Treating sleep issues 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, Valeriana officinalis and Ziziphus jujuba have been evaluated for pharmacological or clinical efficacy. Though not usually curative, they can provide symptomatic relief when used alone or adjunctively.
Following measures are helpful for the sleep issues;
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 in 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.
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