Brief Answer:
follow sleep hygiene

Detailed Answer:
Hello Young man,

Thanks for writing to us. I can understand your concern.

I want to clarify about sleep problem (insomnia).

Insomnia (sleep disturbance) is of two types:

Primary: There is problem of only sleep disturbance and no other physical or psychological problem is there. In this case treatment for sleep problem is needed.
     
Secondary: There is some underlying physical or psychological problem which is responsible for sleep disturbance. In this, main treatment is done for underlying problem.

First of all try to follow some measures called 'sleep hygiene' which would help in sleep. You can find the same in below link.

sleepfoundation.org/ask-the-expert/sleep-hygiene

Drinking a cup of warm milk(with 1 teaspoon ghee if possible) before going to bed helps in 30-40% of patients and they do not need medicines as per my clinical experience.

As such drugs from benzodiazepine group and Z group sedatives (ambien/zolpidem) are used in sleep disturbance.

As such zolpidem is not addictive you think so as per my clinical experience as well as literature. Even tryptomer is quite sedating in many patients.
You can keep 7.5 mg dose for more 2 days with sleep hygiene. After that you can reduce to 5 mg for 2 days then 2.5 mg for 2 days and then stop.Do not think much when you go to bed that you would get sleep or not. You will be able to get sleep without medicine in 1 week with sleep hygiene.

Let me know more so I can guide you further.

- Since when are you suffering from sleep disturbance?

- What is type of sleep disturbance there? Is there difficulty in sleep onset, fragmentation of sleep or early morning awakening?

- What was the schedule (timing) and duration of sleep before the problem started? How much reduction in sleep hours is there from previous?

- Do you have any type of stress (it can be social, economical, relationship, study/work or emotional)?

- Do you have any physical illness?

I guess you are treated by physician. If your primary problem is stress, you need treatment from psychiatrist for better outcome.

I will be happy to help further after your response.
Regards,
Dr.Chintan Solanki.

---

Brief Answer:
modification of lifestyle is required

Detailed Answer:
Hi,

Thanks for information.

Your problem is likely related to work related stress. You need some time management with healthy lifestyle. Follow healthy lifestyle. This includes regular daily exercise (walking or running), hygienic food habits (no junk food, no fatty food, preferably only home-made food with law salt and fat with more fruits and vegetables) and timely scheduled sleep. Yoga- meditation can also help.

For detail description I just want to mention here what I tell to my patients.


Sleep hygiene
Resting at night plays an important role in regulating your daily health and your level of energy throughout a day. Also, not only the quantity but the quality of sleep is also important for a healthy lifestyle. Bedtime habits do play a vital role in shaping up your lifestyle and personality as a whole. Here are 6 lifestyle habits that can help you to get sound sleep on a daily basis.

1. Having a fixed sleep pattern: Going to sleep and waking up approximately during the same time every day helps to maintain an equilibrium in the sleep-wake cycle. If this balance is maintained then your body will be accustomed to this pattern and as a result, you will feel less tired and sleepy during the daytime.

2. Maintaining certain dietary regulations: You should also maintain a proper diet plan and examine the consequences of the foods that you are eating and the fluids that you are drinking. Taking a proper and nutritious diet on a daily basis will help you to stay healthy by not disrupting your natural sleep-wake cycle.

3. Ensuring that your room has appropriate lighting: The level of light also matters at the time of your sleep. You should definitely make sure that there is a very minimal level of light around you during bed time. This should be done because the lesser is the light, the more comfortable you are while sleeping. Additionally, the sleep that you will get into a dark room will also be sound and undistorted as it helps keep all the sensory organs calm.

4. Regular exercise: Exercising regularly helps to improve the overall quality of sleep by making you tired at night and sending you to bed more efficiently. Light to mild exercises also helps cure sleep disorders like insomnia.

5. Opting for some relaxing activities before bed: Depending on your personality, you should follow simple techniques of relaxation in order to calm down the brain before sleep. Some of the most common relaxation techniques include- deep breathing exercise, muscle relaxing activity, visualizing a peaceful setting/ scenario and a light before-bed snack. The above-mentioned activities are just suggestive and you should do anything that helps you to get a sound sleep.

6. Having daytime naps: Having short naps of less than one hour is absolutely okay if you are excessively tired during the day or you did not have a sound sleep the previous night. But, if you are consistently having long naps during the day then you are bound to have sleep issues during the night. So it is advisable to sleep early and wake up early for a healthy schedule.


Ultimately you need to fix your sleep timing. Even you can dive your sleep in 2 parts of the day. And believe me when sleep deprivation is in excess, no harm in taking zolpidem. At this point you just need to stop it and follow sleep hygiene.

GERD is very troublesome problem and it can also affect sleep specifically if you go to bed within 1 hour after dinner. At least keep 2 hours timing between sleep and dinner. Proper management of GERD is also needed.

Not to worry much. I used to get such type of questions form many IT professional and shift duty workers as well as patients in my clinic. Most of them do well with sleep hygiene and lifestyle modifications.

---

Brief Answer:
yes you can use melatonin

Detailed Answer:
Hi,

Yes melatonin is available as natural supplement and you can replace zolpidem with it. It helps in sleep in many patients with mild sleep problem.

I recommend first trying sleep hygiene for few days. You may not need even malatonin also.

Take care.

---

Brief Answer:
you should get result within a week of applying sleep hygiene

Detailed Answer:
Hi,

As per my clinical experience patients with insomnia due to mild stress and improper lifestyle get improve in sleep within a week of properly applying sleep hygiene.

Here is the problem. Your concern (a bit more than the usual) about not being able to get sleep for a while may cause sleep disturbance. Do not think about sleep and actively try to sleep.
You are already on zolpidem and I told to taper it slowly. There is already medicine to help you in sleep until you get complete benefit from sleep hygiene.
By chance if you cannot succeed ( very less chance if you can understand and follow what I recommended), medicines are always there to help. And better to take medicines for sleep from psychiatrist as he is an expert of sleep disorders.

All the best.

---