Diary of a Insomniac Physician aka What to Do If You Can’t Sleep and Suffer Insomnia: Part 2

By Dr. Natan Schleider, M.D.

July 17th, 2017 3:49 AM

Can’t sleep? Join the club. 5.5 million Americans visit their doctor every year for treatment of insomnia and I’m one of them.

Having tried proper sleep hygiene techniques discussed in my blog post yesterday, I visited the drug store.

Sleepytime tea was tried. No effect. Melatonin 1 mg was tried. Nothing. Incidentally, melatonin generally needs to be taken nightly and with regularity to take effect. I increased the dose to 3 mg nightly. No effect. Then 10 mg. Still, I tossed and turned.

Next, I tried some sedating anti-histamines for my trouble sleeping, namely, diphenhydramine better known as Benadryl. This usually comes as 25 mg tablets or capsules at the pharmacy and it is approved by the Food and Drug Administration for short-term treatment of insomnia at doses up to 50 mg nightly taken 30 minutes before bed. [I have some patients that swear by Zzzquil which is actually just diphenhydramine as well].

So how did the diphenhydramine (Benadryl) work? Not at all for me. It made me groggy (and did help my allergies) but did not put me to sleep. Some of my patients find this stuff as sedating as a horse tranquilizer but not me.

Ultimately I went to my doctor where a medley of prescription medicines were tried. He finally pointed out that what was keeping me awake was my increased stress of being on call and the fact that my cell phone may ring at any time in the middle of the night.

So I decided to change the nature of my medical practice and unless I had a patient in the hospital or had a particular patient I was worried about, I now turn my cell phone to silent most nights so I can sleep. This has helped more than all the pills; however, for the sake of thoroughness let’s go over some of my preferred medicines for treating insomnia.

Below is a list of Dr. Natan Schleider’s prescription medicines to consider when you cannot sleep:

  1. If you have trouble falling asleep, controlled-release melatonin or Ramelteon. These are not habit-forming so they are a good place to start. If these do not work, there are a family of medicines called “Z-drugs.” These are drugs like Ambien and Lunesta and are habit-forming. Being an addiction medicine doctor, I caution against these. If you can take them sparingly, that is, one or two nights weekly, your chances of becoming dependent are lower but not impossible. Unlike the melatonin and Ramelteon, the immediate release forms of Z-drugs can be taken IF needed while the melatonin analogs must be taken nightly.
  2. If you have the type of insomnia where you cannot stay asleep consider doxepin (Silenor), an ‘oldy but goody’ in the family of tricyclic antidepressants also FDA approved for insomnia. This is also a nice option if you are diagnosed with depression.
  3. Suvorexant (Belsomra) is a relatively new medicine for treating insomnia which I have zero experience with but for the sake of being thorough I am including this in the list. It is FDA approved for treating insomnia but is a controlled medicine meaning it is habit-forming so caution with use. On a personal note, I tend not to prescribe the newest medicine to hit the market. A lot of new medicines are recalled like Bextra and Vioxx, remember those? Better to go with medicines with a good safety profile in my opinion.
  4. The following medicines are commonly prescribed by psychiatrists for insomnia (and even by me once in a while) although admittedly, the evidence for them is lacking but my patients say they work: trazodone and Seroquel.

Well, there are a lot more medicines out there that are sedating and I’m no sleep specialist, just an insomnia specialist. I’m gonna try to get an hour of sleep before getting my daughter ready for school. Over and out.

Doctor In The Family