It's 2:00 a.m. and you're staring at the ceiling. You
check the clock every five minutes to calculate how much sleep you
can squeeze in before the alarm jolts you awake. You've tried warm
milk and relaxation tapes, yet you're still wide-awake. Should you
take a sleeping pill?
If this sounds like your nightly routine, take heart.
affects millions of people, and new sleep aids and other remedies
claiming to solve the problem are plentiful. What's the best course
of action and how do you know if sleeping pills or other sleep
preparations are safe enough for regular use?
Talk to Your Doctor First
Before taking an over-the-counter sleep aid, speak to your
doctor. Gary K. Zammit, PhD, president of the Sleep Disorders
Institute at St. Luke's Hospital in New York City, advises that
"not all sleep aids are the same and over-the-counter preparations
may not be recommended for your problem. Overall, one should keep
in mind that insomnia not only results in considerable nighttime
distress for the insomnia sufferer, it is associated with next-day
impairment, 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 need
medication that offers flexible options and few side effects," he
Over-the-Counter vs. Prescription Medication
Sleeping pills are available over-the-counter and by
prescription. Use these tips when considering the use of sleep
Take the medication exactly as prescribed.
Try the medication only after you have tried changing your
Use the lowest possible effective dose.
Don't automatically take a pill every night; use the medication
only when you must have an uninterrupted night of sleep. Even then, it's a good idea to take sleeping pills only a few times per week.
Over-the-Counter Sleep Aids
Many over-the-counter sleep aids contain antihistamines, while
other contain the hormone
Sleep aids containing antihistamines are common. They include
medications, such as
, among others.
Some people take a pure antihistamine drug, such as
help them fall asleep. The main problem with these remedies is
known as the "hangover effect," in which the next morning you may
feel sluggish, sleepy, or have difficulty performing daily
Melatonin is a hormone that is secreted in the brain and helps
our bodies to regulate the sleep-wake cycle. Melatonin is sold as a
dietary supplement, rather than as a medication, and is therefore
not 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 are
not exposed to the same kind of rigorous clinical testing as
prescription medications. Therefore, people should speak with their
doctors and consider prescription medication if it is advised.
Insomnia results in distress
impairment, so using no
treatment or the wrong treatment may pose risks."
There is research that supports that melatonin may help treat jet lag. If you decide to try melatonin, talk to your doctor.
There are several prescription
available. Commonly prescribed classes of drugs include: benzodiazepines, nonbenzodiazepine, benzodiazepine-receptor agonists, and antidepressants. Benzodiazepines include medications such as
, and many
Some prescription sleep aids, such as the benzodiazepines, have
been associated with problems of dependence, but, according to Dr.
Zammit, "Recent data suggests that most people who are given sleep
aids use them appropriately." Studies are showing that dependence
may be less of a problem with newer medications, such as
According to the National Sleep Foundation, many factors can
influence potential side effects of prescription sleep aids,
Dose of the drug
The drug's half-life (the amount of time it takes for one-half
of 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 a
sleep medication and subsequently experiences a few nights of
insomnia that is more severe than what was originally experienced
prior to treatment. Rebound insomnia generally occurs with
medications that have a short or intermediate half-life and can be avoided by
slowly tapering the dose. Consult your physician prior to stopping
or increasing your dose.
Healthy Sleep Habits
The goal is to have healthy sleep habits, which may prevent the
need for sleep aids. The National Sleep Foundation recommends the
Keep a regular sleep schedule.
—Our sleep-wake cycles are regulated by a circadian clock
in our brain and the body's need to balance
sleep and wake times. It is beneficial to go to bed and get up at
the same time each day to allow your body to get in sync with
this natural pattern.
Avoid caffeine, nicotine, and alcohol.
and nicotine are stimulants. Nicotine can also cause nightmares. Caffeine-containing products include coffee, tea, and chocolate. Half the amount of caffeine ingested will remain in the body on average from three to five hours, but some people are affected for up to 14 hours.
causes sleep disturbances throughout the night. While alcohol may help you to relax and fall asleep, it can lead to a night of disrupted sleep as the night progresses.
Don't eat or drink too close to bedtime.
—It's best to avoid a heavy meal too close to bedtime. Spicy
foods may cause
, which leads to difficulty staying asleep. A light snack before bed may help you sleep better.
Exercise at the right time to promote sleep.
—Exercising right before bedtime will make falling asleep
difficult. Besides making us alert, exercise causes a rise in body
temperature, which can take approximately six hours to begin to
drop. A cooler body temperature signals the body that it's time for
Use relaxing bedtime rituals.
—This may include taking a bath, reading a book, meditating, or
listening to relaxing music. Use techniques that work best for you
and your bed partner.
Create a sleep-promoting environment.
—The best sleep environment is a cool, quiet, and dark room. Be
sure to check your room for noise or other distractions. Make sure
that your mattress is comfortable and supportive for your body.
If you suffer from chronic insomnia, see your doctor. You may be
experiencing a symptom of a larger problem, such as clinical
or a sleep disorder. Your doctor will help you
find the treatment plan or medication that's best for you.
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