress over exams.

One of the main points of confusion for me is that I always take at least 1 hour to fall asleep. Would this be associated with insomnia or is this normal?

I have tried a variety of methods to reduce the time it takes me to fall asleep normally, and while they often work for a week or two, I have tried everything you included in that list (some of them I do on a daily basis anyway). I always try to keep the time I go to bed as close to 11pm as possible.
doctor
Answered by Dr. Chintan Solanki (8 hours later)
Brief Answer:
Zolpidem is the best suitable medicine for you.

Detailed Answer:
Hello,

Thanks for writing to us. Sorry for delayed reply.

Your problem is clear to me now. You have mentioned that you have severe problem of sleep, while in university and around the exam periods. It suggests that it is your mental subconscious stress which is disturbing you though you do not feel it at conscious level.

During such exam or reading time it is usual to fall asleep late. Normal sleep latency( time from going to bed to fall asleep) is 10 to 20 minutes depending upon individual lifestyle. However, 1 hour of sleep latency is not normal at all. For you, it is part of study related insomnia.

However, if you suffer from this 1 hour sleep latency always(even though there is no study, stress or university), your problem should be evaluated in detail, it may require detail history, mental status examination and sleep EEG study.

It is not the case with you only. It happens to lots of studying students and specially around exam time. They can not sleep when they will suffer insomnia. In such cases, we prescribe zolpidem which is good drug for sleep onset. You can wake up after 3-4 hours without sedation and without affecting your memory. It does not cause dependence if taken under medical supervision and as suggested by the doctor.

Most probably, you were prescribed this drug on the first occasion. Promethazine is not particularly drug for sleep. It is an antihistaminic medicine which can cause sedation as side effect and that's why somewhat useful in sleep.

So consult your doctor, discuss the issue and ask for prescription of Zolpidem.

Hope I have answered your query. I will be glad to answer if more queries.

Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
Answered by
Dr.
Dr. Chintan Solanki

Psychiatrist

Practicing since :2007

Answered : 2406 Questions

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Suggest Treatment For Insomnia

Brief Answer: No need to worry,your problem is curable Detailed Answer: Hi XXXXXXX Thanks for writing to us. You are suffering from insomnia. You did not mention the medicines name you have taken. Insomnia can be of two types. Primary: Only sleep disturbance is the problem and no other major psycholohical or physical disturbance. In which treatment with medicines for sleep is needed. secondary:There is some physical problem e.g headache or psychological problem e.g. depression and due to that sleep disturbance is there. In this, main approach is treatment of underlying problem.Medicines for sleep may or may not been needed. In both types some measures can be helpful for sound sleep. -taking a cup of warm milk before 15 mnt going to bed is helpful in 30-40% patients. -do exercise regularly. Walk for half an hour will also be fine. -do not use your bed for other work than sleep. -do not take heavy dinner or fatty/spicy food at night. -take bath before going to bed -read subjects which you do not like while you go for sleep. Hope I have given useful answer to your query. Please revert back to me with medicine details and any other information (stress in life or any physical problem)if you think you have secondary type of insomnia. Regards, Dr.Chintan Solanki.