Insomnia—Using 
natural modalities and OTC treatments

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Melatonin is a hormone secreted by the pineal gland in the brain and helps regulate sleep.
Melatonin is a hormone secreted by the pineal gland in the brain and helps regulate sleep.

A meta-analysis demonstrated that melatonin had a significant benefit in reducing sleep latency.5 Subjects were noted to fall asleep earlier when using melatonin therapy. Studies have also demonstrated that melatonin significantly increased total sleep time when compared with placebo. Melatonin may interact with blood-thinning medications, diabetes medications, birth control pills, and medications that suppress the immune system.


Improving sleep hygiene is as important as using OTC medications. Sleep hygiene can be improved by implementing some of the steps listed in Table 2. Evaluating sleep habits and changing behavior may sometimes eliminate underlying sleep issues. 


Using the right balance of sleep hygiene, healthy sleep habits, and OTC medications can alleviate the symptoms of insomnia, but individuals must listen to their bodies' cues to know which methods are right. There are many OTC medications available for patients to use for insomnia. Healthcare providers must always verify that these medications do not interact with any prescription medications and medical conditions.

Steps to promote better sleep hygiene:

  1. Get routine exercise but not close to scheduled bedtime.
  2. Limit caffeine during the day, and have none in the evening.
  3. Do not go to bed unless you are tired. 
  4. Do not use your bed to read or watch television.
  5. Sleep at regularly scheduled times (including on weekends).
  6. Darken the bedroom.
  7. Turn the clock away from the bed.
  8. Avoid stimulants such as alcohol, tobacco, and caffeine.
  9. Avoid naps during the day.
  10. Use relaxation techniques such as yoga, meditation, and deep breathing.

Good habits to improve sleep:

  1. Decrease any noise in bedroom; earplugs can help eliminate sound
  2. Do not use electronic devices 1 hour before bedtime; this includes computers, TV, mobile phones, and video games
  3. Meditation &emdash; clear the mind from the day's activities; deep breathing can help relax muscles
  4. Drinking warm milk or decaffeinated tea before bed can help with sleep

Jane F. Myers, APRN, CNP, MSN, is a family nurse practitioner in the Department of Family Medicine and an assistant professor of family medicine in the College of Medicine at the Mayo Clinic in Rochester, Minn.

References


  1. Cunha JP, Shiel WC Jr. Insomnia treatment: sleep aids and stimulants. MedicineNet.com website. Available at: www.medicinenet.com/sleep_aids_and_stimulants/article.htm 

  2. Cunha JP. Insomnia treatment: sleep aids and stimulants. Available at: www.medicinenet.com/sleep_aids_and_stimulants/article.htm

  3. Roth T, Nir T, Zisapel N. Prolonged-release melatonin for improving sleep in totally blind subjects: a pilot placebo-controlled multicenter trial. Nat Sci Sleep. 2015;7:13-23. 

  4. Altun A, Ugur-Altun B. Melatonin: therapeutic and clinical utilization. Int J Clin Pract. 2007;61(5):835-845. 

  5. Ferracioli-Oda E, Qawasmi A, Bloch MH. Meta-analysis: melatonin for the treatment of primary sleep disorders. PLoS One. 2013;8(5):e63773.

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