Go to Sleep

Lack of sleep — less than 7–9 hours — compromises your immune system (putting you at risk for infectious diseases), contributes to decreased work performance, and reduces quality of life. Daytime drowsiness and increased appetite are among the warning signs of needing more zzz.

Here are some suggestions to secure sound sleep:

  • Establish a regular sleep schedule: Keep the same sleep hours, even on your days off.
  • Exercise regularly: This will help you achieve deep sleep. But exercising just before bedtime will have the opposite effect. Try to get in your workout at least 3 hours before you hit the hay.
  • Take a hot bath before bedtime: An evening routine helps relax your body and prepare it for sleep.
  • Spend time outdoors each day: Daily exposure to the sun helps regulate your body’s sleep cycle.
  • Avoid caffeine later in the day: Also check your medications; they could contain caffeine.
  • Don’t watch TV in bed: This can over–stimulate your brain and keep you awake. Darkness is your best bet for falling asleep quickly.

Night Cap

A good night’s rest supports overall health, but according to the National Sleep Foundation most Americans fail to achieve it. Make sure you’re racking up your 40 winks with these sleep aids:


Neutralize nerves. The #1 sleep blocker is stress. Keep a journal to record thoughts and worries that try to take over once your head hits the pillow, and log habits that sabotage your slumber. Enter the snooze zone with a bedtime routine — a warm shower or bath, light reading, or meditation exercises that relax your mind and body. Keep the temperature cool and wear socks, which a study suggests may promote sound sleep cycles.

Stifle stimulation. Avoid TV, heavy meals, alcohol, and caffeine before hitting the hay. And exercise daily for at least 30-45 minutes to release tension — just not too close to bed time or you’ll prompt alertness.

Balance biochemistry. Hormonal responses influence zzz. Too much cortisol and not enough melatonin or serotonin can stir wakefulness. Keep the room dark and remove electronics, which can disrupt natural daily rhythms. If you can’t rise with the sun, use a sun clock instead of an alarm — it mimics the gradual fade in and out of natural light to help synchronize your internal clock. Eat a protein-rich snack with some fruit a few hours before bed to introduce tryptophan into your brain — necessary in melatonin production.

Improve your sleep with simple bedroom fixes

Sleep troubles? You’re not alone: Up to 40 percent of Americans have difficulty sleeping. If you’re stuck in the bleary haze of sleep deprivation, your bedroom could be the source of your problem.

Sleeping in a space that’s too bright, too warm or too stimulating can wreak havoc on healthy rest. Happily, sleep science is pointing the way to a better bedroom that’s a sanctuary for sleep.

Bedroom blunder: Too much light

Exposure to artificial light has drastically increased over the last 100 years, and the negative effect on people’s health and well-being is powerful.

Why it’s critical: Light exposure is one of the strongest regulators of the biological clock. Nighttime light—even the glow from a smartphone or alarm clock—suppresses melatonin and disrupts circadian rhythms.

Quick fixes: Make the house as dark as possible in the hours before bed by drawing curtains and limiting television and video games. Tiny beams of light can affect sleep, so black out the bedroom by installing lightblocking shades, shutting off electronics and turning bright alarm clocks toward the wall.

All lights aren’t created equal—blue lights (found on many modern gadgets) have an especially strong impact. Something about the blue light spectrum affects sleep-wake patterns more than regular white light.

Bedroom blunder: Too warm

When people put up with a too-warm bedroom, sleep suffers. Chilling out can improve your chances of sleeping well.

Why it’s critical: Bedroom temperature is about more than comfort; it’s an important physiological cue. First, a drop in body temperature triggers sleep. Then the body naturally cools over the course of the night, reaching its lowest core temperature two hours before waking.

While the ideal bedroom temperature is experts say cool rules. Between 60 to 68 degrees is ideal.

Quick fixes: If air conditioning is an option, use it to cool the bedroom before turning in. Otherwise, open windows and use fans to help move warm air out of the bedroom. Blackout shades are also helpful, because a room that stays darker will also stay cooler.

Bedroom blunder: Too stimulating

Modern bedrooms are home to a host of electronics, stacks of unfinished work and an unread book or two. It all adds up to a space that sends your brain into overdrive, instead of into restful sleep.

Why it’s critical: When it comes to sleep, our bodies crave routine and repetition. So watching television, working and surfing the Internet in bed programs the brain to wake up and work when it should be settling down for sleep.

Quick fixes: Make the bedroom a haven for sleep by banning laptops, video games, television and work. If reading in bed is a cherished habit, switch to lighter reading materials—flipping through a magazine is less stimulating than a suspense thriller, and less likely to keep your brain buzzing all night.

Bedroom blunder: Too messy

Turns out Mom was right: A messy room can be hazardous to your health. According to the National Sleep Foundation, people who make their beds daily are 19 percent more likely to sleep well every night. And 71 percent of Americans say they sleep better in a fresh-smelling bedroom.

Why it’s critical: We spend a third of our lives in bed, so our bedroom should be a peaceful retreat. Climbing into a clean, fresh bed will help you relax and set aside your cares, while a messy, unkempt room may provoke stress by reminding you of unfinished chores.

Quick fixes
: Find time to make your bed daily, and adopt the feng shui–inspired habit of closing closet and bedroom doors at night. Creating a sense of calm and order in the bedroom can help pave the way for sweeter dreams, starting tonight.

Source: Costco Connection

Sleep Thieves

Our society has launched frontal assaults on alcohol, drugs, and cigarettes; now it’s time to slay the sleepies, contends neuropsychology professor Stanley Coren in this comprehensive book. It seems that sleep, or rather our lack of it, causes Americans a few problems – an estimated 25,000 deaths, 2.5 million disabling injuries, and $56 billion in related costs each year. Armed with numbers like these, Coren aims to lift sleep deprivation to the top of our public health agenda.

Sleep Thieves is essentially a treatise on sleep – what it is, what it does, how it works, and, most importantly, why we should take it more seriously. Sleep, implies Coren, is the Rodney Dangerfield of public health. It just doesn’t get any respect. The dawn of shift work a century ago, brought on by invention of the light bulb and the conveyor belt, hastened our societal sacrifice of sleep for productivity. Unfortunately, this attitude conflicts with 4 million years of human evolution that, like it or not, has established a physiological need for sleep.

The troublesome result, Coren explains, is that most of us are functioning with a serious sleep debt, the debilitating physical effects of accumulated sleep loss over time. Just one hour less sleep each night for a week can cause nose dives in mood, thinking ability, attention, memory, and logical reasoning. To support this and other assertions, he combines fairly dry but informative research findings with engaging interviews and personal anecdotes. In addition to sleep debt, he examines the evolution and physiology of sleep, dreaming, sleep-wake cycles, insomnia, snoring, sleep apnea, substances that affect sleep, the link between sleep and health, and the performance of professionals susceptible to sleep debt, such as shift workers, truck drivers, doctors, and pilots.

While the book contains no astounding revelations, it does contain fun, enlightening sleep questionnaires and a potpourri of tantalizing tidbits that encourage page turns, such as:

Average nightly sleep duration in America is 7 1/2 hours; for optimal functioning we need closer to 10.
You can be chronically sleep deprived and not know it.
For help sleeping, two aspirin may be more effective than non-prescription sleep medication.
Insomnia is not a clinical condition in itself, but rather a symptom of an underlying health problem.
13 million Americans take prescription sleep medications, yet these same medications are a major cause of insomnia.

The explosion of the Challenger, the radiation leak at Chernobyl, and the oil spill by the Exxon Valdez all have one thing in common – sleep-deprived employees.

Coren culminates his call for a more rested continent with his own, somewhat anticlimactic, research finding that in 1991 and 1992 the hour of sleep Canadians lost during the change to daylight-saving time lead to significant increases in traffic accidents. This effect “indicates a sleep debt so high that just a single hour added to it causes people to die,” he states. In support of his theory, the hour of sleep Canadians subsequently reclaimed during their return to standard time in the fall actually reduced traffic accidents.

“Sixty minutes more in bed seems like a small investment,” Coren concludes, “but these data make it clear that in our current sleep-debt-ridden state, it does pay large dividends.” So the next time you struggle to wake up for work, one option may be to lie back and sleep another hour…then bring your boss a copy of Sleep Thieves.

What are some of these non-drug behaviors to treating insomnia?


Dr. Stepanski: The behavioral treatments encompass a whole lot of changes. One of the biggest changes that we focus on is trying to limit the amount of time people spend in bed. When people start to sleep poorly, they tend to make a lot of changes that they think are gonna change them and maybe in the short term do help them, but in the long term make things worse.

For instance, if I’m having trouble sleeping, I might decide I’m really tired tonight. I’m going to go to bed early, and I’m so tired I’m going to stay in bed extra late. I’m going to, later on during the day, try and take naps. I’m going to drink extra coffee because I feel so tired during the day. I may try to self-medicate with alcohol at night and see if that helps me get to sleep. So lots of these things that people do actually take them in the wrong direction. As soon as you’re spending 10 hours or 11 hours in bed at night, from the time you first get into bed until the time you get out of bed, then it means you’re guaranteed to spend a certain amount of time awake. If you were a seven-hour sleeper your whole life, and you’re in bed for 11 hours, then you’re awake for four — even on your really, really best night. You’re going to sleep your seven and be awake for four. So people end up on schedules that are very different from the schedules they kept back when they were a good sleeper.

The other thing that people then start to do is they engage in activities in the middle of the night. So they start to watch TV. They might get something to eat during the night. When people are sleeping well, they go to bed at 11, and they fall asleep in 10 minutes. They sleep through till six or seven. They wakeup feeling rested. It doesn’t occur to them to get up at two in the morning and eat leftover pizza or watch TV, watch a movie, start engaging in their hobby, you know, things like that. But as soon as you spend any amount of time or any number of nights awake from 1 to 3, well then you start to do things like that. You get up and you might check your e-mail. You might see what’s on TV and channel surf. And to some extent, people start to get engaged in activities that might actually wake them up and stimulate them. Certainly eating is like that. Anytime you have something to eat during the night, it’s a very reinforcing kind of an activity, because people usually are eating their favorite foods. So then on subsequent nights they get into that habit. And it might be on night one they eat something and they fell back to sleep faster, so they think, “Well, I think that helps me.” So then they get up, and they start eating every night with that hope. Then after a while they realize it’s not really doing them any good.

So the original problem that started their troubled sleep, it might be bereavement, it might have been job stress, it might have been jet lag, or some very common trigger for bad sleep is gone now. That effect is gone. But now what they have are all the effects of all these other changes that they’ve made, both to their sleep and wake schedule. And there are lots of activities, habits and behaviors that people start to engage in once they’ve had bad sleep for some period of time that have to be eliminated for them to return to being a good sleeper again.

That being said, what are the things people shouldn’t do if you want a good night’s sleep?

Dr. Stepanski: What we do with people a lot is provide education and talk about how to look at their sleep to understand, say, how their biological clock is going to trigger a time when they can get to sleep and the time when it wants to be awake. We help them understand the effects certain kinds of behavior might have right before they go to sleep or what they do to them during the night. We help them to figure out what are they doing right and what are they doing wrong, because a lot of things won’t necessarily be clear to us. We can’t think of necessarily every single thing to ask somebody.

So do you get up and listen to music and dance at night? It turns out people will do things like that and unless we kind of explain what we’re trying to get at they won’t identify that as, perhaps, a problem behavior. We try to teach people to look for those things. The general rule is going to be not to engage in any activity right before bedtime — and I mean within an hour or two of bedtime or during the night — that’s going to be inherently stimulating, either physically or mentally. So even though people think of surfing on the Internet as being a very sedentary, low-key kind of activity, it really isn’t. People are pointing and clicking and going to things that interest them, and that that mental stimulation will wake them up and keep them awake longer than you would think. Same with video games and things like that. Even though a person is laying on the couch engaging in that kind of activity, it will actually get them revved up, and they’ll have a harder time then falling asleep afterwards. We work with people to identify a whole lot of activities like that.

In addition to the behavioral changes that we make, one of the biggest changes that occurs in someone who’s had trouble sleeping over time are what we call cognitive changes — ways that they think about their sleep. Probably the single biggest problem that occurs is that when people are sleeping well, they wake up at two in the morning. They might check the clock and say, “Oh, thank goodness, I can go back to sleep. I’ve got hours to go before I work.” They then roll back over and they go right back to sleep. It doesn’t occur to them to worry about it. If you’d had trouble maintaining sleep with waking up during the night for every night for a couple of months, when you wake up at two in the morning, you look at the clock and go, “Oh my God. What’s going to happen now? I wonder if this is going to be another bad night like last night. I hope I get back to sleep fast.”

People start to catastrophize and start to think a lot about the problem and that automatically raises their arousal level and their tension level. And so the likelihood they can then get back to sleep is going to be very reduced. So we have to do a lot of work on getting people to approach their sleep in a different way and not to approach it as something where they’re trying harder to sleep better. Because as soon as you try hard, you’re more awake and you’re not going to do well.

If they’re trapped in this, how can you change someone’s thinking?

Dr. Stepanski: That’s where it all works together. First of all we make behavioral changes. We actually help people to sleep better in the first place so that their sleep isn’t as bad as it has been. And so with that, they can start to back off of worrying about it as much. On top of that, we take a look at their concerns and their fears.

Very often people have blown it out of proportion to some extent. That is, they feel like, “I’m going to lose my job if I don’t get better sleep. My performance is going to be so bad that I’m going to get in trouble at work or in trouble with my family. My wife will leave me if I feel like this all the time because I have no energy.” When we really explore it, what’s typically the case is that they are the only ones that notice that they feel tired and fatigued during the day, but no one else is aware that they’re having as hard a time getting through the day as they might be.

So there’s some degree of catastrophizing that’s going on and blowing the circumstances a little bit out of proportion. And that’s especially a risk at 2 or 3 in the morning. I mean, everybody at that time doesn’t necessarily have the same perspective on things. If you’re laying awake at 2 in bed thinking about what you have to do the next day, that always seems like a lot bigger deal than it will the next morning. The next morning will come. You’ll get up, you’ll go to work, you’ll do everything like you normally do, and you’ll do it fine. You know, you may be tired but you’ll get it done and you’ll come home. But at 2 in the morning, it seems overwhelming. It seems much more difficult than you can do. And that’s true for everybody. It’s just that most of us are sleeping through that period, and we don’t have to be awake at 2 in the morning thinking about what do I have to do tomorrow and this week, and what big problems do I have to solve and that’s just not a time you want to do that.

So we want to teach people don’t do that. That’s one of the reasons behind not letting yourself lie in a dark, quiet room wide awake for an hour or two. That that’s just doing damage to yourself. If your body’s wide awake and you’re lying in a dark quiet room, you’ll think about all the things that you have to do coming up that day, that week, and any big problems you have.

What should you do if you are lying in bed and do wake up at 2 in the morning? What do you recommend?

Dr. Stepanski: The rule is if you’re feeling calm and peaceful, like you might doze back off, then you stay in bed and that’s fine. But if you’ve been lying there about 20 minutes and you have that feeling like you’re wired, you’re not falling asleep now, or you may not fall asleep any time soon, that’s when we tell people get out of bed and go do something relaxing and then return to bed once you feel sleepy again. Most people understand that difference. They know those times when they feel comfortable. They may have been laying there for a while, but they feel comfortable like they’re about to doze off and that’s fine, then they want to stay there. But that wired feeling and lying in that dark quiet room is a bad combination.

When you say go do something relaxing, what would that be?

Dr. Stepanski: We’ll have people do something again. It’s gotta be just engaging enough that it holds their attention. So if they’re watching TV, it’s a show that holds their attention as opposed to just sitting on the couch thinking, “Oh my gosh, I wish I was back in bed. I wish I was sleeping,” checking their watch to see how many hours they have left before they have to get to work. You know, that kind of thing. It has to be an activity that holds their attention but isn’t inherently stimulating. We tell people not to engage in work things like doing a load of laundry because then, again, you want to stay up until it’s finished. And don’t engage in your real work because that usually, again, is too stimulating. It wakes people up way too much, and then they really can’t get back to sleep after that.

Let’s talk about some of the specifics just that keep coming up. Like when should you not take naps or drink caffeine?

Dr. Stepanski: There are a whole lot of things people should not do if they’re sleeping poorly at night. And, again, I think that this is a big point of confusion because a lot of people say, “I’ve been doing that for 20 years and, you know, that’s not a big deal,” like drinking coffee and this kind of thing. Well yeah, you can do whatever you want if you’re sleeping well. You’re getting away with it. But if your sleep has gone bad, you have to be much more careful and much more particular about your sleep habits.

If you’re sleeping poorly, then taking a nap is probably a bad idea because you’re only going to get so much sleep in a 24-hour period. If you get sleep during the day, you’ll get less sleep at night. And so if your goal is to get as much sleep at night as you possibly can, you should eliminate taking naps during the day.

Drinking coffee is another one of those things that people can get away with sometimes and maybe not at other times when their sleep is bad. The main thing is to try and stop drinking any coffee after noon, and really cut it off from then on because it can be partly long-acting and partly just the tension that people get from the caffeine can actually last longer than the caffeine itself. We usually use noon as our cutoff for someone who’s really having a hard time sleeping at night.

What about exercise?

Dr. Stepanski: We would usually say that you wouldn’t want to exercise, and I mean like aerobic exercise, within three hours of your bedtime as a minimum. Probably five hours would be more preferred — to have that much distance between when you’re doing aerobic exercise and the time that you’re sleeping.

And alcohol?

Dr. Stepanski: Alcohol is another common thing that people use to try and get to sleep, and it actually will allow them to fall asleep faster. The problem with it is that it wears off after a few hours and then when it wears off, people tend to have a rebound and they can wake up and then have choppy sleep after that. We know from doing EEG sleep studies that even people who think they slept well with alcohol didn’t get as good a sleep as they thought they did. And when people try to argue that they are sleeping perfectly fine with alcohol, we examine it and find out when they drink a lot, they’re taking a nap the next afternoon. So what’s that all about? You know, the bottom line is that the really didn’t get the kind of restorative sleep that we’re going after. The other thing is that it’s just obviously not a great long-term solution to the problem if you think about it.

What about a warm bath? You often see that recommended.

Dr. Stepanski: There is data to show that a very hot bath, about 45 minutes before bedtime can make a difference. And the way it makes a difference is by what’s called passive body heating. If you get your core body temperature elevated sufficiently, then you get out of the bath, your core body temperature starts to drop. And it drops naturally as you doze off. If it’s already dropping, it seems to help people get to sleep, but also sleep more deeply. The main effect is you will actually have deeper, better sleep. But in order to do that, it’s gotta really be a very hot bath, and you’ve got to soak in it for like half an hour, you know, before it’s time to go to bed.

OK, so not a warm one, a hot one. Is there anything to the warm glass of milk?

Dr. Stepanski: Nothing to that other than, you know, if it’s a comfort thing. My rule is not to eat anything extreme before bed. A couple slices of pepperoni pizza is probably not the best thing to do right before you go to bed. But a small snack for some people really makes a difference. Milk kind of fills the role of a small snack — nothing that’s going to cause any reflux during the night.

What do you do to get to sleep?

Dr. Stepanski: I’m doing pretty well on regular schedule. I get up at the same time every day. I’m not staying in bed really late on weekends and that kind of thing. And I know how much sleep I need. I’m about a seven-hour sleeper. So if I’m in bed about seven to seven-and-a-half hours, I’m going to end up getting pretty, getting to sleep pretty easily.

Do you watch TV or read or do anything mentally?

Dr. Stepanski: Sure. I do all that stuff in bed like you’re not supposed to. But again, if you’re sleeping OK, you can get away with that. And I, from time to time, do have trouble with sleep. I don’t do as well, and then I change that around, and I don’t do that stuff anymore. I kind of get it back on track again and then I ride it out. Then I’m back on track and do whatever I want.

This article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week.

The Mystery of Sleep: Insomnia


What exactly is insomnia?
Dr. Stepanski: Well, insomnia is by far the most common type of sleep disorder in that it occurs anytime someone cannot get to sleep when they want to, they can’t stay asleep, or just feel like they have non-restorative, poor-quality sleep. And to the extent that it then causes them to have daytime impairment, it becomes a medical condition.

Do you know its incidence?
Dr. Stepanski: About a third of the entire adult population will report having difficulty sleeping at some point in the prior year, and about 10 percent to 15 percent of the population will say it’s a severe problem.

Wow, those are pretty big numbers.
Dr. Stepanski: Yeah. There are millions and millions of people that deal with insomnia on a regular basis.

What ages? Who’s at risk for this?
Dr. Stepanski: It can happen to anybody at any age. In general, not children — children are very good sleepers, and they can sleep pretty well despite a lot of circumstances. But once you reach adulthood, the amount of insomnia goes up, and especially older adults are at greater risk for poor sleep.

Why is that? Why are children good sleepers and older adults poor?
Dr. Stepanski: Developmentally, we get lighter and lighter sleep as we age. So children are getting very, very deep sleep, and so they’re difficult to awaken. Even if you want to wake them up, it’s very hard to awaken them, they’re sleeping so deeply. As our sleep gets lighter and lighter, it’s just easier for us to wake up. And then once we’re awake, it’s harder for us to go back to sleep.

That’s biological?
Dr. Stepanski: A biological event that occurs across the aging process. Now in addition, once you get older, you’ll have greater risk of multiple medical problems, taking medications that might interfere with sleep, and also a risk of primary sleep disorders like abnormal breathing during sleep. So those things further increase the likelihood you’re going to have bad sleep as you get older.

So that’s why everybody says, “I slept like a baby” when they have a good night sleep?
Dr. Stepanski: Yeah. It’s a real deal. When you’re sleeping as a kid, you get pretty much pure, slow-wave sleep and REM sleep. And those are the two kinds of most restorative sleep.

Why else, other than just biological change, is insomnia such a problem? Why is it that one third of adults are having these problems?
Dr. Stepanski: There are lots and lots of things that can disturb sleep. People talk about specific things in our society like that we’re a 24-hour society now. So you have the Internet that’s going to keep people up. You’ve got cable TV. You’ve got a lot more people doing shift work nowadays, so they’re actually working at night or at least part of the night. Recent estimates are 20 percent to 25 percent of the workforce will experience shift work at some point in their career. So a significant number of people that are trying to function at different times of day that didn’t used to before. On the other hand, we think insomnia has actually been a common problem for many, many decades — certainly prior to those kinds of stresses.

How easy is it to get used to shift work? Is that something you can do for a couple weeks and then you get used to it?
Dr. Stepanski: It’s never going to be very easy in that people who work at night and try to sleep during the day will never sleep as well as someone who works during the day and sleeps at night. Some of the reasons for that are obvious in terms of the light/dark cycle and trying to be lined up with that. If you’re trying to sleep and the sun is up, you’re just never going to have as easy a time.

On top of that, it’s going to be a lot noisier, and it’s harder to maintain that same schedule. People will interfere with it. You’ll have friends and family that’ll come over at 2 in the afternoon and wake you up, even though they know you’re supposed to be sleeping, that would never do that at 2 in the morning. It just would never happen. So it’s socially unacceptable to interfere with people’s sleep when they sleep at night. During the day it seems maybe an OK thing to do. So it’s very hard for people to protect their sleep.

The people who make the best adaptation to it are people who do sleep consistently on the same schedule during daytime hours. Unfortunately very few people do that. As soon as their night off comes, they sleep at night, because who wants to stay up all night while your family sleeps and then sleep the next day when your family is awake? So they go back to a nighttime schedule of sleep as soon as they get a day off, and that means they’re constantly shifting back and forth between two different types of sleep schedules.

I have lots of people come in with that circumstance and ask, “Well, how do I deal with this and make everything OK?” And it’s more of a situation of trying to make the best out of a bad situation.

What are current treatments for not being able to sleep?
Dr. Stepanski: All treatment for insomnia comes down to either pharmacologic treatment or behavioral treatments. The pharmacologic treatments would be prescription medications that are aimed at causing sedation or sleep. There are over-the-counter compounds, but those are mostly antihistamines. The downside of using antihistamines is that they’re long-acting, people tend to be groggy the next morning, and they last longer than the whole sleep period. So it may help them get to sleep that night, but then it’s also going to make them groggy when they’re driving to work the next day. The tendency has been toward shorter and shorter-acting medications in order to avoid that kind of problem, so it gets people to sleep at night, but then is metabolized and out of their system by the time they need to get up and function the next morning. That’s the real trick to it.

OK. Are there any dangers with prescription sleep aids right now?
Dr. Stepanski: Prescription medicines as a treatment for insomnia are very good and may be the treatment of choice in a short-term situation. So if someone is in the hospital, for instance, and experiencing post-surgical pain or some other kind of acute stress, then this will deliver improved sleep immediately as opposed to other kinds of treatments that may take longer to work. So they can be useful in that situation. But if you think of it long term — if it’s a chronic insomnia that’s been going on for years — use of medication may not be the best answer to it. It may not deliver the best sleep. People can become dependent upon medication and, in some cases with some medicines, may actually get tolerant to it so it no longer works as well.

So what is your recommendation when someone wants to go on sleeping pills and you get the impression that they’re going to be on them for a long time or want to be on them for a long time? What’s your thought on that?
Dr. Stepanski: Well in general, we try to not have people on medications like that chronically or for a long period. But there are situations where that’s the only treatment that’s going to be affective. So we’ve got, for instance, patients with chronic pain syndromes, where they really experience a lot of pain and that pain at night is disruptive of their sleep. Now we’ll try to control the pain in order to help their sleep improve, but it may be that even with maximum optimal pain treatment they still are having very disruptive sleep at night. If the sleep medication is effective in that instance, then that would be an example of someone where maybe it’s appropriate to go ahead and use sleeping pills on a chronic basis.

The main thing I like to see is that people are getting effective benefit from the sleep medication. And if they’re getting benefit from it, even over long periods of time, then that’s a reasonable approach. Where it’s problematic is when people are no longer sleeping any better with medication but continuing to take the medication or even escalating the dose — so they’re taking perhaps two- or three-times the recommended amount of medication in order to get a night’s sleep. In that case, they really need a different treatment.

Let’s talk a little bit more about the over-the-counter sleep aids, like Tylenol PM and Excedrin PM. How well do they work, and how effective and long-lasting are they?
Dr. Stepanski: The over-the-counter medications, again, are using antihistamines for the most part as the sleep-inducing component of the compound. That will allow them to fall asleep faster for a few nights, but then after that they do get tolerance to those compounds. And so after that period of time, they aren’t really getting any more benefit than they would from just skipping the medication.

Is there harm in taking those — the same kind of harm that might be there if you were taking long treatments of sleeping pills?
Dr. Stepanski: There may be some risk of psychological dependence. Mostly the harm would be, in my view, the morning grogginess that people feel. They’re more tired when they wake up, and maybe they don’t get out of bed as quickly as they should. They tend to lounge around, drive or engage in other activities when they’re not fully awake. That would be the main downside, I think, to that approach.

Source: Ivanhoe News