John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
There are several ways insomnia may be treated without the use of
medication. These include behavioral modification and use of natural herbal
remedies.
When a person consults a health care practitioner about insomnia, the
practitioner may ask the person to keep a sleep log for several weeks to monitor sleep habits. The treatment
options for short-term or chronic insomnia include not only medications, but often sleep habit and behavioral modifications for optimal long-term results.
Evaluating sleep habits is important in the management of insomnia. Treatment of
underlying sleep disorders and in some instances, changing sleep habits may correct the problem without the need for medications. Good sleep habits
(also referred to as good sleep hygiene) should include:
Regular sleep times
A comfortable bed and quiet room at a comfortable, temperature
Darkened room
Regular exercise
but not close to bedtime or late in the evening
A bedroom that is not used for work or other activities not related to sleep
Avoidance of stimulants (for example, caffeine, or tobacco),
alcohol, and large meals close to bedtime (avoidance 2-4 hours before bedtime
if possible)
Many people watch television before falling asleep. TV can be a very
stimulating medium and needs to be closely evaluated if it adds to a person's
insomnia.
Relaxation techniques such as breathing exercises or yoga
No naps during the day
Try drinking warm milk before bed. It is high in the amino acid tryptophan,
which helps induce sleep.
Melatonin
Melatonin (for example, Melatonex) is the only hormone
available OTC for insomnia. Melatonin is a hormone that is
produced by the pineal gland. Melatonin helps regulate the
body's clock or sleep-wake cycle. The secretion of
melatonin is increased by darkness and decreased by light.
The exact mechanism of how melatonin induces sleep has not
been determined. Melatonin also decreases mental alertness
and body temperature.
Melatonin is sold as a dietary supplement and is,
therefore, not regulated by the FDA. It is commonly used for jet lag,
insomnia, and sleep disturbances related to working the
late night shift. Some limited evidence suggests that
melatonin may be useful for treating
sleep disturbances.
In 2005, MIT released the results of a meta-analysis of 17 peer-reviewed
studies using melatonin. It showed that melatonin was effective in helping
people fall asleep at doses of 0.3 milligrams (mg). In some preparations the
dosage of melatonin is significantly higher and these larger doses have shown to
be less effective after only a few days of use.
If a person would like to try melatonin tablets, check first with a health care
practitioner.
Dosing: There is no established dose or time of administration. Individuals should follow the product labeling for dosing and administration.
Pregnancy and lactation: The use of melatonin during
pregnancy or lactation has not been studied adequately. At
high doses (more than 300 mg), melatonin may affect
contraception (birth control) and increase levels of
prolactin in the body. Based on past experience with other
agents and the possibility of unknown risks to the fetus,
melatonin should be avoided during pregnancy or lactation
until more information is available.
Children: The use of melatonin in children should be
avoided until more information about safety is available.
Drug interactions: Although melatonin is sold as a
dietary supplement, it should be thought of as a drug. It
has side effects and may have drug interactions that have
not been identified. The level of melatonin that the body
produces is increased by certain drugs, such as selective
serotonin reuptake inhibitor antidepressants [for example, fluoxetine (Prozac),
sertraline (Zoloft),
paroxetine (Paxil)] and monoamine oxidase inhibitors
[for example,
tranylcypromine (Parnate), phenelzine (Nardil)]. The interaction between these
antidepressants and melatonin that is used as a sleeping
aid has not been assessed.
Side effects: The most common adverse effect of
melatonin is drowsiness. Therefore, tasks that require
alertness (for example, driving) should be avoided for four to five
hours after taking melatonin. Melatonin also may also cause
itching,
abnormal heartbeats, and
headaches. Long-term side
effects of melatonin have not been studied.
Melatonin is either derived from animal sources or
synthesized in a laboratory. Melatonin obtained from animal
sources has a higher likelihood of contamination, which can
cause allergic reactions and viral transmission, than
synthetic melatonin.
Melatonin may stimulate the immune system. Therefore,
people with severe allergies or other disorders that may be
caused by an overactive immune system (for example, systemic lupus
erythematosus, rheumatoid arthritis) should avoid using
melatonin.
Other herbal products: Natural herbal supplements such as valerian, chamomile,
kava kava, and others have been touted as remedies for insomnia. However, the safety or effectiveness of these products has not been documented and it is important to consult
a physician if a person is taking or plan to take any herbal supplements to treat insomnia.
Night sweats are severe hot flashes that occur at night and result in a drenching sweat. In order to distinguish night sweats that arise from medical causes from those that occur because one's surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment.
Restless leg syndrome (RLS or restless legs syndrome) is a common cause for painful legs that typically eases with motion, and becomes worse and more noticeable at rest. This characteristic nighttime worsening can frequently lead to insomnia. Treatment of the symptoms of restless leg syndrome is generally with medication as well as treating any underlying condition causing restless leg syndrome.
A number of vital tasks carried out during sleep help maintain good health and enable people to function at their best. Sleep needs vary from individual to individual and change throughout your life. Not getting enough sleep can hurt memory performance, health, and your mood.
Insomnia is the perception or complaint of inadequate or poor-quality sleep because of difficulty falling asleep; waking up frequently during the night with difficulty returning to sleep; waking up too early in the morning; or unrefreshing sleep. Secondary insomnia is the most common type of insomnia. Treatment for insomnia include lifestyle changes, cognitive behavioral therapy, and medication.
Narcolepsy, a chronic disease of the central nervous system causes have not been fully determined. Some theories include abnormalities in hypocretin neurons in the brain or an autoimmune disorder. Symptoms of narcolepsy include excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, sleep paralysis, disturbed nocturnal sleep, and automatic behavior. Diagnosis of narcolepsy is based on a clinical evaluation, specific questionnaires, sleep logs or diaries, and the results of sleep laboratory tests. Treatments of narcolepsy symptoms include medication and lifestyle changes.
Sleepwalking is a condition in which an individual walks or does other activities while asleep. Factors associated with sleepwalking include genetic, environmental, and physiological. Episodes of sleepwalking may include quiet walking to agitated running. Conditions that may have similar symptoms of sleepwalking, but are not include night terrors, confusional arousals, and nocturnal seizures. Treatment of sleepwalking generally include preventative measures. Medication may be prescribed if necessary.
Hypersomnia is a condition where a person has excessive daytime sleepiness and trouble staying awake during the day. Treatment for hypersomnia includes medication, CPAP machines, and lifestyle changes.
Caring for a loved one or patient with Alzheimer's can become a difficult and overwhelming task at times. This guide helps caregivers of individual's with Alzheimer's deal with communicating, bathing, and dressing; as well as problem solving with incontinence, sleeping, wandering; and coping with difficulties Alzheimer's patients present.
Periodic limb movement disorder (PLMD) is a sleep disorder characterized by rhythmic movements of the limbs during sleep. The movements typically involve the legs, but upper extremity movements may also occur. Movements occur periodically throughout the night and can fluctuate in severity from one night to the next. They tend to cluster in episodes that last anywhere from a few minutes to several hours. These movements are very different from the normal spasms, called hypnic myoclonia, that we often experience initially while trying to fall asleep.
When sleepiness interferes with daily routines and activities, or reduces the ability to function, it is called "problem sleepiness." A person can have problem sleepiness without realizing it. Symptoms of problem sleepiness include: consistently don't get enough sleep, or poor quality sleep, fall asleep while driving, struggle to stay awake when inactive (like watching TV or reading), have difficulty paying attention or concentrating at work, school, or home, have poor performance problems at work or school, have difficulty remembering things, have slowed responses, have difficulty controlling your emotions, and/or if you have to take naps on most days.
Sleep needs in children and teenagers depends on the age of the child. Sleep disorders in children such as sleep apnea, parasomnias, confusional arousals, night terrors, nightmares, narcolepsy, and sleepwalking can effect a child's or teen's sleep. Healthy sleep habits and good sleep hygiene can help your infant, toddler, preschooler, tween, or teenager get a good night's sleep.
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