Better Sleep

It's not surprising to me that patients often relate problems sleeping.

Lots of things can help with getting a handle on better sleep, bearing in mind that persistent problems with sleep may represent bigger issues that merit further evaluation and discussion.

First, avoid things that can make it harder to fall asleep or stay asleep.

• Avoid exercise, caffeine or alcohol within two hours of bedtime.
• Avoid leaving unresolved problems or tasks. Keep a "To Do" list next to the bedside so you can jot down a quick note rather than stay up trying not to forget it.
• Avoid using your bedroom as an office or for watching TV.
• Make sure your bedroom is dark and quiet; use ear plugs and a sleep mask if you need to.

If you can't fall asleep, don't make it harder.

• Go to bed and get up at the same times, no matter how poorly you've slept, every day of the week.
• If you're having trouble sleeping, go to another room to read or listen to some music. Don't watch TV or use your computer; the light can cause you to become more awake!
  
• Avoid naps, or at least don't nap for over 20-30 minutes.
  

As far as sleep aids go,

• You shouldn't have persistent trouble sleeping for over two weeks. This may be a sign of other problems such as untreated pain, asthma, heart failure, restless legs syndrome, sleep apnea or depression and should be managed as such.
• Herbs such as valerian and chamomile can help.
• Warm milk does help, due to the serotonin release that it can produce.
• Melatonin is safe and effective; just realize that it has to be taken about an hour and a half before lights-out to work!
  
• Benadryl can be used for sleep, as long as it doesn't make you feel groggy when you wake up.
• Prescription medicines such as Ambien/CR and Lunesta should be regarded with great caution. They may not be as safe and non-habit forming as believed.

Sleeping Pills

A word about sleeping and sleeping pills.

Ambien was a hot new drug for sleep back in the early 1990's, and went generic as zolipedem in the last year or so. If you watch TV or read magazines you would have noticed because you have been blitzed with ads for the competion: Ambien CR, Lunesta, Sonata and Rozerem all sound like the greatest thing since sliced bread. At least, they do on TV.

Granted, older sedatives often taken for sleep (such as Valium, Ativan, Restoril, Serax, etc.) create problems because they render you unconscious, not asleep. This is crucially different, since you are losing up to half of the really deep, restorative sleep and dream sleep when you take these. When this happens for over three nights in a row, daytime problems will follow; such as forgetfulness, irritability, tiredness, depression, moodiness or difficulty concentrating.

When Ambien first came out, it seemed to be the best of both worlds: helping people to sleep, but without the loss of deep sleep and dream sleep.

Unfortunately, it may be that Ambien and the other newer sleeping pills may not help you sleep any better, they may just keep you from remembering your sleep. This may be why some people who take it have been seen to cook, eat or even drive at night without remembering doing so.

Basically, people get needed sleep. Insomnia is often a symptom of another problem such as stress, depression, sleep apnea, pain,urinary problems, drinking or long-established bad sleep habits. The treatment then is to treat the underlying problem, not to be drugged into unconsciousness every night.

To make it easier to sleep well,

• Go to bed and get up at the same time every day, including weekends, vacations and holidays.
• Don't eat or have alcohol or exercise within two hours of bedtime.
• Don't watch TV in your bedroom.
• If you can't sleep, go to another room and read or listen to some music. Do not watch TV or use your computer! The light from the screens stimulates your brain and wakes you up.
• Try taking 2-3 mg of over-the-counter melatonin about 1-2 hours before your bedtime.
• Tylenol PM is OK to use for sleep, unless you find that it causes side-effects or makes you feel groggy in the morning.
  

Did you sleep OK?

This is a really interesting news item that nicely sums up a lot of recent study on sleep.

In a nutshell, sleeping 8 hours without interruption may not be biologically normal, an expensive mattress may not be better than a good mattress, and sleeping pills may be over-rated.