Q. You recently explained what a circadian rhythm is and the various disorders associated when it gets out of sync. Can you give suggestions on resetting our circadian rhythm?
A. Our circadian rhythm can get disrupted for a variety of reasons which we discussed in a previous Ask the Pharmacist Column. If you do find yourself out of sync with your own circadian rhythm, there are numerous lifestyle modifications that can be used to help reset your body which might prove to be more beneficial than medication.
It is understandable that many people would rather seek a medication to help them get into a better sleep pattern. The following are a few options that you do not need a prescription for that many people try.
· Melatonin is a hormone that we make in our body but is also synthetically manufactured as a sleep aid. It has been used to reduce the time it takes to fall asleep and also to lengthen your night of sleep. If you are travelling across time zones, you can take melatonin at your new local bedtime for the first few nights. This could also be worth trying to help minimize symptoms of shift work sleep disorders. Melatonin is considered safe to take for various age groups but should be avoided in people who take immunosuppressants or blood thinners. Melatonin should be used cautiously if you take blood pressure medications, seizure medications or diabetes medications. There isn’t enough information to suggest its use in pregnancy or nursing mothers. Since melatonin has been shown to inhibit ovulation, it is best to avoid taking if you are tying to conceive. Melatonin doses range from 3mg to 10mg. It is suggested to opt for the usual short-acting melatonin over the long-acting (sustained release) version and to take 3 to 5mg about 2-3 hours before you plan on going to bed to get the best effect.
· Magnesium is a supplement that many people take to reduce the time it takes to fall asleep but it doesn’t appear to lengthen your sleep time. Magnesium can cause stomach upset and diarrhea in higher doses so it is best to keep the overall dose to 350mg elemental magnesium per day.
· Valerian is an option for some sleep disorders but not very useful for short-term needs like shift work or jet lag sleep issues since it can take up to 4 weeks to be effective. There is also some concern with long-term use and hepatoxicity, so it is only recommended to be taken for 6 weeks or less.
It is not recommended to take over-the-counter medications that might seem obvious to try for sleep like Sleep-Ease, Nytol etc. These generally contain diphenhydramine which is the active ingredient in the name brand Benadryl. This product was first launched to help with allergy symptoms but due to their short duration of action (4 to 6 hours) and their propensity to cause drowsiness and the many once daily, non-drowsy formulations that are available, they are not as widely used any longer. Their side effect of drowsiness is why they have been marketed among the sleeping medications. However, they do also have other untoward side effects that could cause harm, particularly in the elderly. They are commonly known to cause anticholinergic side effects such as dry mouth, dry eyes, confusion, constipation, fast heart rate, weak muscles. These are often more exaggerated as we age because many older people do not drink a sufficient amount of water and are already slightly dehydrated to begin with.
Another group of medications that people may resort to for sleep are benzodiazepines such as lorazepam (Ativan), temazepam (Restoril), diazepam (Valium) or other medications for sleep such as zopiclone (Imovane) or zolpidem (Sublinox). These all require a prescription from your health care provider. They all have a tendency to cause dependency and there is concern with possible cognitive impairment with long-term use. There is also an increased risk of falls, particularly in the elderly. They are certainly not recommended for the treatment of circadian rhythm disorders.
Before looking for a medication to take for your sleep disorder, it is strongly suggested to look at your routine and/or habits that might be contributing. Here are a few lifestyle modifications you can do to improve your sleep.
Sleep/Wake Schedule: It is strongly encouraged to go to bed at the same time each night and arise at the same time each evening. This also includes weekends and when you are on vacation or after a horrible night of sleep.
Bedtime Routine: Keep your routine the same each evening so your body can learn that it needs to begin winding down and preparing for sleep when you begin the usual tasks. These activities can include a typical hygiene routine (brushing teeth, washing face), listening to relaxing music, and/or reading. It should not include stimulating activities (hard music, thrilling mystery novel) or bright lights. Limit the use of screens (cell phone, tablet, computer, television) for the few hours before your bedtime. This can be difficult for many as they often scroll on their device while in bed.
Bedroom Environment: Your sleeping quarters should be;
A. Dark: Use black-out curtains to help block out the light and/or use a sleep mask over your eyes.
B. Quiet: Loud noises can disturb your sleep even when you don’t think you are bothered by them. Use of ear plugs, fans or white-noise machine can block the excessive noise.
C. Temperature: Think of Goldilocks when it comes to your bedroom temperature. Keeping your room too warm or too cold can affect your sleep. Aim for a temperature that is “just right”.
D. Pillows: Using extra pillows for between the knees or for your waist or shoulders can help to increase your comfort and reduce awakenings due to pain.
E. Bedroom Activities: Avoid using the bed for any other activities such as eating, reading, watching television or screen activities such as emails, texting, social media scrolling, banking. Your bed should be confined to only sleeping and sex.
After 20 minutes: If you are still lying awake after you have turned out your light and are attempting to fall asleep, leave the room and do some of the mindless activities you like to do when preparing for bed like listening to chill music.
Exercise: This is important for so many facets of our life and not just our sleep. Though exercise does help our body to have a better sleep, it also stimulates our heart rate and our brain function so it should be avoided within 5 hours of your bedtime.
Relaxation: If you are feeling uptight or stressed, chances are you may not be successful in falling asleep. Find an activity that speaks to you to help you relax such as taking a warm bath, time in a hot tub, reading a book, or meditation.
Substances that affect sleep: It is well known that caffeine (coffee, tea, colas, chocolate) is a stimulant and should be avoided within 12 hours of bedtime. Though alcohol may initially make you sleepy, it can also cause you to wake up in the middle of the night or very early in the morning. Water pills (diuretics), appetite suppressants and nicotine can also affect your sleep and should be avoided close to your bedtime.
Snacks: Eating a heavy meal close to bedtime can negatively affect your sleep. On the contrary, going to bed hungry can also have an impact. If this is the case, eat a small, ideally warm, snack.
Daylight: Get outside and immerse yourself with the natural daylight during the day. This works best if done in the morning. This is not always feasible, especially in Grey Bruce County so having bright lights on in the home or your office helps to mimic this effect.
Avoid naps: Naps seem like such a great idea and there is some research that shows benefits for them. However, naps may be the cause of your sleeplessness at bedtime. If you like/need to nap, keep the timing of your nap consistent and ensure it is not longer than 30 minutes.
For more information on this or any other health related topic, contact your pharmacist.
