Sleeping Pills not working. What do I do?

Q:  I’ve had trouble sleeping for about a month now.  A few days ago I told my primary care doctor.  He prescribed Trazedone, but it doesn’t seem to be working.  Now I’m scared because I’m afraid something is very wrong with me.  What do I do?  Will I ever be able to sleep normally again?

A:  As always,  your first option should be to discuss this with your doctor.  That person has examined you and knows your unique medical history.  Beyond that, and presuming you have no untreated medical issues disrupting your sleep,  it’s very important to examine possible nonmedical root sources for insomnia.

Nonmedical root sources for insomnia are wide-ranging and potent, and actually cause more insomnia in more people than medical or psychiatric issues do.

For instance, are you keeping a consistent sleep schedule?  Allowing yourself to sleep in until noon, or to take 4 hour naps later in the day absolutely can and will steal sleep from you at night.

This is because you have an elegant built in system called your homeostatic sleep drive that tracks prior wakefulness.  Normally after about 16 hours of nonstop wakefulness, your sleep drive sends a powerful signal that it’s time to sleep.

Sleep drive actually reinforces another internal sleep regulating system, called your circadian rhythm, which refers to the 24-hour cycles of night and day in our environment.

Sleep for all of us, including all mammals and most animals — even fish and most insects — is controlled largely by our circadian rhythms.  Consistency in your sleep timing helps these two internal systems synchronize and work better.

What about caffeine?  Are you avoiding it later in the day?  Beyond coffee and tea, beware of caffeine hidden in many foods and drinks, including chocolate and sodas.  Generally, you need 4 to 6 hours to metabolize caffeine from your system, so caffeine in any form should be largely avoided from about mid-day on.

Are you getting daily exercise?  Your internal sleep system responds to vigorous exercise by increasing the amount of deep sleep you experience, which is the most restorative kind.  If you aren’t getting daily exercise now, you should consider starting some sort of exercise program right away.

You should also consider the fact that many professionals who specialize in insomnia believe pills that artificially force sleep all too often treat only the symptom and not the true root of the problem.

This is because insomnia is really only a complaint — not a true disease that can be treating directly by drugs.

Trazedone, as an example, is a powerful anti-depressant that is often prescribed for anxiety disorders as well as insomnia.  Have you been diagnosed with depression or an anxiety disorder?  If so, then using this drug as prescribed can be a very useful tool in helping you overcome these issues.

But if you don’t have these disorders, then you should consider the possibility that there is something else disrupting your sleep that you need to address.  There may be something going on that pills can’t by themselves treat.  This situation is actually common with insomniacs.

You might ask your doctor about taking a comprehensive approach to treating the usual nonmedical root sources of insomnia.  The most common nonmedical issues are addressed by CBT-I, cognitive behavioral therapy specifically designed for insomnia.

CBT-I is considered the gold standard for treating primary insomnia, which typically refers to sleeping problems with no legitimate medical basis.  Primary insomnia is by far the most common type of insomnia.

So be assured that regardless of the root source, there every reason to believe you can very successfully address the true underlying issues, and by doing so restore normal sleep.

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