<![CDATA[Sleep]]>

<![CDATA[Sleep]]> en daily 1 <![CDATA[Financial Stress and Insomnia: Should You Try a Sleeping Pill?]]>

staggering loss of U.S. jobs—is enough to keep anyone up at night. If you've ever experienced stress-related insomnia, you probably know the basic sleep rules: Relax before bed, set a consistent schedule, and as you’re lying awake at 3 a.m., try not to think about things that are bothering you.

But with the unstable economy, and jobs and retirement savings hanging in the balance, you also know that’s easier said than done. Americans are more stressed about finances today than they were just six months ago, and many are losing sleep over it. So is it really possible to push all that emotion aside at bedtime? Or is now the time to get help from a doctor or a sleeping pill?

The answer involves how well you’re able to manage stress, says Mary Susan Esther, MD, president of the American Academy of Sleep Medicine. Dr. Esther, who practices sleep medicine at Charlotte Eye Ear Nose & Throat Associates in North Carolina, is no stranger to economy-related sleep woes.

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"Charlotte has been really hit recently; Wachovia [is] based here, and so our phones have just been ringing off the hook the past few weeks with people complaining about sleeplessness and insomnia," she says, referring to the ailing bank that is close to being swallowed up by Wells Fargo. "The economy means our jobs, and that’s always much more threatening than other problems that can seem easier to intellectualize and think through, especially when we’re lying awake and things seem hopeless. It’s our bread and butter, our source of pride, and that hits home a lot faster than other crises."

Next Page: Stress takes a physical toll

 The progressive decline of the economy has been taking a physical and emotional toll on people across the country, according to a 2008 Stress in America survey released in October by the American Psychological Association. About half of the people polled said they are increasingly stressed about their ability to provide for their family’s basic needs, and 80% say the economy is a significant source of stress (up from 66% in April). Women especially reported worries about money, job stability, housing costs, and health problems affecting their families.

Compared with 2007, more respondents also said they are fatigued, irritable or angry, and lying awake at night as a result of stress. Almost one-fifth of Americans reported drinking alcohol to manage their stress, and 16% reported smoking—two factors that can affect your ability to get quality sleep. (Gauge your personal stress level here.)

Another recent survey by BettyConfidential.com found that women are concerned about issues like "affording groceries and other staples like gas," "losing what took so long to acquire," and "things getting worse in the country and it affecting me." One respondent wrote, "I don’t sleep more than four hours a night. I get headaches. I worry that my kids can’t go to college and my doctor now has me on antianxiety meds. (Thankfully, they are cheap!)" It’s not just U.S. citizens who are affected by the global crisis, either: British website NetDoctor.co.uk found that one-fifth of U.K. residents surveyed are regularly getting fewer than five hours of sleep a night, and one-fourth wake up more than three times a night. Two-thirds of those reporting insomnia cited money and work as sources of their sleep troubles.

Next Page: Is it possible to chill out?

Some people may be able to break this cycle by taking a step back: "Turn off the news and turn off your computer a couple of hours before bed," advises Dr. Esther. "We now have access to news 24 hours a day and we are certainly taking advantage of it. And this is a particularly difficult time because it’s been such a roller-coaster ride and everyone is just waiting, checking back constantly to see what will happen. It reminds me of what people went through right after 9/11, this sense of unknown anxiety."

A break from all that intensity may be just what you need. Read a fashion magazine or a funny book—something to make you laugh and get your mind off money and the news. Try getting your news updates in the morning, when you have a fresh start.

Basic sleep hygiene rules are still important: Be sure you’re getting enough downtime before bed, even if it means putting away your checkbook and bills after dinner or promising yourself you’ll leave work at a decent hour. Pay attention to how you handle stress too: If you’re turning to alcohol or cigarettes more than usual, alter your habits—try exercising or taking a walk instead.

Get help if you need it
If these tactics don’t help after a few weeks of sleeplessness, see a doctor. "If patients come to me and say that they just can’t get their mind off these problems, then it’s a perfectly appropriate time to use a sleep aid," Dr. Esther says. She doesn’t often recommend over-the-counter medications (most include antihistamines and can leave people feeling drowsy or hungover the next day); instead, she might prescribe a few weeks' worth of prescription hypnotic medication to break a cycle of sleeplessness.

You and your doctor should decide how—and how often—you’ll take this medication. Some patients benefit from a pill every night, while others may take pills only as needed, such as two or three times a week.

"Often Sunday nights are particularly difficult, because you’ve been up all weekend and you’re worried about work the next day," says Dr. Esther. "It always depends on the patient." Newer prescription sleep medications, called nonbenzodiazepines, have been shown to cause less rebound insomnia—so you can stop taking them as soon as your sleep problems are under control, provided you continue to practice good sleep habits.

It’s also important to talk to your doctor to see if you may be at increased risk for depression—especially if your sleeplessness lasts for more than a few weeks or leads you to spend your daylight hours sitting at home dozing in and out. In such cases, an antidepressant may work better than a normal sleeping pill.

Whether you’re out of work or overworked, a few things remain constant. Establishing a regular routine—including waking up at the same time, exercising, and getting out in the sunshine during the day—and working step-by-step toward goals can help keep you focused and upbeat. And putting your sleep needs first—whether that means closing your laptop, devoting eight hours to bed, or talking to your doctor about short-term solutions—will leave you better able to overcome the challenges ahead.

]]> Don't overdose on stressful financial news, especially right before bed. (FOTOLIA) <![CDATA[Tired of Ambien? Meet the Sleep Medications of the Near Future]]>

insomnia to restless legs syndrome, they haven't stopped the pharmaceutical industry from searching for newer, more effective, and more profitable medications.

No new prescription sleep drugs hit the market in 2008, but research in several fields is under way. "I'm excited about a lot of these new drugs," says Lisa Shives, MD, president and medical director of Northshore Sleep Medicine in Evanston, Ill., and spokesperson for the American Academy of Sleep Medicine. "The brain is a complicated setup with approximately 17 different neurotransmitters involved in the sleep-wake cycle and, as soon as we fully understand all of them, drugs will present better solutions for sleep disorders."

Here, some potential treatments that could soon help you rest easier—and suggestions for what to do in the meantime.

For jet lag or shift work
In the pipeline: Two clinical trials have found that a new medication called tasimelteon helped subjects whose sleep pattern had been shifted forward by five hours fall asleep faster and sleep for longer. The drug, called a melatonin analogue, works by targeting melatonin receptors in the brain. Melatonin is the naturally occurring hormone that helps regulate the body's sleep-wake patterns. Unlike existing benzodiazepine-hypnotic sleep medications, melatonin analogues have shown no tendency toward addiction or dependence. The manufacturer of tasimelteon hopes the product will be available to patients within the next few years.

For now: While there's no drug specifically approved for helping jet lag sufferers sleep, Dr. Shives explains that taking over-the-counter melatonin "one or two hours before your new adjusted bedtime" for two to four days before an east-bound flight can help your body transition. (East-bound flights are typically tougher on sleep schedules than west-bound flights.) Upon arrival at your destination, you would take melatonin at your desired bedtime, and then upon your return home, you'd take it again at your regular bedtime to help readjust. Read more about melatonin.

For age-related sleep issues
In the pipeline: Circadin, a new drug developed in Israel, may help people 55 and older get much-needed sleep, as melatonin levels in their brains decrease as a consequence of aging. By slowly releasing small amounts of melatonin over time—rather than one immediate dose, as is typically the case with over-the-counter melatonin—the drug has been shown to help people sleep thorough the night without sacrificing next-day alertness. Already available in several European countries, Circadin is expected to be offered stateside sometime in 2009.

For now: The first thing Dr. Shives recommends is a thorough examination to determine the cause of the sleeplessness, whether it's insomnia or an underlying problem like sleep apnea. For insomnia, she recommends patients try cognitive behavioral therapy along with low doses of prescription nonbenzodiazepines, such as Ambien, Lunesta, or Sonata, which have been shown to cause relatively low incidences of grogginess and next-day alertness problems. Although she does not recommend it, she notes that it was common in the past for people to take over-the-counter antihistamines for their sedating properties. "If an antihistamine doesn't say it's non-drowsy, it will make you drowsy," she explains. "But we should always be careful when using antihistamines because they may have the opposite affect and make older patients feel wide awake." Read more about sleep and aging.

Next Page: For those who can't sleep through the night

For those who can't sleep through the night
In the pipeline: U.S. Food and Drug Administration approval is pending for Intermezzo, a new medication to help insomnia sufferers fall back to sleep when they wake up in the middle of the night. The lozenge, which dissolves on the tongue in about two minutes, contains 28% of the active ingredient zolpidem, which is found in Ambien and its generic version. This lower dosage allows Intermezzo's effect to wear off in three or four hours, making waking up in the morning easier.

Why not just take half of a stronger pill? "The doses come in 1.75 and 3.5 milligrams, so it's not quite the same as cutting a [5- or 10-milligram] Ambien in half," explains Dr. Shives.

For now: If you're taking these medications as directed and still wake up in the middle of the night, talk to your doctor about altering your plan. You might consider changing medications, raising your dosage, adding a shorter acting drug to your regimen, or taking half of a pill when you wake up. (Some medications, though, such as Ambien CR and other time-release formulas, will not work properly when cut in half.) Read more on prescription sleep aids.

For restless legs syndrome
In the pipeline: Calming jittery legs may one day be as easy as slapping on a Band-Aid. The medicated skin patch Neupro, which is approved in Europe for the treatment of Parkinson's disease, was shown to help relieve RLS symptoms in a July 2008 study. Neupro contains the dopamine agonist rotigotine and is designed to be applied once a day to offer 24-hour support for moderate to extreme suffers. Although the rotigotine patch was previously available in the United States for the treatment of early-stage Parkinson's disease symptoms, it was pulled off the market in April 2008, due to problems with its delivery system. The manufacturer plans to initiate proceedings with the FDA in 2009 to bring the patch back to the U.S. market.

Another new drug, called Solzira, has also shown promise in the treatment of RLS. Unlike previous dopamine agonist RLS medications, Solzira's active ingredient is gabapentin—an anticonvulsant drug currently approved to treat epilepsy and also commonly prescribed off-label to relieve hot flashes. (It's also commonly used to treat migraines and chronic pain.) Clinical trials have shown safety and effectiveness in easing RLS symptoms in the course of 12 weeks, and the FDA recently asked Solzira's manufacturer to reorganize and resubmit its application for drug approval consideration.

For now: The prescription dopamine-agonist Requip became available as the generic ropinirole in May 2008, giving RLS sufferers a less expensive treatment option. The other leading drug approved for restless legs syndrome, Mirapex, is still available as a brand name only. Read about drug-free treatment options.

Next Page: For insomnia

For insomnia
In the pipeline: In higher doses, the drug doxepin is used to treat depression and anxiety—but at doses as small as 3 to 6 milligrams, it has been shown to help insomniacs too. The drug's sedative abilities improved the total sleep time of those involved in a clinical trial. Silenor, the proposed trademark name, is expected to receive FDA review by February 28, 2009.

For now: "There have been lots of clinical studies showing that cognitive behavioral therapy does better in the long run for people with chronic insomnia," Dr. Shives says. "But it can be hard to find CBT physicians, they're not always covered by insurance, and it takes at least four to eight sessions before it begins to work. For those patients are willing to try CBT, sometimes they need short-term medication as well." Watch how medications and behavioral changes can work together to help you sleep.

For sleep apnea
In the (not-too-near) pipeline: The severity of sleep apnea might be related to levels of omega-3 fatty acids in the body, researchers from the University of Missouri in Kansas City reported in a 2008 study. Of the 350 test subjects, those with lower body levels of docosahexaenoic acid (DHA), a type of omega-3 fatty acid, had more severe cases of apnea. It's not clear yet whether severe apnea lowers DHA levels, or whether less DHA leads to worsening apnea. More studies are certainly required, but if this link is established, a DHA-derived drug treatment is a possibility.

Dr. Shives is hopeful that drug therapies that target the brain's neurotransmitters may hold promise for patients with sleep apnea. "If you asked me a couple of years ago if we'd ever have another treatment besides the CPAP machine, I'd have said no," says Dr. Shives, referring to the continuous positive airway pressure device. "But it all goes back to the neurotransmitters." The same chemicals that control the sleep-wake cycle may also control the tone and stiffening of the muscles in your throat that keep the airway open, she explains. If researchers can develop a pill to activate those neurotransmitters to keep throat muscles toned, in theory, airway tissues wouldn't collapse and sleep apnea could be lessened or even avoided.

For now: Though it's too early to draw any specific guidelines from the University of Missouri research, you can increase your omega-3 intake by adding fish and nuts to your diet. And though sometimes uncomfortable, the CPAP machine has proven results. Read more about sleep apnea treatments.

It's estimated that it takes an average of 12 years and nearly $500 million to get a new drug from the lab to pharmacies—and even once a drug is approved, post-marketing studies are often just beginning. The fact that these medications have shown promising results is encouraging, but there's no guarantee that they'll solve your specific sleep problems or even make it to the market. Until you can try them for yourselves, talk to your doctor about healthy habits, relaxation techniques, and current treatment options that can help you get your z's.

]]> New sleep medications could reach pharmacy shelves in 2009. (ISTOCKPHOTO) <![CDATA[Quick Facts About Insomnia: What You Need to Know Now]]>

Insomnia is a common problem that affects almost everyone at some point. Without enough sleep, you may feel sleepy during the day. This can make you more likely to have an accident and also makes driving dangerous. You may also feel grumpy from lack of sleep. Some people have trouble remembering things, don't get as much done, and don't enjoy being with family and friends.

Having trouble sleeping from time to time is often linked to short-term stress. It can last for days to weeks. It often gets better in less than a month.

Insomnia can also become an ongoing sleep problem, especially when you worry about not sleeping well. This is called chronic insomnia. It is often a symptom of another health problem, such as depression or chronic pain. Chronic insomnia is less common than short-term sleep problems. It affects up to 10% to 15% of adults.

What causes insomnia?
There are many things that can cause sleep problems. Insomnia may be caused by:

Stress. Stress can be caused by fear about a single event, such as giving a speech. Or you may have ongoing stress, such as worry about work.
Depression, anxiety, and other mental or emotional conditions.
Poor sleep habits, such as watching TV in bed or not having a regular bedtime schedule. If you have trouble sleeping, you may worry about being able to fall asleep. This can make the problem worse.
Changes in your sleep habits or surroundings. This includes changes that happen where you sleep, such as noise, light, or sleeping in a different bed. It also includes changes in your sleep pattern, such as having jet lag or working a late shift.
Pain, breathing problems, restless legs syndrome, and many other health problems.
Using stimulants that can cause sleep problems, such as tobacco and caffeine, as well as certain medicines, alcohol, and drugs.
Lack of regular exercise.

How common is insomnia?
Insomnia is very common and can affect people at any stage in life. One recent study reported that about 1 out of 5 children has insomnia. It is more common in women and older people. Almost half of older adults are affected by sleep problems, and up to 14% use sleeping pills regularly.

Sleep patterns also change as you get older, and many older adults sleep less than younger adults. If you are an older adult, you may have a harder time falling asleep, and your sleep may not be as deep. Health problems and medicines can also affect how much or how well you sleep. But having trouble getting to sleep or not sleeping well is not normal, no matter what your age. If you are having trouble sleeping, discuss it with your doctor at your next checkup.

]]> <![CDATA[Provigil and Nuvigil: Medication Options for Sleep Apnea and Daytime Sleepiness]]>

Obstructive sleep apnea is not generally treated with medication; in fact, sleeping pills and other sedatives can worsen the condition. But if a patient suffers from excessive daytime sleepiness even while using a continuous positive airway pressure (CPAP) machine at night, there are medication options that can promote wakefulness.

These drugs are available by prescription only, are not meant to be a substitute for other sleep apnea treatments, and should only be taken in addition to nightly CPAP therapy.

The following is from our A-Z Health Library:

]]> <![CDATA[Cancer, Chemotherapy, and Insomnia: 15 Home Treatment Tips to Help You Sleep]]>

]]> <![CDATA[Prescription Sleep Drugs: What You Need to Know Now]]>

Hypnotic medications help you fall asleep or stay asleep.
Antidepressants that have a calming or sedative effect can be used to aid sleep.
Rozerem is a different type of sleep medicine that helps regulate your body's internal clock. Rozerem has few side effects and is not habit-forming.

If you are taking any of these medications, it's usually best if you take them only for a short time, at the lowest effective dose, and stop taking them as soon as you can. This is true for all people, but it is particularly true for older adults, who can become dependent on sleep enhancers and sometimes experience diminished thinking capability during and after long-term sleeping medication use.

The most successful long-term treatment results have been achieved with behavior therapy. Behavior therapy results in similar improvements in both overall sleep quality and less time in getting to sleep compared to using medications, without any side effects. Many people receiving such therapy benefit from the treatments and become good sleepers. Perhaps most important, these results are maintained over time.

]]> <![CDATA[Sleep Studies: What You Need to Know Before You Go]]>

]]> <![CDATA[How Doctors Diagnose Insomnia, and What You Can Do to Help]]>

]]> <![CDATA[Insomnia Treatments Options: What You Need to Know Now]]>

chronic pain, or an emotional problem, such as stress, treating that problem may help you sleep better. You may be able to sleep better by making some small changes. It may help to:

• Go to bed at the same time each night.
• Get up at the same time each day.
• Avoid caffeine or alcohol for several hours before bedtime.
• Get regular exercise. But make sure you finish the exercise at least 4 hours before you go to bed.
• Avoid daytime naps.

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Do you fight insomnia with medication, therapy, or both?