Insomnia remedies

Antihistamines such as diphenhydramine are known for their sedating properties and are frequently used over-the-counter medications (usual doses 25-50 mg) for difficulty sleeping. Diphenhydramine is approved by the FDA for the treatment of insomnia and can be effective at reducing sleep latency and increasing sleep time.43 However, diphenhydramine produces undesirable anticholinergic effects and carryover sedation that limit its use. As with TCAs and BZDRAs, diphenhydramine should be used with caution in the elderly. Valerian root is an herbal sleep remedy that has inconsistent effects on sleep but may reduce sleep latency and efficiency at commonly used doses of 400 to 900 mg valerian extract. Ramelteon, a new melatonin receptor agonist, is indicated for insomnia characterized by difficulty with sleep onset. The recommended dose is 8 mg at bedtime. Ramelteon is not a controlled substance and thus may be a viable option for patients with a history of substance abuse. 

Everyone has experienced a sleepless night at one time or another. Typical triggers include the night before an important presentation, a test at school, or after some stress like a dispute with a loved one. Insomnia usually has an abrupt onset during a period of stress or illness. Most insomniacs were sleeping well just before the stress and usually return to normal sleep when the stress subsides. During this brief period, most do not seek professional help. They simply tough it out or use home remedies (e.g., warm milk, hot bath, and unfortunately sometimes alcohol) or over-the-counter medications (e.g., Sleep-Eze, Benadryl, Tylenol PM) to hasten the onset of sleep. 

The symbolic importance of doctor-prescribed pill-taking as a kind of identity point of no return is powerfully illustrated by Sarah s case. Recall from Chapter 3 that Sarah s persistent insomnia had caused her, in her own words, to abuse over-the-counter remedies for many years. However, she had steadfastly refused to visit a psychiatrist or to take prescribed medications. Then, after her mother s death, she had found a large stockpile of Xanax, a powerful antianxiety drug, among her mother s belong-... 

So how is insomnia treated Most commonly, people self-medicate their insomnia with over-the-counter medications such as Tylenol PM , Sominex , Unisom , or other drugs such as antihistamines (discussed in Chapter 3). Other people try natural remedies such as melatonin (see Chapter 4). When such medications don t work, people often ask their doctor for a prescription sleep aid, which is usually a type of medication called a benzodiazepine such as Halcion or a related type of drug such as Ambien or Sonata (see Chapter 6 for more on these types of drugs). 

In recent years, natural products such as melatonin and herbs such as valerian have become popular over-the-counter remedies for insomnia. There are no comprehensive evaluations of safety and efficacy of these products. Beyond questions of safety and efficacy, there is no consensus on what their doses should be. Nevertheless, these products continue to be used widely by some patients. 

It is a toxic plant and has properties similar to strychnine, which is obtained from Strychnos nux vomica. Once recommended as a remedy for cholera, the plant is used to treat fever and acute emotional and mental afflictions such as hysteria, insomnia, and depression. In toxic doses, it causes muscle spasms, painful convulsions, and even death by asphyxiation (see Chapter 62). 

Passion flowers contain harmine and harmaline, which have been used in the treatment of Parkinson s disease. Folk remedies use passion flower to treat depression and insomnia (see Chapter 65). 

In 1903, barbital with the brand name of Veronal was marketed as a sleeping pill. Before that time, remedies for insomnia included drinking alcohol or taking bromides, chloral hydrate, or opiates. 

In spite of this lack of information, several popular books came out during the 1990s advocating the supposed usefulness of melatonin as a treatment for everything from insomnia to jet lag to aging. Consumer interest in melatonin increased dramatically. It is estimated that millions of Americans take melatonin supplements as a natural remedy. 

Insomnia is a common symptom that is difficult to assess. The most common complaint is of insufficient and unsatisfying sleep. However, patients may feel tired during the day, and then blame insufficient sleep without convincing evidence. They then resort too easily to chemical remedies for their putative problem, in the form of self-administered or prescribed medication [1],... 

As well as compounds specifically indicated for the short-term treatment of insomnia, some benzodiazepines used primarily as anxiolytics have found extensive usage as symptomatic remedies for insomnia in anxious individuals. Examples include oxazepam, lorazepam, and diazepam. Patterns of use vary from country to country and at different times. 

A popular remedy for chronic catarrhal conditions following colds, and is also given for nervous headaches and hysterical tendencies. The infusion is 1 drachm in 1 pint of boiling water, and bed-time baths in equivalent strength will sometimes help those suffering from insomnia. 

The possibility that mental illness may be alleviated by biogenic amine precursors is an appealing one (SEDA-4, 18). Tryptophan is a naturally-occurring essential amino acid, which has been advocated as an innocuous health food for the treatment of depression, insomnia, stress, behavioral disorders, and premenstrual syndrome. The availability of amino acids in health food stores and a contemporary interest in natural remedies led to reported widespread use of tryptophan to treat depression. It was estimated in 1976 that up to that time several hundred patients with affective disorders had been studied, with results reported in at least 21 papers (1). However, the results of clinical trials with L-tryptophan in the treatment of depressive disorders are inconsistent (2). 

We favor less toxic remedies for insomnia, such as increased exercise during the day, decreased use of stimulants, especially in the evening (remember to read labels of any pain pills, cold tablets, and other remedies to see if they contain caffeine or other stimulants), relaxation techniques, warm baths, and simple nutritional supplements such as calcium and magnesium tablets, which relax many people when taken at bedtime... 

Valerian is an herbal sleep remedy that has been studied for its sedative-hypnotic properties in patients with insomnia. The mechanism of action of this herb is still unknown, but it may involve inhibition of the enzyme that breaks down y-aminobutyric acid (GABA). The recommended dose for insomnia ranges from 300 to 600 mg. An equivalent dose of dried herbal valerian root is 2 to 3 grams soaked in 1 cup of hot water for 20 to 25 minutes. As with melatonin, and other herbal products not regulated by the Food and Drug Administration (FDA), valerian is not regulated for quality or consistency. 

Davidson, J., and K. Connor. Herbs for the Mind What Science Tells Us about Nature s Remedies for Depression, Stress, Memory Loss, and Insomnia. New York Guilford Press, 2000. 

Reserpine and vincaleukoblastine represent the most important plant-derived medicinals introduced into medicine by our generation, and it is instructive to compare their history with those of morphine and quinine. Descriptions of the use of extracts of plants resembling Rauwolfia may be traced back to ancient Hindu ayurvedic writings. They were used in primitive Hindu medicine for a variety of diseases, including snake bite, hypertension, insomnia, and insanity. The early remedies were used for various other purposes, but it seems clear now that our present day application of Rauwolfia alkaloids in treating hypertension and mental disease was foreshadowed in the folk medicine of the Eastern peoples. 

Traditionally, Erythrina species have found use amongst different communities for various ailments. The bark of E. fusca and E. indica, for example, has been used for the treatment of fever, malaria, rheumatism, toothache, boils and fractures. Boiled roots of the same were taken internally as a remedy for beriberi. In Kenya, a concoction of dried bark of E. ahyssinica has been used for the treatment of trachoma (oral) and elephantiasis (external) and its roots against malaria and syphilis, while the pounded green stem bark is taken as an antihelminthic [3]. The water extract of flowers of E. americana have been used in Mexico for the treatment of insomnia. The resl of other documented traditional medicinal uses are listed in Table 1. 

W 0 (X X w Caffeine Adenosine receptor antagonist. High dose T Ca++ permeability in sarcoplasmic reticulum and T cAMP by inhibiting phosphodiesterase. Stimulates CNS, constricts cerebral arterioles, induces diuresis, stimulates heart, bronchodilates. Prolonged apnea in pre-term infants (unlabeled use). Included in some over-the counter analgesic preps, particularly headache remedies. Insomnia, restlessness, anxiety neurosis, nausea, tachycardia, diuresis. 

Besides coffee and cola drinks, other sources of caffeine are tea, chocolate, and cocoa. Caffeine is a mild stimulant of the respiratory and central nervous systems, the reason for its well-known side effects of nervousness and insomnia. These characteristics, together with its behavior as a mild diuretic, account for the use of caffeine in a wide variety of products, including pain relievers, cold remedies, diet pills, and stay-awake pills (No-Doz ). Because caffeine is considered to be a drug, pregnant women should be prudent about how much caffeine they consume. Like most other drugs, caffeine enters the bloodstream, crosses the placental barrier, and reaches the fetus. 

Traditional use Valerian is used as a sedative, carminative, and vermifuge, as an aid in digestion, and to treat hypercondria, psychological traumas, hysteria, migraines, convulsive pains, heart pains, heart failure, epilepsy, insomnia, and anxiety (Turova and Sapozhnikova 1984 Altimishev 1991). A decoction or tincture is used as a heart remedy, a sedative to treat nervous disorders, as well as to treat headaches, and cancer, and to improve the appetite. It is used in a bath to relax hyperactive children so they sleep well and to treat hysteria, convulsions, acute typhus, epilepsy, and internal aches (Kurochkin 1998). 

Black pepper is historically used also in traditional medicines and home remedies in India [3]. Black pepper figures in remedies in Ayurveda, Siddha, and Unani medicine in India for such illnesses as constipation, diarrhea, earache, gangrene, heart disease, hernia, hoarseness, indigestion, insect bites, insomnia, joint pain, liver problems, lung disease, oral abscesses, sunburn, tooth decay, and toothaches. Black pepper was relied upon to treat specific conditions such as diarrhea and fevers, but it appears that the extensive, generalized use was to enhance the effects of many herbal remedies [3]. 

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