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TREATMENT
A variety of treatments exist for sleep disorders. The specifics of the sleep disorder determine which type of treatment will be recommended.
Insomnia
Transient and intermittent insomnia may not require treatment because episodes only a few days. Some women who experience daytime sleepiness and impaired performance from transient insomnia can find relief with short-acting sleeping pills.
However, over-the-counter sleep medicines, if used at all, should be used on a short-term basis and are not recommended for chronic insomnia.
Lifestyle changes (described below) and consultation with a health care professional are your best options for persistent insomnia.
These consist of:
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Identifying and treating any underlying medical or psychological problems.
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Reducing sleep-impairing activities, such as limiting caffeine consumption or managing stress
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Modifying behavior through special behavioral techniques, such as:
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Relaxation therapy. Specific techniques to reduce or eliminate anxiety and body tension, such as yoga, meditation or guided imagery. Ideally, your mind is able to stop racing, your muscles can relax, and you can get some restful sleep. You typically have to practice these techniques for a few weeks before they're effective, however.
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Sleep restriction. Some people suffering from insomnia spend too much time in bed trying to sleep. They may benefit from a program that initially allows only a few hours of sleep during the night, gradually increasing sleep time until a more normal night's sleep is achieved.
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Reconditioning. Another treatment is to recondition yourself so you learn to associate the bed and bedtime with sleep. For most people, this means not using the bed or bedroom for any activities other than sleep and sex; this is also referred to as "stimulus control." As part of the reconditioning process, you should only go to bed when you're sleepy. If you're not able to fall asleep, get up, stay up until you're sleepy, and then return to bed. Throughout this process, you should avoid naps, and wake up and go to bed at the same time each day. Eventually your body and mind begins to associate the bed and bedtime with sleep.
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Using medications that aid in insomnia treatment. These include:
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Hypnotic medications. Prescription drugs that promote sleep are called hypnotics. One group of hypnotics is the benzodiazepines. Medications in this group include: flurazepam (Dalmane), estazolam (ProSom), and temazepam (Restoril). These drugs can help induce and maintain sleep, relieving nighttime and daytime symptoms. The most common side effect is residual daytime drowsiness and short-term memory impairment. While hypnotics are usually safe and effective treatments, they are no longer used as a first line of treatment; lifestyle approaches that promote restful sleep should be pursued first.
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Zaleplon (Sonata) and zolpidem (Ambien) are other prescription medications available for short-term treatment of insomnia that fall into a class of drugs known as non-benzodiazepines or benzodiazepine receptor agonists. They have minimal next-day effects due to their rapid metabolism; however, daytime drowsiness may still occur. Withdrawal symptoms, such as nausea, may occur if you abruptly stop taking these medications. These drugs seem to have better safety profiles than benzodiazepines, so health care professionals are more likely to prescribe them than benzodiazepines.
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Eszopiclone (Lunesta), a third non-benzodiazepine medication, was approved by the U.S. Food and Drug Administration in December 2004 for long-term nightly use in treating insomnia. Lunesta differs from the other two drugs in its class in that it can be used nightly for up to six months.
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Antidepressants. Your health care professional may prescribe sedating antidepressants such as trazodone (Desyrel), but there is little data to support their use as a sleep aid in women who are not depressed.
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Antihistamines. Because they have sedative effects, antihistamines may be prescribed for insomnia. Diphenhydramine products (Benadryl, Nytol and Sominex) are available without a prescription. Side effects include daytime sleepiness, problems thinking, high blood pressure and dry mouth. You shouldn't use these for more than a couple of nights.
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Don't drink alcohol if you're taking any sleep medications because it can intensify their effects.
Excessive Sleepiness Associated with Narcolepsy and Cataplexy
Although there is no cure for narcolepsy, individualized treatments can help reduce symptoms, although it may take weeks or months to find what works best for you.
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Lifestyle approaches, such as taking three or more short, scheduled naps throughout the day, may help control excessive sleepiness (ES) and help you stay alert. However, daytime naps can't replace restful nighttime sleep.
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Prescription medications, such as:
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Modafinil (Provigil). This is considered the first-line prescription medication for treating narcolepsy. It helps you stay awake but doesn't interfere with nighttime sleep. It works on the sleep/wake centers of the brain so you are less likely to feel jittery or overly stimulated as you might with caffeine or other stimulant medications. The most commonly observed side effects are headache, nausea, nervousness, anxiety and insomnia.
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Central nervous system stimulants These include dextroamphetamine sulfate (Dexedrine) and methylphenidate hydrochloride (Ritalin). Although these drugs are usually effective in people with narcolepsy, they also produce some undesirable side effects and so must be carefully monitored. The most common side effects include headache, irritability, nervousness, insomnia, palpitations and mood changes.
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Antidepressants. Several categories are prescribed to treat cataplexy, hypnagogic hallucinations and sleep paralysis. One category includes tricyclic antidepressants, such as imipramine (Tofranil), desipramine (Norpramin), clomipramine (Anafranil) and protriptyline (Vivactil). Other antidepressants commonly used are the selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft). Venlafaxine (Effexor) has properties similar to the SSRIs and is also sometimes used to treat the symptoms of narcolepsy. Side effects from tricyclics include drowsiness, sexual dysfunction and low blood pressure. In some women, SSRIs may cause over-excitement, anxiety, insomnia, nausea and reduced sexual drive.
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Also, if you have narcolepsy and other health conditions, such as high blood pressure or heart disease, make sure you talk with your doctor about any possible medication interactions.
Sleep Apnea
Medications are usually not helpful in treating sleep apnea. The most common and effective treatment is nasal continuous positive airway pressure (CPAP). With this treatment, you wear a mask over your nose while you sleep. Air is forced through your nasal passages to prevent your throat from collapsing during sleep. The device must be worn every night.
Despite the use of the nasal CPAP device, some patients may continue to experience residual excessive sleepiness and seek additional therapies. For patients who continue to experience excessive sleepiness despite treatment with CPAP, modafinil (Provigil), a prescription medication, can be combined with CPAP therapy to treat excessive sleepiness. Although Provigil does not treat obstructive sleep apnea and is not meant to replace sleep, it can help reduce the excessive sleepiness associated with obstructive sleep apnea.
Other treatments include:
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Behavioral therapy. Behavioral changes are an important part of the treatment program, and in mild cases, behavioral therapy may be all that is needed. You should avoid using alcohol, tobacco and sleeping pills, which make the airway more likely to collapse during sleep and prolong the apneic periods. Overweight people almost invariably benefit from losing weight; even a 10 percent weight loss can significantly reduce the number of apneic events. Sometimes in mild sleep apnea, breathing pauses occur only when you sleep on your back; in this case, using pillows and other devices that help you sleep in a side position can reduce apneic events.
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Physical or mechanical therapy. In addition to CPAP, cases of mild to moderate sleep apnea can be treated using a dental appliance that repositions the lower jaw and the tongue. Possible side effects include damage to teeth, soft tissues and the jaw joint. These should be fitted by a dentist or orthodontist.
Surgery is a last resort and not always successful. Several procedures can increase the size of the airway, but they all have risks. Some of the more common procedures include:
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Removing nasal polyps or other growths
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Laser-assisted uvulopalatoplasty (LAUP), or removal of portions of the uvula and soft palate
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Uvulapalatopharyngoplasty (UPPP), which is similar to LAUP but uses different surgical technique and typically is more extensive.
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Radio frequency somnoplasty, a procedure is similar to LAUP and UPPP, but uses sound waves applied through a needle to heat the targeted tissue; this damages the tissue and eventually leads to scarring and shrinkage of the treated areas. This treatment is currently being investigated for use in sleep apnea.
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Surgically correcting structural deformities in the face and/or lower jaw.
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Tracheostomy, used in people with severe, life-threatening sleep apnea. In this procedure, a small hole is made in the windpipe and a tube inserted into the opening. The tube remains closed during waking hours and is only opened during sleep so air flows directly into the windpipe and lungs, bypassing any upper airway obstruction. Although this procedure is highly effective, it is an extreme measure and is not often used.
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Surgical procedures to treat obesity
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Restless Legs Syndrome
Some women find that activities such as taking a hot bath, massaging their legs, using a heating pad or ice pack, exercising and eliminating caffeine help relieve symptoms of restless legs syndrome (RLS). In more severe cases, medications may be prescribed.
Physicians may suggest a variety of drugs to treat RLS. In 2005, the drug ropinirole (Requip) became the first drug specifically approved by the FDA to treat mild to moderate RLS. Since then, pramipexole (Mirapex) has also been approved for treating RLS. These drugs are in a class of medications known as dopamine agonists and were first approved for the treatment of Parkinson's disease. Beyond these, the most commonly used medications for RLS are:
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Benzodiazepines central nervous system depressants that allow you to get more sleep but don't fully suppress RLS sensations or leg movements. The most commonly prescribed benzodiazepine for RLS is clonazepam (Klonopin). The most common side effects of benzodiazepines are residual daytime drowsiness and short-term memory impairment.
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Opioid analgesics, such as propoxyphene hydrochloride (Darvon), oxycodone (Percocet) and codeine are pain-relieving medications that can also suppress RLS and PLMS. Side effects include dizziness, nausea, vomiting, constipation and the risk of addiction.
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Anticonvulsant drugs, such as carbamazepine (Epitol) and gabapentin (Neurontin), may also help reduce the sensory disturbances (creeping and crawling sensations) associated with RLS. Dizziness, fatigue and sleepiness are among the possible side effects.
Circadian Rhythm Disorder
The following treatments can help eliminate the symptoms of circadian rhythm disorder, a recurring disruption in the body's natural psychological and biological sleep rhythms that is common in students and those who work evening and night shifts.
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Follow the principles of sleep hygiene as much as possible, including establishing a sleep schedule in which you go to sleep and wake up at the same time every day.
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Exercise at least three to five times a week for at least 20 minutes to help relieve stress.
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Follow a healthy diet.
Some people with advanced or delayed sleep phase syndrome benefit from phototherapy, a treatment in which you are exposed to bright lights at certain times of the day to reset your circadian clock. If you have delayed sleep phase syndrome you receive the exposure in the morning, while those with advanced sleep phase syndrome are exposed in the evening.
In addition, treatments such as melatonin (a hormone available over the counter), short-term sleep aids and wake-promoting agents may be used to get someone with circadian rhythm disorder on a desired schedule.
