INSOMNIA AND ZOLPIDEM
Jan 25, 2012
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Snow and wind follow Cliff Clavin as he walks into Cheers and orders a cold beer. Diane asks how Cliff how he could drink cold beer on such a cold day. Cliff explains its all about equilibrium. It is a well-known fact that when the British were in India they drank hot tea on hot days to equilibrate their inside and outside temperatures, Cliff explains. So Diane asks why Cliff drinks ice cold beer on hot summer days. Cliff answers, What else are you going to do with it?
On the TV show Cheers, Cliff Clavin has been known to tell stories that bored people to sleep. In real life, weve all had trouble sleeping at one time or another. Sometimes we were worried about an exam at school. Sometimes problems from family or work just seem to bounce around in our heads when we try to relax. So what can we do to improve our sleep?
Lets start with normal sleep. Normal sleep involves four to six cycles divided between rapid eye movement (REM) and non-REM sleep. Non-REM sleep consists of four stages. Stage 1 is a transition from wakefulness to sleep and lasts 30 seconds to 7 minutes. Stage 2 is a light sleep and we are in stage 2 about half the time we are sleeping. Stages 3 and 4 (sometimes called delta sleep) are deep sleep stages and these stages make you feel rested the next morning. If something disturbs your delta sleep, you will wake up in the morning not feeling rested. REM sleep is when you eyes move back and forth under your lids very quickly, but the rest of your body remains very still. REM is when you do your dreaming.
Insomnia can be having trouble falling asleep, getting enough sleep, but not feeling rested, broken up sleep, or waking up too early. There are some general rules you should follow to help get a good nights sleep. Go to sleep and get up at the same time every day. Use the bedroom only for sleep and sex. Dont read, knit, work, or watch TV in the bedroom. Do not drink coffee, tea or cola 4-6 hours before sleep, and try to drink as little of these caffeinated beverages as possible during the day. If you cannot sleep after 15 to 20 minutes, get out of bed and go to another room and read in a dimly lit area. Avoid watching TV as the bright light may wake you up more. Go back to bed only when feeling sleepy again. Avoid watching the clock. Some people even turn the clock face away them. Finally, avoid daytime naps.
If you still arent sleeping well after adopting good sleep habits, you might need a medication to help you. If that is the case, talk to your doctor. First your doctor will check you for any underlying health problems. For example, insomnia can be a symptom of another condition like painful arthritis. If we treat the arthritis pain, sometimes the insomnia will go away on its own.
If your doctor decides you need a sleep medication, there are several to choose from. Many over the counter sleep medications contain diphenhydramine. It is safe in many patients, but it doesnt work as well as the prescription sleep aids. It starts working in 30-60 minutes, but probably shouldnt be used more than 3 nights in a row or the patient will become tolerant to the effects. One of the common prescription medications for sleep problems are the benzodiazepines. A common benzodiazepine used for sleep is temazepam. Temazepam takes 1-2 hours to kick in and lasts 6-10 hours. Benzodiazepines work well for sleeping, but can become habit forming. Because temazepam can last for 10 hours in some people, morning drowsiness can be a problem. A different prescription sleep aid is zopiclone. Zopiclone starts working in 15-30 minutes and lasts 8 hours or longer. Because it is not a benzodiazepine, it is less likely to be habit forming. It has the interesting side effect of leaving a bitter, metallic taste in the mouth. If you drink something acidic like orange juice in the morning, that usually washes it away. If you drink something plain like water it can make it worse.
There is a new prescription sleep aid on the market called zolpidem. It is marketed in Canada as Sublinox. Youve probably seen the US TV ads for Ambien. Ambien is the US trade name for zolpidem. Zolpidem is one of the most popular sleep aids in the world. It starts working in 15 to 30 minutes and lasts 7-8 hours. This should mean less chance of morning drowsiness. It isnt recommended in patients over 65 years old due to the risk of dizziness, drowsiness and falls. An interesting thing about zolpidem is it is an oral disintegrating tablet. That means it dissolves quickly when you put it in your mouth. The downside is it cant be split in half. If you try, the remaining half will just turn to dust.
A general warning with all the sleeping medications, is dont mix your sleeping medication with alcohol. Alcohol can prolong the effects of a sleeping medication, effect your breathing , and mixing alcohol and sleeping medications have lead to very dangerous things like driving and having no memory of doing so.
If you have questions about sleep or sleeping medications, come down to the Dauphin Clinic Pharmacy where everybody knows your name. Everyone one needs someone like our pharmacists in their corner. Because like Norm would say, Its a dog eat dog world out there and Im wearing milk bone underwear.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
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As always if you have any questions or concerns about these or other products, ask your pharmacist.