Sunday, June 21, 2009

STI: Don't lose sleep over it

June 21, 2009

Don't lose sleep over it

Suffering from insomnia? Follow these cost-effective steps and get the shut-eye you need

New York - Being chronically sleep-deprived is more than just tiring. It can lead to depression, high blood pressure and lower productivity, both on and off the job.

If the problem is just insomnia rather than sleep apnoea or another medical problem, there are smart and affordable options.

Here are some of the most cost-effective ways to get the sleep you need as well as a few things you should avoid.

Do the free stuff first

You have probably heard these sleep dos and don'ts before but they bear repeating.

If you have been tossing and turning, do not drink caffeine after 2pm. And avoid drinking more than one glass of wine or the equivalent amount of other alcohol in the evening.

Save stressful activities, such as arguments with your children or a review of your finances, for early in the day.

Get into bed half an hour before you plan to switch off the lights and read a calming book. No television, BlackBerry or electronic diversion of any kind about an hour before bed because they tend to be stimulating, not relaxing.

Exercise regularly and reduce the overall level of stress in your life. Free? Yes. Easy? Not always.

Do not waste your money on fancy mattresses or herbs such as Valerian.

There is no proof that herbs or special bedding help chronic insomnia.

Over-the-counter medications that contain sleep-inducing antihistamines are fine for only one or two nights. They typically do not work over the long term and bring unpleasant side effects such as dry mouth and grogginess, says Dr Alex Chediak, a former president of the American Academy of Sleep Medicine and an associate professor of medicine at the University of Miami. If you still cannot sleep, see a doctor.

Find a sleep specialist

If you have a mild case of insomnia, see a general practitioner. But if you have been having trouble sleeping for months and feel tired most days, consult a sleep doctor.

The Singapore General Hospital runs a comprehensive sleep disorder programme.

A sleep doctor will first try to rule out an underlying medical condition, such as a thyroid problem or depression, which would require treatment by a different type of specialist. If you have primary insomnia, a medical condition in its own right, your doctor will probably begin treatment immediately.

Try a generic drug

Your doctor may prescribe a 'hypnotic' drug to help you sleep through the night. Be sure to ask if there is a generic option - such as zolpidem, the generic version of Ambien - which will be much cheaper than brand- name medications such as Ambien CR or Lunesta.

If your main problem is falling asleep in the first place, zolpidem is very effective and works quickly, Dr Chediak says. But if your problem is waking too early, he might suggest a longer-duration drug such as temazepam, the generic version of Restoril.

Consider a non-drug option

When your insomnia is chronic, meaning it has been going on for months, your doctor might also recommend cognitive behavioural therapy or CBT.

CBT for insomnia is meant to help patients change the behaviours and thoughts that can get in the way of a good night's sleep. Proponents say it is remarkably effective and that once you learn it, you may never have to spend a dime on medications again.

The cognitive part of the process teaches you to change anxiety-producing thoughts that interfere with your ability to sleep, says Dr Gregg Jacobs, who has a doctorate in behavioural medicine and is an insomnia specialist at the Sleep Disorders Center at UMass Memorial Medical Center in Worcester, Massachusetts.

He says: 'You might lie awake worrying 'I have to get eight hours of sleep or I will be a wreck tomorrow'. Most people, however, can function fine on seven hours.'

The behavioural part aims at actions that impair your ability to sleep, such as spending too much time in bed. 'CBT should be the first-line therapy for people with chronic insomnia,' says Dr John Winkelman, medical director of the Sleep Health Center at Brigham and Women's Hospital in Boston who has been a consultant to several pharmaceutical companies.

It typically takes about five sessions over six weeks to learn the therapy and reap the benefits. A study published in the May 20 issue of The Journal Of The American Medical Association looked at the effectiveness of behavioural therapy alone and therapy in conjunction with zolpidem.

The study found that patients who used both therapy and zolpidem fared better during the first six weeks of the study. But by the six-month mark, subjects who relied on behavioural therapy alone made the most progress.

'In the short run, medication is helpful,' said the study's primary author, Charles Morin, a psychology professor at Laval University in Quebec. 'But in the long run, people need to change their actual sleep habits. That's what CBT helps them do.'

Your sleep doctor may be able to do the therapy with you or may refer you to a psychologist who is trained in behavioural sleep medicine.

Stick with it

'The most wasteful thing is not doing anything,' Dr Winkelman said. 'The cost of living with insomnia can be far more than the cost of treating it.'

New York Times

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