Take advantage of natural sleep science

Night of the living dead
Until 15 years ago, sleeping pills were mainly addictive barbiturates (such as Seconal, Halcion, Qualude) and sedatives called benzodiazepines (Valium and Dalmane). For this reason, they were less popular and less prescribed. That changed in the early 1990s when Ambien, which is less addictive, came on the market. It acts on the same neural receptors as a benzodiazepine, but is safer. It is the only hypnotic drug Kripke recommends — and even then, only for less than four weeks. Other new hypnotic drugs are safe but ineffective, he says.

Most sleeping pills are recommended for short-term use, but lots of people take them frequently and become dependent upon them to fall asleep. Most sleeping pills, especially when taken over long periods of time, stay in the bloodstream, giving a hangover the next day and beyond, impairing memory and performance on the job and at home.

A time-release version of Ambien, known as Ambien CR, is bound for the market and designed to prevent waking after four hours, when the drug normally would wear off. One of the newest pills on the market — Lunesta, or eszopiclone — is also designed for longer-term use. But Kripke said the long-lasting pills might be even more harmful in terms of impairing "day-after" performance.

Hypnotic drugs have dangerous side effects, Kripke says. For one, they reduce fear of risky behavior, such as driving fast. Ironically, that could result in the inability to see that the sleeping pills are doing more harm than good over time.

A recent study published in the British Medical Journal showed that the risks of taking sleeping pills (benzodiazepines and other sedatives, in this case) outweighed the benefits among people older than 60 in a series of studies carried out between 1966 and 2003. The pills helped people fall asleep, and they slept more. But they were twice as likely to slip and fall, or crash a car due to dizziness from the pills than they were to get a better night's sleep.

Even the safest hypnotic drugs have strange side effects, as the alleged Ambien sleepwalkers showed.

And one over-the-counter approach, the hormone melatonin, was found by scientists at the University of Alberta in Canada to be ineffective in treating jet lag and sleep trouble associated with medical problems. Studies also show it is associated with skin blanching in frogs, gonadal atrophy in small animals, and obesity in some mammals.

Are you sleeping?
The real number of Americans with sleep problems is unclear because the same figure — 70 million — appears on National Institutes of Health documents from 2006 and from 1994. This catch-all category reportedly includes insomnia, jetlag, sleepwalking, bed wetting, night terrors, restless legs syndrome, narcolepsy and disordered breathing during sleep (called apnea).

The National Sleep Foundation, the source of many sleep surveys and statistics, has financial and institutional ties to sleeping pill manufacturers, according to the Sacramento Bee newspaper.

Sleep problems could be increasing, Kripke says, but there is no evidence for this. If they are increasing, it could be a result of less exposure to daylight (due to cable TV, the Internet, indoor gyms) and increasing obesity, which causes apnea. But he still recommends against taking sleeping pills in nearly all cases and in favor of improved sleep habits.

"Sleeping pills usually do more harm than good," he says.

SLEEPING AIDS Improved sleep behavior and attitudes do more good than sleeping pills for the treatment of insomnia, experts at a recent National Institutes of Health Consensus Conference said. Here are the changes recommended by Daniel Kripke of the University of California at San Diego: • Don't take sleeping pills, including over-the-counter pills or melatonin. • Don't go to bed until you're sleepy. If you have trouble sleeping, try going to bed later or getting up earlier. • Get up at the same time every morning, even after a bad night's sleep. The next night, you'll be sleepy at bedtime. • If you wake up in the middle of the night and can't fall back to sleep, get out of bed and return only when you are sleepy. • Avoid worrying, watching TV, reading scary books, and doing other things in bed besides sleeping and sex. If you worry, read thrillers or watch TV, do that in a chair that's not in the bedroom. • Do not drink or eat anything caffeinated within six hours of bedtime. • Avoid alcohol. It's relaxing at first but can lead to insomnia later. • Spend time outdoors. Exposure to daylight or bright light fosters sleep. LiveScience

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