What are non-addictive medications for severe chronic insomnia?

Question

Hello doctor,

I am 43 years old with severe chronic insomnia for three years, which is absolutely destroying my life and mental health. I lie awake for hours every single night, despite being completely exhausted, maybe sleeping two to three hours total if I am lucky.

I have tried melatonin, antihistamines, sleep hygiene changes, and meditation apps, and nothing helps me fall or stay asleep at all. During the day, I am unable to concentrate at work, extremely irritable with my family, and have made dangerous mistakes while driving drowsy.

My job performance is suffering terribly because I cannot focus on details or remember important deadlines. My doctor prescribed Ambien, which worked initially but now does not help anymore, and I am worried about dependency and addiction.

I am gaining weight due to exhaustion, a slowing metabolism, and having zero energy to exercise regularly. My marriage is extremely strained because I am constantly moody, and my husband does not understand why I cannot just sleep normally.

The anxiety about not sleeping makes insomnia even worse, creating a terrible, frustrating cycle every night. Are there newer non-addictive medications or CBT for insomnia that actually work? I desperately need sleep to function like a normal person.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

What you have described is serious, and I can understand the extreme psychological pain you may have been going through. I am here to help you.

One of the major effects of chronic insomnia is the development of dysfunctional thoughts such as "I might not be able to sleep," "I will get up," or "How will I manage tomorrow?" These thoughts initiate the fight-or-flight response in our body. Once your brain is in fight-or-flight mode, it releases neurotransmitters that cause awakeness.

Therefore, you strongly need cognitive behavioral therapy for insomnia (CBT-I). It is a therapy that will work on your thoughts and help you learn relaxation exercises that will help you in the long run. Rule out other comorbid conditions, such as depression and anxiety disorder, which interfere with normal sleep and should be treated.

Non-dependent, good medication options include Ramelteon, Orexin receptor antagonists such as Suvorexant, and atypical antidepressants such as Mirtazapine 7 to 15 mg or Trazodone 50 mg. Other lifestyle modifications should be continued, such as following sleep hygiene, reducing caffeine intake, and taking an evening walk for 30 minutes.

In my opinion, you strongly need CBT-I and Mirtazapine 7 mg at night. It will help you a lot. Get screening for depression, anxiety disorder, and hyperthyroidism.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.