Posted tagged ‘Medication’

Why an integrated approach?

January 26, 2010

There are a vast number of ways to approach sleeping problems.  Some are, in my opinion, utterly worthless.  I am not interested in purported treatments which are based on sham theories or have failed to stand up to scientific testing.  There are, however, a number of treatments which at present hover uncertainly between the alternative and orthodox worlds of medicine.

Light therapy is mostly on the orthodox side, for instance, although I have heard of a few rather dubious applications of it, such as a pulsed light mask that purports to treat migraine and PMS (there was one trial by the manufacturer, then it was never heard of again).  Bright light therapy for Seasonal Affective Disorder is by now very well established and offered as a routine treatment in many countries.  A smaller but still significant number of trials have shown that it is almost as effective for non-seasonal depression.  Bright light therapy for sleep disorders has been fairly well researched by now, but it is not yet as well established within the medical profession, although I think it is slowly getting there. Dawn simulation has generally been researched for SAD (it mostly comes out as nearly as effective as bright light therapy) and for sleep, in particular for people who struggle to get up in the morning.

Darkness therapy is a much smaller affair, perhaps because there is less money to be made by selling products for it.  It is generally researched by the same people who research light therapy and follows on from the same research, for instance into how different wavelengths of light are received by the eye and affect hormones within the body.  The main application at present is sleep, although there has been some interesting research concerning rapid cycling bipolar disorder.

Herbalism is a big sprawling system of medicine that has been going on for thousands of years and probably contains every plant known to mankind by now.  Various orthodox medications are based on herbal remedies, for instance aspirin comes from willow bark, and some of the most effective have become relatively well integrated into orthodox medicine in some countries.  Since a few herbs have been subject to a decent number of clinical trials and have stood up well in research, I am sticking to those.  Herbal medicines are generally, though not always, milder in action than orthodox medicines and with a lower rate of side-effects.  Sadly, they are still poorly regulated and it is important to read up on dosage and make sure that you are buying from a reputable manufacturer.

Then there are the therapies where research is rather scanty but not entirely absent, and where at least some of the effect may come from the therapy’s being pleasant and relaxing.  I don’t think that aromatherapy will cure a severe sleep disorder, but I’ve heard many doctors recommend lavender oil for mild insomnia, and having a nice warm bath with Epsom salts (magnesium sulphate) seems to be at a similar level.

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Medication for sleep

January 26, 2010

Short-term medication

Doctors are reluctant to hand out sleeping tablets for good reason.  They’re most often highly addictive and can cause rebound insomnia, as well as the usual risk of side-effects.  They can be used sensibly, however.  If you’re going through a particularly stressful time such as a bereavement, sleeping tablets may be used for a few weeks.  If your bedtime has crept to far too late, sleeping tablets may be used for a short time (no more than a week; I can only do three days, then I get rebound insomnia), preferably in conjunction with bright light therapy, to move it back to where it should be.  Sleeping tablets can be scary things, so research side effects carefully and the first time you take a new med, make sure you can sleep in the next morning if need be.  I’ve tried Zolpidol and Zolpidem (Ambien), and while Ambien seemed to work OK at first, I tried it again and got hallucinations that night and was groggy for the next week.  I now use Temazepam 20mg for no more than three nights in a row, and probably do this a few times a year.  That said, now that I am nicely settled into darkness therapy, it doesn’t seem to be necessary.

Long-term medication

Most people shouldn’t be taking this, but instead improving their sleep hygiene and so forth.  If you have a sleep disorder that can only be helped by medication, it may be possible, though it should always be discussed with your doctor.  My sleep study showed that I don’t get enough deep sleep, as is common with ME.  I can improve my sleep hygiene until the cows come home, I’m never going to get enough deep sleep, so long-term meds make sense for people like me as long as I can tolerate them, and since I have only recently discovered darkness therapy, this is what my GP spent some time trying me on.  Rarely people will take the stronger hypnotics for long-term use, but it’s far from being a first port of call and I would not be able to do it myself.  Antihistamines and low-dose tricyclic antidepressants are common for long-term use.  I didn’t get on well with either: the antihistamines made me a zombie in the day but not particularly sleepy at night, while the amitriptylene (low-dose tricyclic) did great things for my sleep but caused too many side-effects.

I spent several months taking a herbal sleeping aid, Lifeplan Valerian Formula, before I discovered that I didn’t need it once I had the orange glasses for darkness therapy.  If you’ve tried herbal sleeping tablets before and found them useless, check the dosage you were taking, as most of the ones on the market are so low-dose that I doubt there’s more than a placebo effect going on.  The Lifeplan one has a nice reasonable dose, and some people take two capsules at a time.  Some studies suggest that valerian should be taken off and on to avoid building up a tolerance, so for half my cycle I took the valerian formula, and the other half (when I’m premenstrual and more likely to get anxiety) I took 600mg passiflora and 400mg skullcap at bedtime, both in capsule form by Biohealth herbs.  Now that the darkness therapy has kicked in, I’m just using the passiflora and skullcap, as they are useful to treat the PMS, won’t harm my sleep even when taken on top of darkness therapy, and would make me groggy if I took them during the daytime.  The main herbs for sleep are relatively well-researched by now and often come up as effective as benxodiazepines, so again do your research, make sure it’s a reputable manufacturer, and talk to your doctor about what you’re doing.  This should only be used long-term by people who have pretty much no other way of getting a good night’s sleep, however; if you’re reasonably healthy, just keep it for occasional use.

I’ve tried melatonin tablets but they didn’t do a thing for me.  They’re not used in the UK, which makes me fairly cautious of them to begin with, and it’s uncertain how well melatonin works when given in oral tablet form.  This site discusses the problems that can occur from taking melatonin tablets.  I prefer to use darkness therapy instead, where I’m stimulating my body to produce melatonin itself.  If it’s a long-term sleeping problem, I’d suggest trying darkness therapy before medication, unless you need the medication for other reasons anyway, such as low-dose tricyclic antidepressants for pain.