Patient Education
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Tips to Help Patients Improve Sleep |
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Did you know that your behavior can affect how well you sleep? It can be helpful to examine your habits and determine if some simple adjustments can get your sleep pattern back on track. Do you spend too much time lying awake in bed? Have you figured out how much sleep you need? Do you use the bedroom for non-sleep related activites? Do you feel comfortable and secure in your bedroom? Do you go to bed and wake up at the same time every day? Some final tips: • Watch your intake of caffeine and nicotine. If you are sensitive to the sleep-disruptive effects of these substances, you may need to “cut yourself off” early in the day. • Do not use alcohol as a sleep aid. It may seem to help you fall asleep, but it results in poor sleep quality. • Exercise moderately on a regular basis, but only during the day. Avoid strenuous exercise in the evening — it can worsen sleep. • Devise a relaxing bedtime ritual, it will contribute to a sleep response. Pleasant dreams! |
Information on the importance of sleep to overall health and well being is a good starting point in counseling an individual regarding treatment for insomnia. A discussion on lifestyle and an action plan for the implementation of both drug and non-drug interventions should occur. Lifestyle interventions include obvious but important advice regarding a regular sleep schedule, a comfortable, dark bedroom environment, and avoidance of factors that interfere with sleep onset like caffeine, vigorous exercise, large meals, and alcohol near bedtime. Goals of treatment, realistic expectations, and expected duration of therapy should be reviewed. Reviewing individual patient factors influencing the type of drug therapy recommended reassures the person how the hypnotic will relieve their specific sleep problem. For example, a discussion regarding the lack of daytime sleepiness with zaleplon and zolpidem is useful when a patient expresses concerns over falling asleep at work. A discussion of how a drug like temazepam requires dosing one to two hours prior to sleep for maximum sleep-inducing effects is necessary to prevent the patient from considering that drug ineffective. A better understanding of how a drug works can help patients appreciate the effect of the medication in their situation. Patients can benefit from being better educated regarding realistic expectations from their hypnotic drug. Patients should understand that hypnotic efficacy means a return to normal sleep patterns with its natural variation of occasional delayed sleep latency and nighttime awakenings. Patients should understand that success of hypnotic drug therapy is not measured by immediate unconsciousness that lasts eight hours every night.
Conclusion
The availability of newer drugs with an extremely short duration of effect offers the potential to dramatically change how insomnia is treated pharmacologically. Historically, hypnotic drugs have been taken prior to bedtime in anticipation of sleep difficulty. Drugs such as zaleplon, with a duration of effect of only one hour, now allow the treatment of insomnia when it occurs — either at bedtime or after the patient experiences difficulty falling asleep during the night. Just as the history of hypnotic agents has unfolded over the last 30 years and caused dramatic changes in prescribing patterns, it is certain that the agents will continue to evolve and will yield better and better pharmacological treatment options for insomnia. Clinicians must take full clinical advantage of what hypnotic agents offer, become familiar with what newer agents may offer, and maximize benefits and minimize adverse consequences through appropriate drug selection, dosing, and patient education.