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Why am I not able to sleep well?

Q: I am a 47 years old schizophrenic since 14 years with complaints related to irrelevant talk, paranoid delusions, restlessness and insomnia. I had a relapse first time 13 years ago then got it again after 2 years. The last episode took place 6 years back with depression. Now I am taking Arip MT 15 mg for maintenance; but for the last 14 days I am not able to sleep well, so with the permission of the doctor I increased the dose of Aripiprazole tablet to 30 mg and taken Zapiz 0.25 mg for 3 days. I checked my blood pressure and it was 130/90 mmHg. So, my family doctor gave multi-vitamins and Alprax 0.5 mg. What is the reason for disturbed sleep? What medicines should be taken for proper sleep?

A:Sleep disturbance can occur because of many reasons. Amongst the common are recent stress, late nights, use of large amounts of stimulants like nicotine, alcohol, coffee, etc. or just a primary sleep disturbance. Sometimes sleep disturbance can be the early warning sign of an impending relapse, which thereafter progresses into a full-blown relapse. It is useful to approach the management of sleep disturbance based on the possible causes. There are medications available to manage sleep disturbance, which is acute in nature, besides a long list of non-medication options, which are grouped under Sleep Hygiene Techniques. It is a good practice to visit a doctor to get a prescription of medications, which can help in management of sleep disturbance - the common ones tried are Zaleplon, Zopiclone and Zolpidem besides in some cases Melatonin and in other depending on the cause benzodiazepines. It is useful to try non-benzodiazepine options as much as possible. However, the focus should not be just on medications but also non- medications techniques. It is useful to follow these techniques consistently and persistently. These techniques incorporate simple instructions and suggestions like: going to bed only when sleepy, using the bed only for sleep or sex and not for sitting a chatting or reading or any other tasks, leaving the bed if unable to fall asleep within say 15 to 20 minutes, always waking up at the same time each morning regardless of the amount of sleep and avoiding naps altogether. It also focuses on life style changes like regular exercise, focus on diet, reducing /avoiding the use of alcohol, nicotine, coffee, not watching TV. It requires other alterations like light modification, reducing sounds/ noises, effective temperature control etc. It would be useful for you to explore if you have been under any recent stress, and visiting your psychiatrist to see if there is an impending relapse, which can help you to focus on the right technique to manage your sleep disturbance.

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