Good Night's Sleep: Medicine and Simple Routines Help

by Food and Drug Administration (FDA)

Come, blessed barrier between day
and day,
Dear mother of fresh thoughts and
joyous health!

— William Wordsworth in To Sleep (1806)

For years, there were no refreshing lulls between days for Lauren Ero. Rather than waking up feeling clearheaded and healthy, the 37-year-old mother of two spent four years perpetually listless and moody.

"Those years are like a fog to me. I just remember how hard it was and how hopeless I felt," she says. "I would be more tired in the morning than when I went to bed the night before. I was too exhausted to do even day-to-day activities like taking care of my kids and things around the house."

Ero was suffering not from depression, as one doctor surmised based on her look-alike symptoms of despondent mood and irritability, but from insomnia.

The definition of insomnia, according to the American Sleep Disorders Association (ASDA), is difficulty falling asleep or staying asleep. If it occurs every night or most nights for an extended time, like Ero's, it's called chronic insomnia.

According to ASDA estimates, more than 35 million Americans suffer from this long-lasting type of insomnia, with 20 to 30 million others suffering shorter-term sleeplessness. Men and women of all ages experience insomnia, but it is more common in the elderly and in women, especially after menopause. The consequences of a "Sleepless Society" can be serious.

Overcoming Roadblocks to Sleep

Like a headache or fever, insomnia may be a symptom of another problem. It can result from something as simple as anticipating a stressful event, like a test or meeting, or from a longer-lasting stressful circumstance, such as a sick child or troubled marriage. Even worrying about having a tough time falling asleep may itself prevent a person from drifting off.

Other common causes of nighttime wakefulness include environmental disturbances, such as noise from traffic or television, an uncomfortable temperature, or light from the sun or other source; use of alcohol or stimulants, such as caffeine or nicotine; and erratic hours, like those of shift workers and people whose air travel takes them across time zones.

Sometimes short-term insomnia may go away on its own or with simple changes in daytime or sleep-time habits. (See "Wooing Sleep.") If these lifestyle changes don't work, the careful use of sleeping pills approved by the Food and Drug Administration may help provide temporary relief from insomnia.

A doctor can help choose an appropriate medicine. One factor to consider is the drug's half-life, or the time it takes to be cleared from the body. Drugs with shorter half-lives are less likely to have carry-over sedation that affects daytime functioning.

A second factor is the drug's toxicity. Because of their lower risk of overdose, the newer benzodiazepines and benzodiazepine-like drugs are used more often to treat insomnia than barbiturates and other older drugs. Among the most commonly prescribed benzodiazepine sleep-aids are flurazepam (Dalmane), estazolam (ProSom), quazepam (Doral), temazepam (Restoril), and triazolam (Halcion). The prescription sleep-aid zolpidem (Ambien) is in the imidazopyridine class of drugs.

As a rule, these sleeping pills should be used only for short periods because of the risk of developing dependency and withdrawal symptoms when the drugs are stopped. So, while they may help with short-term insomnia induced by jet lag, shift work schedule changes, or short-term stress, they should generally not be used for chronic insomnia because of their potential addictiveness and because they can mask underlying medical problems.

Some other sleep-aids are available without a prescription, including diphenhydramine (in Nytol, Sleep-Eze, and Sominex) and doxylamine (in Unisom Nighttime). These products contain a sedating antihistamine and, like prescription drugs, must be used with care. Even if taken at night, they can cause daytime drowsiness, which can make driving and other tasks risky.

Sleep Apnea: More Than Simple Snoring

Unlike short-term sleeplessness, chronic insomnia is often a symptom of a serious underlying medical disorder. Depression and other psychiatric disorders account for many cases of insomnia, as do wholly physical illnesses, such as asthma, arthritis, Parkinson's disease, kidney or heart disease, and hyperthyroidism.

Sleep apnea is among the most common and most dangerous types of sleep disorder. An estimated 18 million Americans have the condition, which is marked by repeated episodes of cessation of breathing during sleep that over time can lead to high blood pressure, cardiac disease, and disordered thinking.

Sleep apnea was the culprit in Lauren Ero's case. After two years of trying various antidepressants that offered her no relief, Ero sought a second medical opinion and was sent for a sleep analysis.

"Then it was really obvious what it was," says Ero, who recently began working for the American Sleep Apnea Association. "It was a classic case."

The tests revealed what Ero didn't know and what her husband hadn't found alarming: Ero was snoring. But her "snoring" problem was distinct from the merely annoying type because she was also gasping for air throughout the night — possibly tens of times each hour — which repeatedly roused her out of her refreshing, deep sleep. The results were the telltale signs of sleep apnea: excessive daytime sleepiness and difficulty functioning.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.