Sleeping difficulty

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Depression and insomnia

(Page 2)

Your health care provider will do a physical examination. To help better understand your sleeping problems, he or she may ask the following:

• Do you have difficulty falling asleep, staying asleep, or awakening too early?
• Do you wake up feeling unrested?
• How often do you wake up at night?
• How long have you had the problem?
• Have you taken any over-the-counter sleeping products?
• What medications do you take?
• Do you take any herbal supplements or alternative remedies?
• Do you drink much coffee or alcohol? Have you recently cut down on your coffee or alcohol?
• Do you have any excessive stress or anxiety?
• How much do you normally sleep? What hours?
• What do you do during the few hours before you go to bed?
• Does your sleep schedule change often? (shift work)
• Do you fall asleep at the wrong times or places?
• Does your sleep schedule change a lot on weekends?
• Do you worry too much about sleep?
• Do you have breath-holding spells, or do you snore?
• Do you have any aches or pains that prevent you from sleeping?

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In some cases, the health care provider may recommend the following:

• Sleep log record
• Thyroid tests (TSH, T3, T4)

In some rare cases, your health care provider may want you to see a sleep medicine specialist who will perform a sleep study (polysomnography)

MEDICATIONS

Some people may need medications to help with sleep for a period of time. Your health care provider can talk to you about using prescribed medications if they think it will be helpful

Some antidepressants such as Trazadone can be used at bedtime because they make you drowsy. If insomnia is caused by depression, treating the depression with the right medications or therapy should solve the problem.

Benzodiazepine sedatives such as clonazepam (Klonopin) or lorazepam (Ativan) are anti-anxiety medications that can also help people sleep. They must be used with caution because they can cause addiction.

Newer sleep medicines called hynpotics help reduce the time it takes you to fall asleep. They are less likely to be addictive than benzodiazepines. Two examples are the prescription medicines zolpidem (Ambien) and zaleplon (Sonata).

WARNING: The FDA has asked manufacturers of sedative-hypnotic sleep medicines to put stronger warning labels on their products so that consumers are more aware of the potential risks. Possible risks while taking such medicines include severe allergic reactions and dangerous sleep-related behaviors, including sleep-driving.

Review Date: 03/31/2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Michelle Benger Merrill, MD, Instructor in Clinical Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).