When to see a provider

If someone is struggling with bad sleep health or insomnia, they should see a healthcare provider when they have ongoing sleep problems that affect their daytime life and overall well-being. According to the American College of Physicians, chronic insomnia is defined as having trouble falling asleep, staying asleep, or waking up too early at least three times a week for three months, which causes significant distress or problems in important areas of life.

Here are some specific signs that indicate it’s time to seek medical help:

• Persistent Symptoms: If sleep problems continue even after trying good sleep habits, it’s important to get professional help.
• Daytime Impairment: When sleep difficulties lead to significant daytime issues like extreme sleepiness, tiredness, mood swings, or trouble concentrating.
• Other Health Issues: If insomnia is linked to other medical or mental health conditions, such as depression, anxiety, or chronic pain, that could make sleep problems worse.
• Impact on Daily Life: When sleep issues interfere with everyday activities, job performance, or relationships with others.
• Use of Sleep Aids: If someone is relying on over the counter or prescription sleep medications without seeing improvements in sleep quality.

Getting help early is very important because untreated insomnia can lead to serious health problems, including heart disease, metabolic disorders, and mental health issues. 

The role of medications

Medications are important for treating insomnia and poor sleep health, when lifestyle interventions are not enough. Here’s a breakdown of the main types of medications used for insomnia:

Common Pharmacologic Agents:

• Melatonin: Melatonin is a natural substance made by the body to help induce sleep.  It can also be purchased over the counter. It is not addictive and is often a first-line approach for people who struggle with sleep disorders when combined with lifestyle changes.
• Benzodiazepine Receptor Agonists (BZRAs): These include medications like zolpidem, eszopiclone, and zaleplon. They help people fall asleep and stay asleep but should only be used at the lowest dose for the shortest time possible because they can lead to dependence and other side effects.
• Dual Orexin Receptor Antagonists (DORAs): Examples include daridorexant, lemborexant, and suvorexant. These medications help people sleep by blocking wakefulness instead of just making them sleepy. They are effective for both falling asleep and staying asleep and have a lower risk of withdrawal effects.
• Melatonin Receptor Agonists: Ramelteon is a medication that helps with falling asleep and is generally well-tolerated, making it good for long-term use.
• Low-Dose Doxepin: This is a type of tricyclic antidepressant that works well for people who have trouble staying asleep and has fewer side effects when taken at low doses.

Other Considerations:

• Benzodiazepines: These are usually not recommended because they have a high risk of abuse and can cause serious side effects, especially in older adults.
• Off-Label Medications: Some doctors may prescribe medications like trazodone or other sedating antidepressants, but these don’t always have strong evidence supporting their effectiveness and can have side effects.