Insomnia is essentially displeasure with sleep quality or quantity. Insomnia may lead to irritability, difficulty concentrating, lack of productivity, accidents, daytime fatigue, decline of overall health, and many other issues. Insomnia is frequently diagnosed with other psychiatric disorders such as anxiety or depression, which may be the underlying cause. Someone with an anxiety disorder may have difficulty unwinding or shutting down racing or ruminating thoughts or fears. Depressed individuals often wake up earlier than intended and are not able to return to sleep. Insomnia itself can also lead to, or exacerbate, anxiety, depression, or other mental health disorders. The potential causes of insomnia are numerous. Underlying causes could be medical in origin or psychiatric in origin and are often “idiopathic” (unknown).
At this practice we primarily treat insomnia that exists with, or is caused by, other psychiatric disorders, such as depression or anxiety. By treating the underlying psychiatric disorder, sleep often improves on its own over time. In the short-term we may also treat the insomnia directly while working on resolving the primary disorder. As always, we start by obtaining a thorough medical and family history to rule out medical disorders or medications as an underlying cause. Usually, it is not that difficult or complicated to treat the insomnia. In some cases, we may order lab work, recommend a physical exam, recommend a sleep study, or refer to a sleep specialist if insomnia is treatment-resistant or a medical cause is suspected.
We are not able to treat severe insomnia where an individual is non-functional or poses a serious safety risk due to lack of sleep, treatment-resistant insomnia (non-responsive to 2+ medication trials specifically for insomnia), or insomnia that requires controlled substances to manage. If insomnia has an underlying medical origin or suspected medical origin, we may refer to relevant outside sources.
Antidepressants: Antidepressants are first-line medications for depression and anxiety and by treating these disorders sleep can improve as well. However, certain antidepressants are known to help individuals begin sleeping immediately.
Prescription antihistamine: There is a particular antihistamine medication that may aid with sleep in addition to providing short-term and fast-acting anxiety relief.
Sedative hypnotics & benzodiazepines: These medications can be effective for short-term relief of insomnia. However, they are usually not good options, even for short-term use. They are not believed to work long-term, can worsen numerous psychiatric symptoms, and cause serious issues such as increased risk of motor vehicle accidents. They are highly addictive and have the ability to cause a very serious physical dependence, that can even be fatal if medication is stopped abruptly. These classes of medications typically create far more problems than they solve. Baltimore Psychiatry does not prescribe these medications for new patients. In the very limited instances we do prescribe them, use is limited to 1 to 2 weeks.
Natural remedies: There are a couple natural remedies which may be helpful with mild to moderate insomnia. However, due to a lack of regulatory oversight many alternative medications or supplements are often not available in a reliable, standardized dosage free of contaminants. Mixing alternative medications with prescription medications may also present unknown risk of interactions. Some natural or alternative medications may be a viable treatment option in some cases and can be discussed with your provider.
Before beginning any medication to treat insomnia we believe strongly in adopting good “sleep hygiene.”
While many of us think of the term “hygiene” in relation to cleanliness, the term is also used to refer to a beneficial set of practices. Sleep hygiene is an invaluable set of practices that can rival the power of medication without any of the downsides.
During the day
Prior to bed
Preparing the bedroom and sleeping
Adopting these practices with genuine effort can be immensely helpful and may even be more beneficial than medication, without any of the downsides. These practices cost nothing and can be performed, at least to some extent, virtually anywhere. However, when these practices alone are not enough you may need a professional evaluation or medication to help you sleep.
Cognitive Behavioral Therapy-Insomnia or “CBT-I” is a type of short-term cognitive behavioral therapy specifically focused on improving sleep. It may be beneficial for individuals suffering from insomnia that has not responded well to other treatments. Regular CBT or other forms of therapy may also be indirectly helpful for improving sleep by reducing overall levels of depression and anxiety, when applicable.