The Controversy On Treatment For Insomnia

7 July 2016

I can’t sleep; I lay their awake for hours at time, my workday just drag on without being able to accomplish my work in a timely manor. My boss doesn’t know and the lack of sleep is going to get me a poor review. I want to go out tonight but I’m just too tired, I need to sleep. This is the effect of insomnia, statements like these cause people to search out a solution to the problem. Some will turn prescription drugs others will turn to therapy to find the answer that will work for them. Insomnia is a condition that can cause serious problem in all areas of life not limiting it to only work related performance.

Prescription drugs come with complications that result in unwanted side effects. Prescription Drugs and Cognitive Behavioral Therapy, both can treat insomnia, finding out which one is better creates a controversy for anyone seeking relief from insomnia. Cognitive Behavioral Therapy treatment finds and targets to cure the issues, which created insomnia in the first place. Insomnia can be caused from more than one problem. It can be medical from disease or physiological problems, and sometimes it can be both. Prescription drugs can assist in a good nights rest, but it only treats the symptoms.

The Controversy On Treatment For Insomnia Essay Example

Leaving the cause of insomnia behind for possible rebound insomnia. Cognitive Behavioral Therapy the best way for insomnia to be treated; it may not be the fastest but it is more effective treatment due to resolving the root cause. Insomnia can affect anyone; all who are affected by it are not always able to carry out everyday tasked due to lack of sleep. Insomnia will stop some people from participating in regular activities and social events. Insomnia is a sleep disorder making it “difficult initiating or maintaining sleep, waking up too early, non-restorative sleep, or sleep difficulty despite appropriate opportunities for sleep (ONS Connect, 2011).

” This is not a simple disorder because insomnia can have more than one cause. That would be considered a “secondary insomnia: also called comorbid insomnia, this type of insomnia is attributed to a medical condition (ONS Connect, 2011). ” To get a handle on this issue many turn to prescription drugs, which may be a quick fix. The drugs may assist with sleep, but may not be the cure; drugs can only treat the symptom. This can leave the sufferer taking prescription drugs to sleep for a long time; prescriptions can be a quick fix for any kind of symptom.

For insomnia it is not different. One of the popular prescribed drugs today is Zolpidem. It has reached the top of the list due to its effect of introducing sleep for insomniacs. Most patients do well on this medication, which is reflected in the studies that have been conducted. Zolpidem is prescribed for people who are suffering from insomnia. This prescription drug purpose is to assist patients with getting the sleep they need. There is no secondary use listed it’s sole purpose is to induce sleep. The drug is taken for calming or sleep inducing.

It’s main use is to be given to those who have insomnia assisting them with what ever is preventing them from falling asleep or sleeping the whole night through. To give further define the use of the prescription drug “Zolpiderm it is a sedative hypnotic that binds selectively at the benzoliazene site (Kleykamp, B. , 2012). ” Zolpiderm use can be prescribed without any limitation. Zolpiderm has no “treatment duration limit (Kleykamp, B. , 2012). ” With the sedative people have gained the sleep they need to function everyday. Of course side effects need to be monitored, incase they cause some problems for the patient.

The primary and only function for Zolpiderm is sleep inducing. The medication does need some trail and error for any particular patient so the dosage will be correct. This can take a few weeks for complete satisfaction and there are some down falls from the medication. Zolpidem has some small side effect issues that is according to the Journal from Human Psychopharmacology: Clinical & Experimental written by Otmani (2008). The journal states “no effects on next morning psychomotor or driving performance were observed except that the decline in memory recall after zolpidem was more pronounced in the next day.

No pharmacokinetic interactions were found (Otmani, 2008). ” This drug seems to be safe, however one may encounter memory issues, not everyone is able to take this drug. Some have experienced not such a great outcome after trying Zolpidem. In another study that was conduct we see there were side effects that showed up, Otmani might have had a great run for his trial as stated above. On the other side most prescription drugs have side effects, which show up, they may be low but they are still present.

The drug Zolpidem has been blamed for about “4% of patients discontinued because of an adverse event; the most common of these events included daytime drowsiness, dizziness/vertigo, amnesia, nausea, headache and vomiting (Yang, L. , 2012)”. The side effects may not be so alarming as in the numbers, but having the issue with just one can be difficult to handle. Zolpidem maybe a wonderful drug to some to some people. Others it is not so wonderful, however prescription drugs are not the only treatment for insomnia. Drugs may treat the symptom, but the side effects could be a problem.

Patients using Zolpidem have to take into the considerations of all the side effects of the medication. For some people major problems have arisen with the use of Zolpidem, they are real alarming. Even though Zolpidem doesn’t have a duration limit there are withdrawal symptoms that can occur. The Journal Of Substance Use published an article written by Chia-Chang Chien. Chien listed the side effects from withdrawals due to the use of Zolpidem. Those withdrawals not limited to but included “rebound insomnia”; the report covered five cases, which presented withdrawal problems after high doses of Zolpidem.

The withdrawal problems were “delirium, seizure, acute psychosis, and orofacial dyskinesia complications (Chien, C. , 2011)”. The side effects listed are a little shocking from reading above only a small percentage of participants dropped out because of side effects. Using sleep-enhancing prescription drugs needs to be done with caution of possible harmful side effects. The drug may have helped people get the rest needed, but was it worth risking all the side effects possible. Chien’s article did site five cases where horrible side effects did happen. All five cases had originally started out with normal small dosage of Zolpidem.

After liking the effect of the drug they began seeking a stronger dosage on their own. They visited different doctors and different clinics to obtain the higher dosages they desired. All had suffered from either depression disorder an anxiety disorder along with insomnia. Not one of the cases had a past of substance abuse before the withdrawal problems from Zolpidem. The drug may induce sleep, but at higher dosages addiction type behavior has occurred. Up until this point, the descriptive research being reviewed for this paper, the side effects were not noted as possible alarming problems.

As someone who has suffered from insomnia and have taken prescription drugs to be able to sleep the whole night, it shocked me when I read some of the information and warnings concerning Zolpidem. I was not aware of the side effects list when I took the prescription although if I was I would of turned it down. I had high hopes Zolpidem would not have a long list of problems, but unfortunately it comes with a long list of warnings. The warnings that are listed below do come directly from the patient information. They like many prescription drugs are scary when you realize what you are taking.

From YOUR MEDICATION INFORMATION: Zolpidem extended release (generic)/AMBIEN CR (BRAND) 2011, under warnings: “Worsening of insomnia or the emergence of new thinking or abnormal behavior… tell your doctor” “reports of ‘sleep-driving’ and other complex behaviors… often with out memory of the event. ” “some people may experience memory loss” “Under Dependence: Taking sleep medicine regularly for a longer than a few weeks or at high doses can cause dependence in some people” Zolpidem has no time duration limit! Then there is “Withdrawal…

In mild cases, they include abdominal and muscle cramps, vomiting, sweating, shakiness and rarely, seizures. Rebound insomnia may also occur when medicines are first stopped” (YOUR MEDICATION INFORMATION 2011) The above are only small portions quoted there is way too much information to list them all. I was sadden to see so much listed, I thought Zolpidem was something that could assist people where they did not have worry or have great concern about the side effects. Another kind of treatment for insomnia is Psychology, which can play a great role in curing insomnia.

Research has been done to treat patients with finding that psychology Cognitive Behavioral Therapy will not only work to cure insomnia, but for depression and anxiety also. According to the Psychology: The Human Puzzle “Cognitivism provides explanations for behavior based on our ability to symbolize, to uncover cause-and-effect relationships, to determine what goes with what, and to anticipate the consequences of our actions: (LeFrancois, G. , 2011)”. When one is not able to sleep and suffers from insomnia we have to look at what is the real cause of the insomnia.

Cognitive Behavioral Therapy will do just that, opening up to the deep down thing that is the real cause for insomnia, Psychology can become the answer. From studies along the lines for Cognitive Behavior Therapy the answers are revealed. One of the top reasons for insomnia is depression; Cognitive Behavior Therapy (CBT-I) for insomnia can be combined together with treatment for depression. One of the studies conducted and is noted in the Journal of Clinical Psychology looked into CBT-I.

The research for this provides a “collective findings provide further evidence for the bidirectional relationship between insomnia and non-sleep depressive symptoms that interventions targeting insomnia can have direct effects on depressive symptoms (Wagley, J. , 2013)”. Being able to conquer two issues with one treatment strengthen the reason for CBT-I. A conclusion to limit CBT-I to treating only two issues would be putting limitations on how successful it can be. The CBT-I sessions for treatments assist with more than insomnia and depression as we seen above.

The developmental psychologist takes a deeper look to include insomnia within the CBT-I treatment for insomnia to find studies including anxiety. It is becoming a well-known fact that CBT-I can treat many disorders such as “worry, anxiety, and depression (ONS Connect, 2011)” which can all be related to the source of insomnia. CBT-I does not have limits on what it can do; only limit is how much a person will give into sessions they take. To limit the problems that society faces CBT-I is one of the best ways to start and complete treatment.

To create the basics on how therapy can work, studies to treat the insomnia used a treatment plan that included; a sleep journal, sleep hygiene regimen and several sessions of therapy. (Maroti, D. , 2011) CBT-I starts with the basics to rid one of inadequate thoughts or ideas about sleep. Blaming daytime problems on the lack of quality sleep can stop an insomniac from being able to sleep, because they can start to over think the shortcomings of the day. “General cognitive errors, including overgeneralization, rumination, and magnification. High anxiety regarding sleep that often emerges with the start of bedtime activities (Ebben, M., 2012).

” Cognitive speaking if we can make someone’s thoughts better sleep habits will improve and insomnia will start to disappear. However, the cure is not always easy to say change what you are thinking about when you go to sleep. Someone who is really suffering from insomnia may not be able to shut his or her mind off when it is time to sleep. It goes back to the saying it is easier said then done. The major controversy of therapy verse use of medication is time. Some people don’t want to take the time to do therapy sessions or don’t want to take sleep-enhancing drugs to sleep through the night.

No mater which one a person chooses the end results need to come out the same, a full nights sleep. Insomnia, horrible to suffer from, a solution must be found and it needs to be a good fit. Answering the controversy of therapy verse medication can be difficult for anyone to decide. Getting to the defining cause may take some time to assist with sleeping through the night completely. Time is something the American public always seems to run short on; the demands of everyday life can create so much anxiety for anyone. The treatments for CBT-I secessions will be different for every patient.

One study was done that ran the CBT-I for six months with results of about 75% having good results (Jarnefelt, H. , 2012). This study was conducted without the use of sleep enhancing medications. Patients were able to sleep and have complete solid nights sleep, without the worry of medication side effects and wake time issues. The root cause of insomnia can be resolved without use of drugs. While CBT-I can be the best way to resolve insomnia it does not come without some work and of course commitment to complete the full therapy.

As research has continued looking into the CBT-I, it is easy to see why some people are reluctant to use this method. From reading a Journal of Clinical Psychology, addressed the appropriateness of using CBT-I. The journal article titled From Bedside Back to Bench? , looked into how effective the therapy is. The journal did point out the effectiveness of the CBT-I depends greatly on the patient in “session attendance, sleep diary records, retrospective questionnaires (Kyle, S. D. , 2013). ” If the commitment were not there a patient would have difficulty in achieving the goal of not having to deal with insomnia.

Although this set back for having a solution for insomnia sufferers it is not something that could cause medical issues for any said patient. Just as discussed above CBT-I has had a possible set back due to a patient’s lack of commitment, it’s a negative point, but it does not outweigh the good. Patients who are committed to CBT-I treatment can come to complete resolution resulting in a cure. As the article Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review, points out the sessions can be short as 6-8 weeks (Mitchell, M. D., 2012).

Also noted in this article was the good that came from the CBT-I treatment, especially when looking at prescription drugs. This is considered a positive effect for CBT-I due to not having a need for prescription drugs; it does not turn into a long-term dependency. Patients may not stay committed to the therapy, but those who do will have good success without having long-term prescription drug usage. Indeed, while prescription drugs come with complications and the results in unwanted side effects, and CBT-I has a time commitment both can treat insomnia.

Finding out which one is better does create a controversy for anyone seeking relief from insomnia. In detailing out all the analysis of the findings for this paper has been an eye opening experience. From the viewpoint as someone who is studying to become a psychologist of course CBT-I would be the way I would want this paper to end. When starting the study on Zolpidem I thought this might be something of great to use with it being so popular, so many physicians are prescribing it; it has to be really useful. For insomniac’s maybe it is a great quick fix, but after the descriptive research involving the archives I quickly changed my mind.

The side effects of Zolpidem were just too much to overcome and be able to say Zolpidem is a safe choice. CBT-I has won to controversy for me. I can’t sleep; I lay their awake for hours at a time waiting for sleep. People look all the time for a quick fix to every problem that comes into their life. With insomniacs it is no different, relief from not being able to have good night rest; which is in high demand for those who suffer from insomnia. Looking at CBT-I can turn people away because of the commitment to the treatment. It is true what you put into it will be what you get out of it.

Insomnia is better treated with CBT-I because there is no problem with memory loss, no prescription drugs to be taken, only some homework for sleep hygiene and a sleep journal. CBT-I treats more than insomnia; it is not limited on what it can cure. Sessions do not need to drag on for years, usually for insomnia can be short-term lasting only a couple months. CBT-I will also cover more than just insomnia where Zolpidem is limited to only treating insomnia CBT-I can treat anxiety and depression all at once. CBT-I may not be the fastest, but it is the more effective treatment due to resolving the root cause.

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