Sleep Hygiene

Natural Insomnia Program

Best Treatments for Insomnia

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1. Encourage patient to keep a consistent pattern of waking, and sleeping at the same time each day.

2. Avoid large meals before bedtime.

3. Discontinue stimulant caffeine, alcohol, or nicotine.

4. Avoid daytime naps

5. Engage in regular exercise, but avoid exercise before sleeping.

6. Allow for a period of relaxation before bedtime (hot bath)

Agents Used for Insomnia

Agent

Dosage

Ave Half-life of Metabolites

Comments

Zolpidem (Ambien)

5-10 mg qhs

3 hours

Non-benzodiazepine; no daytime hangover

Zaleplon (Sonata)

5 -10 mg

1 hour

Non-benzodiazepine; no daytime hangover

Triazolam (Halcion)

0.125-0.25 mg qhs

2 hours

Short acting, some patients can experience perceptual disturbances

Estazolam (ProSom)

1-2 mg qhs

17 hours

Short acting

Flurazepam (Dalmane)

15-30 mg qhs

100 hours, active metabolites long t V

Hangover is common. Can accumulate in elderly.

Temazepam (Restoril)

7.5-30 mg qhs

11 hours

Antidepressants

(Doxepin)

50-100 mg

long

Anticholinergic side effects

Antihistamines

Diphenhydramine

(Benadryl)

50 mg

NA

Limited efficacy for mild initial insomnia.

Chloral Hydrate

500 - 1000 mg

metabolite: 8-11 hours

Tolerance after 2 weeks, GI side effects common.

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