Insomnia
Up to 40% of adults endure frequent nights of inadequate sleep. As a family physician I often hear from frustrated patients about their difficulties in getting a restful night. When I give lectures or seminars on how to sleep better, countless people describe to me their anguish and despair. One young woman says that even walking past her bedroom gives her a panicky feeling. She fears her bed. She associates her bed with horrible nights of alertness in the dark.

Many insomniacs use over-the-counter medicines like Benadryl, Nyquil, or Sominex. Some try herbal products such as valerian root or sip chamomile tea.

There are many causes for inadequate or disrupted sleep (see the following table). If you suffer from insomnia, consult this list to see if any of the reasons apply to you. Take necessary steps to correct them. Follow the twenty tips to deep sleep as outlined in Chapter 9. If, after following all these steps, you continue with frequent episodes of insomnia, consult a physician to make sure you have no serious medical or psychological causes. If your exam and tests are normal, it may be appropriate to temporarily attempt the help of a sleep medicine. A good choice is melatonin.

MacFarlane, from McMaster University in Toronto, Canada, tested the effect of 75 mg of melatonin administered nightly at 10 pm to 13 insomniacs. A significant improvement in sleep and daytime alertness was observed with melatonin compared to treatment with placebo. Six of the 13 participants also reported improved mood. In some insomniacs the response to melatonin was delayed by several nights.

The dosage used to treat insomnia is quite variable. One option is to start with 1 mg 2 hours before bed. Try this for a few nights. If no improvement is noted, try 2 or 3 mg. Use this higher dosage for a few more nights. Experiment to see what hour before bedtime is right for you to take melatonin. Some people may find taking a pill several hours before bed helps them more than taking it 1 hour before. It may be trial and error until you come up with the best dosage and timing for your unique self.

There is a condition called delayed sleep phase insomnia. People with this condition cannot fall asleep at the same clock time, but have no difficulty sleeping when bedtime is delayed 2-5 hours. If bedtime the first night is 12 midnight, the following night they would sleep normally at 2 am, the night after at 4 am, and so on. Melatonin seems to be very effective for patients who have this syndrome. It resets their clock, by advancing their sleep phase. Dahlitz, from the University of London, successfully treated 8 patients with this syndrome using 5 mg of melatonin at 10 pm.

In cases of severe insomnia where a pharmaceutical pill alone is not effective, combining it and melatonin, both at low doses, may be of great benefit (Ferini-Strambi, 1993). Taking lower doses of pharmaceutical sleeping pills should reduce their side effects.

When deciding to stop the use of melatonin or any sleeping medicine, it is best to taper off over a period of 1 to 2 weeks to avoid any sleep disturbances. Melatonin may in some individuals cause rebound insomnia, as do some other sleeping pills, but to a much lesser degree. Only a small percentage of people feel any withdrawal symptoms. Marilyn, a survey participant, writes, "I stopped taking melatonin last summer after regular use and noticed no withdrawal symptoms at that time. Most recently, I have noticed that if I stop taking it after a few days (usually 3 or 4), I have more trouble falling asleep. I also wake more often during the night."