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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: Mental Health
Satisfied Customers: 56786
Experience:  MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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Insomnia, Diphenhydramine but it doesn’t work anymore, I

Customer Question

Insomnia
JA: Have you seen a doctor about this yet? What medications are you taking?
Customer: Diphenhydramine but it doesn’t work anymore
JA: Is there anything else the Psychologist should know before I connect you? Rest assured that they'll be able to help you.
Customer: I have extreme insomnia due to stress
Submitted: 17 days ago.
Category: Mental Health
Customer: replied 17 days ago.
I really need some other form of sleeping tablets
Customer: replied 17 days ago.
I haven’t slept for 48 hours
Expert:  Dr. Arun Phophalia replied 17 days ago.

Welcome to Just Answer.
Answers here are for education and information.
I will respond shortly with an answer or further information request.

Expert:  Dr. Arun Phophalia replied 17 days ago.

You may try;

Valerian root or

Melatonin.

Stress needs to be handled primarily by counseling which will help you with insomnia as you know.

Cognitive-behavioral therapy (CBT) is also considered the most appropriate treatment for patients with insomnia. The components of CBT are;

1) Sleep hygiene education

2) Cognitive therapy

3) Relaxation therapy

4) Stimulus-control therapy

5) Sleep-restriction therapy

Phytotherapy for the treatment of insomnia is an exciting new therapeutic option, which might benefit patients suffering from different degrees of insomnia. Insomnia or sleeplessness is a disorder characterized by difficulty initiating or maintaining sleep. It affects sleep quality and quantity leading to increased morbidity. Sleep disturbances are thought to be caused by abnormalities of the circadian system as indicated by misalignments of the endogenous circadian cycle and the sleep-wake cycle. Several contributory factors may be involved such as stress, health status, and medicines (e.g. caffeine).

Treating insomnia is a big challenge as the available medications are associated with several side effects. Herbal medicines are being looked at as an ideal replacement for these medications. Among the ethnobotanicals used for sleep disorders, only Valeriana officinalis and Ziziphus jujuba have been evaluated for pharmacological or clinical efficacy against insomnia. Sedative-hypnotics are the most commonly prescribed drugs for insomnia. Though not usually curative, they can provide symptomatic relief when used alone or adjunctively:

Short- and intermediate-acting benzodiazepines (triazolam, temazepam, estazolam)
Eszopiclone
Zolpidem
Zaleplon
Ramelteon

A physical illness is uncommon with the sleep issue. Off-and-on sleeplessness needs to dig the cause for underlying anxiety, depression, or other related issues. A thorough evaluation of the history is done to reach a conclusion. Accordingly, the medical treatment is commenced. The precipitating factors can be;

1) depression,

2) anxiety,

3) sleep-wake schedule changes,

4) medications,

5) other sleep disorders,

6) medical conditions

7) work-related issues

8) family problem,

9) health events.

All these in isolation or in combination play problems in sleep issues. Good sleep cycle, handling the specific problem, counseling, cognitive-behavioral therapy, medications are employed for the treatment.

The following measures are helpful;

1) Avoid if you do;

a) caffeine or alcohol use,

b) environmental noise,

c) inappropriate room temperature,

d) watching TV in bed.

e) avoid large meals at dinner.

2) Relaxation techniques

3) Acupressure and acupuncture.

A study comparing zolpidem with CBT showed continued efficacy for the patients treated with CBT. Please see the reference;

Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW. Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med. Sep 27 2004;164(17):1888-96. [Medline].

Dietary measures which are useful:

1) Avoid caffeinated beverages in the late afternoon or evening.

2) Avoid alcohol in the evening.

3) Avoid large meals near bedtime.

Acupressure on the Shenmen points of both wrists significantly decreased insomnia, with the benefit persisting for up to 2 weeks afterward. Please see the reference;

Sun JL, Sung MS, Huang MY, Cheng GC, Lin CC. Effectiveness of acupressure for residents of long-term care facilities with insomnia: a randomized controlled trial. Int J Nurs Stud. Jul 2010;47(7):798-805. [Medline].

The following is the guideline when using medications:

1) Try the lowest dose of the medication.

2) Use the medication for not more than 2-4 weeks in a single stretch.

3) Medications with a rapid onset of action, such as zolpidem or zaleplon, are preferable when the problem is falling asleep.

4) If the problem is staying asleep, temazepam, estazolam, flurazepam are more useful.

5) If one is depressed, an antidepressant with sedative properties, such as trazodone, mirtazapine, or amitriptyline, may be preferable.

Relaxation therapy is to take part in pleasurable activities like group sports, watching comedy serials, etc. People with insomnia often display high levels of arousal (physiologic and cognitive) at night and during the daytime. The various techniques which deactivate the arousal system are (1) progressive muscle relaxation, (2) biofeedback, and (3) imagery training and thoughts to stop.

Meditation relaxes the body muscles by concentrating on an object for 5-10 minutes once or twice a day.

In sleep restriction, therapy patients are allowed less time in bed which accumulates the sleep which helps in sleep later. Once the insomnia is better, sleep restriction is also tapered off.

Stimulus control and sleep hygiene are:

1) to go to bed when sleepy only,

2) use the bed only for sleep and intimacy,

3) to get up at the same time each morning even if the sleep was inadequate at the night

4) avoid daytime naps.

Please read;

https://www.sleepassociation.org/about-sleep/sleep-hygiene-tips/

Following measures also may help:

Acupressure can help. Please see the reference;

Sun JL, Sung MS, Huang MY, Cheng GC, Lin CC. Effectiveness of acupressure for residents of long-term care facilities with insomnia: a randomized controlled trial. Int J Nurs Stud. 2010 Jul. 47(7):798-805. [Medline].

You can also try Cerêve Sleep System. The system consists of a bedside device controlled by software that cools and pumps fluid to a forehead pad that the patient wears throughout the night.

Anderson, P. FDA Approves New Device for Insomnia. Medscape Medical News. Available at http://www.medscape.com/viewarticle/864509.

I wish your symptoms resolve soon.

I would be happy to assist you further if you need any more information.
Thanks for using Just Answer.