April 19, 2009
Too anxious to fall asleep
Reaching for that bottle of pills to keep insomnia at bay can do more harm than good in the long run
Hartford, Connecticut - It is 1am. You have to get up at six.
You are exhausted but you cannot sleep. What do you do? You may find yourself slurping a spoonful of NyQuil or taking a Tylenol PM. Is that the best approach? It all depends on how often you are in this situation, experts say.
Psychologist Lynelle Schneeberg, director of the behavioural sleep medicine programme at Gaylord Hospital in Wallingford, Connecticut, says: 'If you're talking short-term insomnia during a short-term stressful situation, then taking a pill can be okay. But chronic insomnia, when you are talking six months or longer, is a different animal.'
For many, worries about jobs and the economy interfere with sleep. Almost one-third of Americans say their sleep has been disturbed at least a few nights a week in the past month because of financial concerns, the economy or employment worries, according to a survey by the National Sleep Foundation.
Taken once in a while, over-the-counter medications might be just the push you need to drift into dreamland.
But there are downsides. For starters, the sedating effects caused by the antihistamine in such products as NyQuil and Tylenol PM may not end when you wake up. And if you take them frequently, they might even be associated with occasional memory problems.
Sleep expert Dr Edward O'Malley says antihistamines can continue to affect people six to eight hours after ingestion.
Dr Amarish Dave, an Illinois-based neurologist, says many sedating medications can 'slow cognitive performance'. Whenever he sees patients complaining of not feeling sharp mentally, he looks at what medications they have been using.
Taking sedatives can also cause problems for people with breathing disorders. It can also cause cardiac problems in elderly people, Dr O'Malley says.
Experts have varying opinions on herbal remedies. Dr O'Malley says they may be preferable to over-the-counter sleeping medications but he suggests that people use only synthetically made melatonin rather than those made from animal brain tissue.
Melatonin is the hormone secreted when the body is naturally preparing itself for sleep. Dr O'Malley says it is most appropriate when treating jet lag.
If you take sleep-enhancing medications every night, you 'can become psychologically and physically dependent on them', she adds, and even lose your ability to get to sleep without taking something.
In general, however, sleep experts agree that the best way to address sleep problems is through behaviour changes. Ms Schneeberg teaches people how to behave when they cannot sleep.
'They do all the wrong things with the right intentions,' she says. 'They lie in bed trying really hard to sleep. They will tell me, 'At least I'm resting,' but what they are doing is they are conditioning their beds to be a place associated with worry and frustration. We don't want the bed to be associated with anything but drowsiness and sleep.'
After 20 minutes of wakefulness, it is best to leave the bed and do something quiet and relaxing such as reading, she says. It is best if this is done as near to the bedroom as possible without disturbing a partner. 'Sometime the act of climbing the stairs wakes you up,' she says.
Good sleep habits also involve going to bed and getting up at about the same time every day.
'The body loves routine,' she says.
Other tips: A light snack before bedtime is okay but not a heavy meal. Exercise during the day to make you tired at night and avoid naps.
Los Angeles Times - Washington Post News Service
Third night rule on drugs
Ms Schneeberg tells patients about the 'every third night' rule when they ask about taking medications that may enhance sleep, whether they are over-the-counter or prescription ones such as Lunesta or Ambien.
The theory is that if you sleep poorly on Monday night, you probably will have a sound sleep on Tuesday night. But sometimes that does not happen, partly because people lie awake consumed with worry.
But if you know that on the third night, Wednesday night, you will allow yourself to take a sleep medication, Ms Schneeberg says.
Sometimes that is all you need to ease yourself to sleep on Tuesday night.
'If you know that every third night is a rescue night, it lowers your anxiety,' she says. 'You really will never get into too much trouble if you take it every third night.'