Insomnia

Insomnia, Can Tang Psychiatric Treatment Area

Insomnia is such a common complaint of my patients that I decided to learn as much as I can about its treatment.  People with insomnia complain about difficulty falling asleep, waking up many times at night, can’t stay asleep, or feel tired in the morning. Left untreated, people feel irritable and unproductive the next day. Many patients expect that I will just give them a sleeping pill like Ambien or Lunesta if they complain about sleep issues.  This however is not my approach.

I take an integrative approach to treating insomnia as I do not believe that sleeping medications is an ideal long term solution as they can be addictive, cause memory problems, and impair judgment.

My stepwise approach is as follows:

  1. The first thing I establish is whether the insomnia is acute or chronic, and any triggers for its onset.
  2. Then I discuss about lifestyle that may contribute to it, for example,  amount of caffeine consumption, nicotine use, energy drinks, and sodas.
  3. I discuss practical ways to manage common stressors:
    1. marital/relationship problems,
    2. recent death of someone close,
    3. lost of job or career,
    4. lost of independence,
    5. taking care of children or aging parents,
    6. having a chronic physical illness such as chronic pain,
    7. stress at work or school.
  4. The next step is to evaluate for possible psychiatric conditions that may contribute to insomnia. Common ones include depression, obsessive worrying, bipolar disorder, and anxiety.
  5.  Another important step I take is to discuss patient’s medication regimen, as many can cause insomnia as side effects.
  6. It is also important that I go over my patient’s medical history to look for any conditions that can contribute to insomnia, for example: thyroid issues, hormone changes, and menopause.
  7. Lastly, I discuss and educate patients about possible sleep disorders that can contribute to their insomnia such as sleep apnea.

 

Treatment for Insomnia

Treatment depends on numerous factors.

  • what we think are the causes of the insomnia,
  • severity of insomnia,
  • how long it has been going on for,
  • how long we expect it to continue,
  • what the patient has tried (i.e. over the counter sleep aids, exercise, yoga, meditation, relaxation techniques),
  • co-existing psychiatric or physical illness.

One option obviously is sleeping medications. There are numerous medication options to help with sleep and this is a long conversation I have with patients all the time. They will have a good understanding after our discussion. I find that there are a lot of misconceptions about sleeping medications. They can make a big difference in quality of life if used judiciously. If medication management is the best approach, I work with my patients to find solutions that they are comfortable with and that I feel is safe to prescribe.

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Can Tang, MD, MPH,
Board Certified Psychiatrist

9070 Irvine Center Drive, #105
Irvine, CA 92618

tel: (949)363-3325

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Can Tang, MD, MPH, Board Certified Psychiatrist