Behavioral therapies & Medications for Treatment of Insomnia:
Behavioral treatments teach you new sleep behaviors and ways to make your sleeping environment more conducive to sleep. Some studies have shown behavioral therapies are equally or more effective than sleep medications. They can also be used in combination with prescription sleeping medications.
Taking prescription sleeping pills, such as zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata) or ramelteon (Rozerem), until there's less stress in your life may help you get to sleep until you notice benefits from behavioral treatments. Ramelteon is the newest sleep medication, and it doesn't appear to have the same risk of dependency and rebound insomnia that the other sleep medications do. However, all of these medications may cause severe allergic reaction, facial swelling and complex sleep-related behaviors such as sleep-driving and preparing and eating food while asleep.
Doctors generally don't recommend relying on prescription sleeping pills for more than a few days because they may cause side effects, and developing your ability to sleep without the help of medication is the goal. In addition, sleeping pills can, rarely, be habit-forming and become less effective after a while.
The antidepressant trazodone (Desyrel) also may help with insomnia. Over-the-counter sleep aids contain antihistamines that can induce drowsiness. They're OK for occasional sleepless nights, but they, too, often lose their effectiveness the more you take them. Many sleeping pills contain diphenhydramine, which can cause difficulty urinating and a drowsy feeling in the daytime.
Oral appliances, also called dental appliances or devices, may be an option for patients who cannot tolerate CPAP.
The American Academy of Sleep Medicine recommends dental devices for patients with mild-to-moderate obstructive sleep apnea who are not appropriate candidates for CPAP or who have not been helped by it. (CPAP should be used for patients with severe sleep apnea whenever possible.) Several different dental devices are available. A trained dental professional such as a dentist or orthodontist should fit these devices.
Benefits of Mandibular Advancement Device MAD and similar devices seem to offer the following benefits:
According to a 2006 review, dental devices help control sleep apnea in 52% of treated patients. A 2002 report indicated that long-term use of a dental device achieved an 81% success rate in apnea improvement, which was significantly higher than the 53% success rate noted for uvulopalatopharyngoplasty (UPPP), the standard surgical treatment. There were also few complications with the dental device.
Dental devices, including MAD, are not as effective as CPAP therapy. The cost of these devices tends to be high.
Orthodontal Treatments
An orthodontic treatment called rapid maxillary expansion, in which a screw device is temporarily applied to the upper teeth and tightened regularly, may help patients with sleep apnea and a narrow upper jaw. This nonsurgical procedure helps to reduce nasal pressure and improve breathing.
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