Insomnia: Causes, Treatments, and Alternatives for Young Adults

Insomnia issues

Hello Dr.
Ding, I have some questions I would like to ask.
My girlfriend is 24 years old and may be experiencing insomnia due to work-related stress.
She recently visited a hospital where the doctor prescribed her "Suvorexant." She was able to sleep well for the first week of taking it, but this week she has started to experience insomnia again at times.
Is it possible that the medication is losing its effectiveness, or could there be other reasons? I am actually hesitant to have her continue taking sleeping pills due to the risk of dependence, but she says she cannot sleep without them.
Additionally, my girlfriend is able to sleep without medication on Friday and Saturday nights.
I have talked to her about trying to relax, but it doesn't seem to help much.
I would appreciate it if you could take some time to address my concerns.
Thank you.

Yǒnghéng de jìntóu, 20~29 year old female. Ask Date: 2013/05/30

Dr. Ding Shuyan reply Psychiatry

Hello, insomnia is a common manifestation of many diseases or issues.
Therefore, the severity of insomnia symptoms can change with the progression of the condition and the effectiveness of treatment.
The use of sleep medications like Stednos primarily serves as a symptomatic relief.
Identifying the underlying causes of insomnia or the true disorders behind it (such as anxiety disorders or depression) and treating them is what constitutes the fundamental approach to treatment.

Your girlfriend's insomnia resurfacing after a week of taking Stednos is likely not related to habituation, which in medical terms is referred to as tolerance, and typically occurs only after prolonged continuous use.
It is more plausible that the initial week of taking the sleep medication was influenced by the confidence and placebo effect associated with first-time use.
Additionally, her tendency to sleep better on weekends is clearly related to psychosocial factors such as work-related stress, making it important to address how to alleviate this stress.
Finding ways to reduce stress in her life or at work can sometimes be challenging due to the subjective nature of the situation.
You might consider discussing her work content, workload, her competency level, workplace relationships, and her expectations versus reality regarding the job, as these factors can significantly impact her work-related stress.
The appropriate use of sleep medications can greatly enhance our quality of life.
If your girlfriend is unable to sleep at night without medication, taking a physician-prescribed medication for a good night's sleep can help her wake up refreshed and ready for work the next day, which should not cause excessive concern about using sleep medications.
However, this should not be the focus of our treatment.
As mentioned earlier, identifying and treating the root causes of insomnia will help alleviate worries about persistent insomnia and the potential for prolonged use of sleep medications.
Wishing you all the best,
Dr.
Ding Shuo-Yan

Reply Date: 2013/05/30

More Info

Understanding insomnia, especially in young adults, is crucial as it can significantly impact their daily lives, mental health, and overall well-being. Your girlfriend's situation is not uncommon, particularly among young professionals who face various stressors in their work environment. Let's delve into the potential causes of her insomnia, treatment options, and alternatives to medication.

Causes of Insomnia
1. Stress and Anxiety: As you mentioned, work-related stress is a significant factor. Stress can lead to hyperarousal, making it difficult for the brain to relax and transition into sleep. This is often compounded by anxiety about work performance, deadlines, and job security.

2. Sleep Environment: Factors such as noise, light, and temperature can disrupt sleep. If your girlfriend's sleeping environment is not conducive to rest, it could contribute to her insomnia.

3. Lifestyle Choices: Caffeine intake, irregular sleep schedules, and excessive screen time before bed can all interfere with the body's natural sleep-wake cycle. It's essential to maintain a consistent sleep routine and limit stimulants, especially in the hours leading up to bedtime.

4. Psychological Factors: Conditions such as depression or generalized anxiety disorder can manifest as insomnia. If your girlfriend has a history of mental health issues, this could be a contributing factor.

Treatment Options
1. Medication: While medications like "Zolpidem" (the generic name for "使蒂諾斯") can be effective for short-term relief, they are not a long-term solution. The concern about dependency is valid; thus, it's essential to use these medications under strict medical supervision. If her insomnia persists despite medication, it may be worth discussing with her healthcare provider about adjusting the dosage or exploring alternative medications.

2. Cognitive Behavioral Therapy for Insomnia (CBT-I): This is a highly effective treatment that focuses on changing sleep habits and misconceptions about sleep. It involves techniques such as sleep restriction, stimulus control, and cognitive restructuring to address the underlying issues contributing to insomnia.

3. Relaxation Techniques: Encouraging your girlfriend to practice relaxation methods such as mindfulness meditation, deep breathing exercises, or progressive muscle relaxation can help reduce anxiety and promote better sleep.

4. Sleep Hygiene: Establishing a bedtime routine that promotes relaxation can be beneficial. This includes creating a comfortable sleep environment, maintaining a consistent sleep schedule, and avoiding screens before bed. Encouraging her to engage in calming activities, such as reading or taking a warm bath, can also help signal to her body that it's time to wind down.

Alternatives to Medication
1. Natural Supplements: Some individuals find relief from insomnia through natural supplements like melatonin, valerian root, or magnesium. However, it's essential to consult with a healthcare provider before starting any new supplement, as they can interact with other medications.

2. Lifestyle Modifications: Regular physical activity can improve sleep quality. Encouraging her to incorporate exercise into her routine, preferably earlier in the day, can help reduce stress and promote better sleep.

3. Mindfulness and Stress Management: Engaging in activities that promote mental well-being, such as yoga or tai chi, can help manage stress levels and improve sleep quality.

Conclusion
It's understandable that you are concerned about your girlfriend's reliance on sleep medication. While it can provide temporary relief, addressing the root causes of her insomnia is crucial for long-term improvement. Encouraging her to explore non-pharmacological treatments, such as CBT-I, relaxation techniques, and lifestyle changes, can be beneficial. Additionally, maintaining open communication about her feelings and experiences with sleep can help her feel supported as she navigates this challenging situation. If her insomnia persists, it may be worth seeking a second opinion or consulting a sleep specialist for further evaluation and tailored treatment options.

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