Q:

I have been a mild insomniac for several years, but since coming to college, I have gotten worse. It generally takes me an hour and a half (on a good night) and three hours plus (on a bad night) to fall asleep, and, as far as I can tell, there are two reasons for this: I am highly sensitive (to light, noise, movement, physical position, temperature, etc.) and I continue to have a high level of mental activity after going to bed. Even when my body is physically tired and ready to turn off, it's very difficult for my brain to follow suit. I occasionally take nonprescription sleeping pills, but I'm afraid of developing a tolerance to/dependency on them and of them reacting with each other. I also read before going to bed and try to transition between "awake time" and "sleep time," but it doesn't seem to help much.
I can't tell if this is a physical problem, a mental problem, or both. Should I look into seeing a physical doctor, a therapist, or both? Would prescription sleeping pills be a viable approach? Any advice would be appreciated!

 

A:

As you have already observed, there are highly sensitive people who don't "turn off" easily to go to sleep at night. This typically is related to stress factors, possibly subtle mood disorders and anxiety, but can be aggravated by metabolic or hormonal imbalances and, of course, use of substances that can be detrimental to sleep.

There are a number of approaches. One is to have a metabolic blood screen at the Health Center to make sure your thyroid is not over active, that your blood sugar and blood count are normal, and to make sure that caffeine, nicotine and alcohol are not factors. You can learn some self-soothing and self-relaxation techniques through the Counseling Center workshops. You can adapt a regular exercise schedule earlier in the day that will help with the extra mental energy you are infused with at night. You can be screened for possible depression and anxiety disorders and treated as needed.

Sleep aids have varying success, and some can be very addictive (anything in the benzodiazepine drug class). Over the counter aids and herbals are mild and safe, but have limited effectiveness used long term. There are some prescription medications like Remeron and Rozerem that don't appear to have any long term use issues, and the older tricyclic medications like Doxepin and amitryptiline, in low doses, can be very safe and effective. We also prescribe trazodone frequently in low doses.

The newer sleep aids such as ambien, lunesta and sonata are not approved for long term use, though it is not clear how tolerant people get, reducing their effectiveness. They remain quite expensive and can have a problem with "black out" of no memory for events that occur while under the influence of the drug, which can be very risky, especially if used in conjunction with other drugs or substances.

The experts in insomnia management are the sleep study doctors (there are two sleep clinics in Bellingham) and psychiatrists. We are very able at the Health Center to work with you to determine what makes most sense for your situation.

~The Doc