by Bethanne Black It's 2:00 a.m. and you're staring at the ceiling. Youcheck the clock every five minutes to calculate how much sleep youcan squeeze in before the alarm jolts you awake. You've tried warmmilk and relaxation tapes, yet you're still wide-awake. Should youtake a sleeping pill? If this sounds like your nightly routine, take heart. Insomnia affects millions of people, and new sleep aids and other remediesclaiming to solve the problem are plentiful. What's the best courseof action and how do you know if sleeping pills or other sleeppreparations are safe enough for regular use? Talk to Your Doctor First Before taking an over-the-counter sleep aid, speak to yourdoctor. Gary K. Zammit, PhD, president of the Sleep DisordersInstitute at St. Luke's Hospital in New York City, advises that"not all sleep aids are the same and over-the-counter preparationsmay not be recommended for your problem. Overall, one should keepin mind that insomnia not only results in considerable nighttimedistress for the insomnia sufferer, it is associated with next-dayimpairment, and may even have effects on health and mood." Dr. Zammit also stresses that everyone's needs are different."Some people need to use a medication nightly, [while] others needmedication that offers flexible options and few side effects," hesays.
Over-the-Counter vs. Prescription Medication Sleeping pills are available over-the-counter and byprescription. Use these tips when considering the use of sleepaids: Take the medication exactly as prescribed.Try the medication only after you have tried changing yourbehavior.Use the lowest possible effective dose.Don't automatically take a pill every night; use the medicationonly when you must have an uninterrupted night of sleep. Even then,it's a good idea to take only a few sleeping pills per week. Over-the-Counter Sleep Aids Many over-the-counter sleep aids contain antihistamines, whileother contain the hormone melatonin. Sleep aids containing antihistamines are common and includemedications such as Tylenol PM, Nytol, and Unisom, among others.Some people take a pure antihistamine drug, such as Benadryl, tohelp them fall asleep. The main problem with these remedies isknown as the "hangover effect," in which the next morning you mayfeel sluggish, sleepy, or have difficulty performing dailytasks. Melatonin is a hormone that is secreted in the brain and helpsour bodies to regulate the sleep-wake cycle. Melatonin is sold as adietary supplement, rather than as a medication, and is thereforenot subject to regulation by the Food and Drug Administration (FDA)for standards of potency and purity, so proceed with caution.
Dr. Zammit concurs, "Over-the-counter health food products arenot exposed to the same kind of rigorous clinical testing asprescription medications. Therefore, people should speak with theirdoctors and consider prescription medication if it is advised.Insomnia results in distress and impairment, so using notreatment or the wrong treatment may pose risks." There is some research that supports that melatonin may helptreat jet lag and insomnia. However, initial studies are incompleteand an optimal dosage has not officially been established. If youdecide to try melatonin, be sure to first consult yourphysician. Prescription Medications There are several prescription sleep aids available. Mostphysicians prescribe a class of drugs called benzodiazepines or an antidepressant. Benzodiazepinesinclude medications such as Valium, Xanax, Klonopin, and manyothers. Some prescription sleep aids, such as the benzodiazepines, havebeen associated with problems of dependence, but, according to Dr.Zammit, "Recent data suggests that most people who are given sleepaids use them appropriately." Studies are showing that dependencemay be less of a problem with newer medications, such as Ambien and Sonata.
According to the National Sleep foundation, many factors caninfluence potential side effects of prescription sleep aids,including:
- Dose of the drug
- The drug's half-life (the amount of time it takes for one-halfof the drug to be lost through biological processes)
High doses of sleep medications may result in what is known as rebound insomnia. This occurs when a person stops taking asleep medication and subsequently experiences a few nights ofinsomnia that is more severe than what was originally experiencedprior to treatment. Rebound insomnia generally occurs withmedications that have a short half-life and can be avoided byslowly tapering the dose. Consult your physician prior to stoppingor increasing your dose.
The goal is to have healthy sleep habits, which may prevent theneed for sleep aids. The National Sleep Foundation recommends thefollowing:
- Keep a regular sleep schedule.Our sleep-wake cycles are regulated by a circadian clock in our brain and the body's need to balancesleep and wake times. It is beneficial to go to bed and get up atthe same time each night to allow your body to get in sync withthis natural pattern.
- Avoid caffeine, nicotine, and alcohol.Caffeine and nicotine are stimulants. Nicotine can also causenightmares. Caffeine-containing products such as coffee, tea, andchocolate remain in the body on average from three to five hours,but some people are affected for up to 12 hours. Alcohol causes sleep disturbances throughout the night. Whilealcohol may help you to relax and fall asleep, it can lead to anight of less restful and shallow sleep.
- Don't eat or drink too close to bedtime.It's best to avoid a heavy meal too close to bedtime. Spicyfoods may cause heartburn, which leads to difficulty falling asleep anddiscomfort during the night. A light snack is often best before bedand may help you sleep better.
- Exercise at the Right Time to Promote Sleep.Exercising right before bedtime will make falling asleepdifficult. Besides making us alert, exercise causes a rise in bodytemperature, which can take approximately six hours to begin todrop. A cooler body temperature signals the body that it's time forsleep.
- Use relaxing bedtime rituals.This may include taking a bath, reading a book, meditating, orlistening to relaxing music. Use techniques that work best for youand your bed partner.
- Create a sleep-promoting environment.The best sleep environment is a cool, quiet, and dark room. Besure to check your room for noise or other distractions. Make surethat your mattress is comfortable and supportive for your body.
If you suffer from chronic insomnia, see your doctor. You may beexperiencing a symptom of a larger problem such as clinical depression or a sleep disorder. Your physician will help youfind the treatment plan or medication that's best for you. RESOURCES: National Heart, Lung, and Blood Institutehttp://www.nhlbi.nih.gov National Sleep Foundation http://www.sleepfoundation.org References: Ball N, Hough N. The Sleep Solution: a 21-NightProgram to Better Sleep. UlyssesPress; 1998. Jacobs GD, Benson H. Say Goodnight to Insomnia. Owl Books; 1999. National Sleep Foundation website. Available at: http://www.sleepfoundation.org. Trickett S. Free Yourself From Tranquilizersand Sleeping Pills: a Natural Approach. UlyssesPress; 1997. Last reviewed July 2007 by J. Thomas Megerian, MD, PhD, FAAP Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.