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Sleep

Insomnia is the new epidemic of the 21st century. In today’s overdriving, overproducing, pedal-to-the-metal, Starbucks-fueled society, insomnia is a symptom of life out of balance. Our ancestors rose with the sun and slept with the stars. None of them ever dreamed of doing exercise, because strenuous physical activity was a part of their everyday life. Ever since the days of Thomas Edison we have steadily lengthened our days and shortened our nights just to keep pace with the modern world. The advent of cell phones, email, laptops, palm pilots and red-eye flights have only compounded and magnified the problem in an exponential fashion over the past decade.

Of course it’s great to be productive, but this hectic pace has not come without a price. Rates of obesity, diabetes, cancer and autoimmune diseases are all at the highest levels ever in history. And yet drug companies are actively researching medications that would allow us to do without sleep altogether, or at least to minimize our sleep requirements. For now we can only guess what the health effects of such a pill would be.

Even now, Americans are grasping at anything that might help them sleep soundly. Americans currently spend $2.4 billion on prescription sleeping pills and hundreds of millions of dollars on nonprescription remedies such as melatonin and others. These pills and remedies would be acceptable if they were safe and effective, but unfortunately they are neither.

Regular use of sleeping pills has been associated with higher death rates for a number of reasons. People taking a sleeping pill daily were more likely to commit suicide than non-users. Also, sleeping pill users have been shown to have higher rates of hip fracture and other fractures (from falling after getting up at night while under the influence of these drugs). Death rates from common ailments such as heart disease, cancer and stroke may also be higher in regular sleeping pill users. The sleeping pills, of course, may not have been the cause of these deaths, but people who regularly use sleeping pill are in a higher risk category for death.

Aside from the health and safety issues, regular use of sleeping pills is also not an effective way of improving sleep. All of the sleeping remedies have the same problem – tolerance. That is, when these pills are used on a regular basis, they lose their effectiveness – they stop putting someone to sleep or fail to keep them asleep after just a few nights of regular use. It’s a very similar process to the tolerance that develops quickly to alcohol – after just a few nights of drinking it becomes much harder to get drunk. The same occurs with sleeping pills.

The temptation is then to increase the dose of the sleeping pill in order to get the desired effect – people often find they need a second pill or they won’t fall asleep. This leads to the dangerous but well-known cycle of dependency, tolerance, addiction and withdrawal. The phenomenon of tolerance is not restricted to one or two different sleeping pills, but to these drugs as a class. All of the prescription sleeping pills (known as the sedative hypnotic class) exhibit the same problem with tolerance. This includes common prescription sleeping pills such as Ambien, Sonata, Restoril, Xanax, Ativan, Halcion, Serax and others.

Side effects of these medications include drowsiness, memory loss, dizziness, loss of balance, depression, confusion, liver dysfunction, reduced sex drive and even insomnia! Insomnia itself is a side effect of regular use of sleeping pills. Why? Because once the effect of the sleeping pill wears off in the middle of the night, then the process of withdrawal begins – this withdrawal causes arousal, which wakes us up. At that point there are only two options – lay awake, or take another sleeping pill, which aggravates the cycle of dependency, tolerance and addiction.

So is there a solution to this dilemma?

Of course. For starters, try to avoid getting caught up in the potentially unsafe and ineffective habit of using sleeping pills on a regular basis. If you have been prescribed a sleeping pill, it’s best to use it seldom if at all to avoid tolerance and dependency. Next, you should reprogram your sleep habits.

As surprising as it may seem, sleep is largely a learned behavior. Our sleep habits are conditioned, very similar to Pavlov’s dogs. Our bodies learn the pattern of our sleep and then “practice” that pattern each night. In order to restore normal sleep patterns, we need to retrain our bodies to learn new habits. As with learning anything new, practice makes perfect. It takes a diligent effort to retrain our bodies to sleep well again.

Here are ten steps to help retrain your sleep patterns:

• Maintain a regular sleep-wake schedule. Try to go to sleep and wake up at the same time each day. This begins to teach your body the timing of sleep and arousal. Try not to deviate by staying up too late every few nights and sleeping in late on weekends. Don’t nap during the daytime if possible; this disrupts your body’s internal clock.
• Don’t read, write, watch TV or talk on the phone in bed. The goal here is for your body to learn that your bed means sleep, not staying awake doing something else.
• Keep your bedroom absolutely dark. Research suggests that even tiny amounts of light (such as from a nightlight, or a crack of light through a door) may be enough to disrupt chemical signals in the brain such as melatonin that regulate sleep.
• Turn your clock away from your bed. If you do wake up during the night, you shouldn’t find yourself staring at your clock. This only causes arousal, which will make it more difficult to fall back asleep.
• Practice a ritual relaxation technique. Before going to sleep, practice a simple relaxation technique. Begin by briefly writing down anything on your mind at bedtime so you can clear these thoughts and concentrate on sleep. Practice a brief relaxation exercise, whether this is a short meditation, listening to calming music, doing a stretching or breathing exercise, praying or reading (not in bed). You could also take a hot bath with soothing essential oils or have a cup of warm herbal tea. Once in bed, begin by relaxing each body part from your toes up to your face in a sequential fashion until all of your muscles feel fully and completely relaxed. Don’t forget your shoulders and face (where tension often resides).
• Exercise regularly during the day. Regular exercise has a number of beneficial effects. Exercise certainly makes you more tired when you go to bed. But exercise also lowers levels of stimulatory hormones including adrenaline and cortisol, and exercise also helps to improve melatonin levels. Melatonin is one of the hormones made in our brain (by the pineal gland), which helps to keep our bodies’ internal clock. Try to exercise in the morning or afternoon, rather than in the evening right before bed, when exercise can be stimulating.
• Avoid stimulants after noontime. Stimulants such as caffeine in coffee (even decaf), tea, soft drinks, or over-the-counter medications (Excedrin & others) can disrupt your normal sleep-wake cycle.
• Limit or eliminate alcohol. Alcohol has an identical effect to sleeping pills, that is, it also causes tolerance, dependency, addiction and withdrawal. Although that glass of wine seems to relax you and make you a little groggy, it is also the thing that’s waking you up at 3 AM when the effects wear off and your body arouses from withdrawal from the alcohol.
• Eat calming foods at dinner. Calming foods include some form of carbohydrate that temporarily boosts the brain levels of serotonin, a brain chemical involved with sleep. If you’ve been cutting down on carbs to reduce appetite or lose weight, dinner is the best time to re-introduce some carbohydrates to help with sleep.
• If you do wake up, try and stay in bed until you fall back asleep. Getting out of bed only reinforces unwanted habits; so if you do wake up, don’t get upset. Just relax your body again from the toes up and drift back off to sleep.

Because there are several health conditions that can cause insomnia, it’s important to tell your doctor about your sleeping habits. Your doctor will be able to rule out serious causes of insomnia such as sleep apnea, hormonal imbalances, thyroid disorders, mood disorders (depression, anxiety, bipolar disorder or others), restless leg syndrome or other medical conditions that might require specific therapy. You can still follow the ten steps above, but for better sleep for a lifetime, avoid the sleeping pills!