Error 4:04 a.m. Sleep Not Found

By Kevin Chilbert, Pharmacy Resident, Baptist Health Medical Center-Little Rock
 
Tired throughout the day? Lay awake at night? Constantly toss and turn trying to fall asleep? By the time you finally fall asleep your alarm goes off? Sleep is a very complex subject, but it is vital to the success of our daily lives and anything that alters it can have a profound impact.
 
Insomnia, the inability to fall asleep at night, can be very frustrating and even debilitating. It is something that everyone seems to go through at some point in life, and it can leave you feeling tired throughout the day and stressed at night. It can impair your ability to perform at an optimal level.
 
The list of what can cause insomnia is just about as long as the list of people who suffer from it. The most common causes are stress, medications, and environmental factors –– but proper sleep hygiene can actually be the best medicine of all.
 
Stress is something we all experience and can be hard to control. When we are stressed, our body compensates by releasing stress hormones, one of which is a steroid hormone called cortisol. This can be an excellent biological response in a multitude of situations, but not when you are trying to fall asleep.
 
Cortisol can cause hyperactivity and an inability to sleep. When this cortisol level is heightened around bedtime, you can remain restless and tossing around becoming even more stressed that you can’t fall asleep. And when those cortisol levels eventually drop to allow you to sleep, your alarm goes off.
 
There are many different things you can do to try and relieve stress such as daily workouts and staying physically active. Activity throughout the day can also make it easier to fall asleep. Other stress relievers include yoga, Pilates, meditation, or even taking time throughout the day to just breathe for a minute or two. For the stressors that can’t be resolved by these methods, you can try to live by the credo to not sweat the small stuff. Little stressors can build up if you hold on to them.
 
Medications that you may be taking may be another factor to cause you to not sleep well. Some of these include medications like steroids (remember cortisol?), stimulants like Adderall, decongestants like Sudafed, and select seizure and antidepressant medications. Other medications such as diuretics or water pills can cause you to have to get up and go to the bathroom throughout the night. If you are taking some of these medications too close to your bedtime, this may be contributing to your sleepless nights.
 
Talk to your doctor or pharmacist if any of the medications you are taking are to blame and to ask when the ideal time to take certain medications are or if there are alternate medications you can use that do not have these side effects.
 
Two other important substances to consider are caffeine and alcohol. We drink our cup of coffee in the morning to help wake us up, and if you have any during the evening hours, this can be a contributing factor as to why it is hard to fall asleep. Caffeine can be in medications, soft drinks, and, of course, coffee.  It is best to look at the ingredients of what you are taking to be sure there is no caffeine in it before you head to bed.
 
Alcohol can make you drowsy, which may seem enticing when trying to fall asleep. However, alcohol does not mean you will get restful sleep. It can disrupt your natural sleep architecture and leave you more tired in the morning. 
 
Another significant factor is your environment. Things like light, sound, television, and cell phones can alter your quality of sleep. Too much light in your room can alter how your body releases a natural sleep hormone called melatonin, which can make it harder to fall asleep. People sensitive to sound when they fall asleep but cannot control it can try simple earplugs every night (though be sure to have a good alarm to wake up on time).
 
Televisions and cell phones at night are becoming increasingly common. If you say you are going to go to bed at 10 p.m. but then spend the next hour scrolling through your phone, you are setting yourself up for a hard time falling asleep. Your eyes are subjected to a light source very close to your face for an extended period of time, and it may decrease the release of your melatonin and keep your brain active. Instead, stay off the phone and limit the amount of electronics in your bedroom. Your bed should be for sleep, not scrolling at night.
 
Proper sleep hygiene, including going to bed and waking up at the same time every day, can resolve most people’s sleepless nights. For those who have tried sleep hygiene and it isn’t enough, there are a variety of medications that can help you sleep at night ranging from natural products to prescriptions.
 
Before trying any medication to help you sleep, talk to your doctor or pharmacist to see which is best for you. For example, diphenhydramine (Benadryl, ZzzQuil), should not be used as a daily sleep aid nor should it be used by people over 65. Diphenhydramine can cause dry mouth, urinary retention, delirium, and pose as a fall risk –– and those over 65 can be especially sensitive to these side effects.
 
Melatonin is a natural product that can help people who work night shifts to control their sleep/wake cycle.
 
Many sleep medications are not something that should be taken lightly due to potential adverse effects, which is why it is best to talk to your pharmacist or physician about which specific medication may be the best for you, if you need one.