People who often have difficulty going to sleep, staying asleep or falling asleep again if they wake up early in the night or morning are usually suffer varied degrees of insomnia. The usual causes of sleeping disorders are

• Old age (especially between ages 45 - 60)
• Emotional distress
• Jet lag
• Recreational drugs such as caffeine, alcohol, nicotine.
• Medications such as beta blockers for high blood pressure, stimulants for dieting thyroid medications or pseudoephedrine for blocked nose
• Physical ailments such as arthritis, nerve compression pain (neural), nerve inflammation of the backbone (spondylolysis) etc.
• Medical problems such as hypertension, congestive heart failure, obesity narcolepsy (suddenly falling asleep without realizing at any time of the day) and psychiatric disorders

Aids for insomnia can be separated into natural aids, which are more common and widely available, and medicinal/psychological aids.

Valerian (Valeriana Officinalis)

Studies have shown that with continuous use after two weeks, it can increase sleep efficiency and quality. It can also be used in children with intellect deficit and has been found to decrease night awakenings, increase sleeping time and quality. It is however, not for jet lag because it has a slow onset of action. But, it can be used as a daytime sedative for restlessness and tension. It can be an alternative for patients who have withdrawn from sleeping pills. The recommended dosage is 400 mg - 900 mg standardized valerian extract to be taken half an hour before retiring. Valerian is best avoided in patients with liver problems.

Melatonin

It is natural and produced by our body. Melatonin might induce sleep patterns comparable to prescriptive medications (such as Valium® Ativan®), Studies have found melatonin to be beneficial for jet lag and sleeping disorders caused by depression, anxiety, narcolepsy etc. Compared to medications, melatonin has fewer adverse effects. A dose of 2.5-5mg can actually shorten time to fall asleep while 1-3 mg can usually resolve sudden awakenings. Melatonin is best avoided with the use of blood pressure medications, sleeping tablets and stimulants. Patients suffering from liver impairment, brain disorders, psychiatric problems and nerve dysfunction should avoid this supplement.

Passionflower (Passiflora incarnata)

Studies have shown that Passionflower has sedative effects resembling conventional sleeping pills, but without the cognitive impairment commonly experienced with those pills eg Valium®. It can also be used for insomnia-related anxiety and pediatric excitability. Passionflower should not be taken with blood-thinning medications, other depressant drugs and alcohol.

Aromatherapy (Ylang ylang, chamomile and lavender)

Aromatherapy is commonly used for muscle I relaxation and to improve sleep. Massages that incorporate aromatherapy can help to improve blood circulation and insomnia. It can be used to treat insomnia-related migraines and nerve discomfort due to its calming effect. Other oils such as geranium, lemon balm. jasmine, rose, and clary sage can also help to relieve insomnia.

Psychological treatments are behavioral interventions that change habits presumed to maintain insomnia.

1 Stimulus control treatment: This encourages patients to got out of bed and engage in activities followed by lengthy periods of restlessness until they feel sleepy and retire to bed. The goal is to re-associate the bedroom with sleep.

2 Sleep restriction therapies are used to induce transient sleepiness by curtailing sleep.

3 Sleep hygiene educations involves changing lifestyle habits such as restraining caffeine intake before bedtime, maintaining regular waking hours and engaging in relaxing activities before bedtime.

4 Cognitive therapies address thoughts and beliefs that interfere with sleep and adjust expectations.

Medicinal/ Pharmacological aids

Paxidorm® is approved for the relief of transient mild-moderate insomnia and is dispensed by a pharmacist. However, continuous usage might result in dependence and tolerance. Medications such as Valium®, Ativan®, Imovane® are prescribed for insomnia and sleep disorders. However, they should not be continuously used for more than two to four weeks for treatment of insomnia unless otherwise stated. Some of the sleeping pills such as Valium® have longer lasting effects which may result in morning drowsiness and amnesia. Hence, physicians will usually prescribe short and fast acting medications to counter the residual morning effects. Note that prescribed sleeping pills are not suitable for everyone, so it is best to seek pharmacist or physician's advice and stringently follow it.