No more tossing and turning: drug-free ways to get your zzz's - includes sources and related articles

Vegetarian Times, Nov, 1996 by Linda B. White

"AMERICA IS A NATION whose citizens do not get enough sleep," says William C. Dement, M.D., Ph.D., director of the Stanford University Sleep Disorders Clinic in Stanford, California. He ranks sleep deprivation along with sleep disorders as our number one health problem.

Dr. Dement is not alone in his concern. Recent research indicates the problem of sleeplessness has reached epidemic proportions in America and may be getting worse. A 1995 Gallup Poll conducted for the National Sleep Foundation, a non-profit organization in Washington, D.C., found 50 percent of Americans have trouble sleeping some of the time and 12 percent have frequent insomnia, compared to 1991 figures, when 33 percent reported trouble sleeping some of the time 10 percent complained of frequent insomnia (duration of three or more weeks.)

Where has this epidemic come from? No one knows the specific cause but many experts implicate our increasingly hectic way of life. Nancy K. Lonsdorf, M.D., Center in Washington, D.C. offers this explanation, "We have a society that has created insomnia through overwork and pressure at the expense of inner peace, harmony and balance."

Most of us have experience this lack of inner peace firsthand, watching infomercials through the wee hours of the morning. After nights like these when we've had trouble falling asleep or sleeping soundly, we feel the consequences the next day. Peter Haurim Ph.D., director of the Mayo Sleep Disorders Clinic, in Rochester, Minn. and co-author of No More Sleepless Nights (John Wiley and Sons, 1990), says the main effect is feeling sleepier than usual with a lower attention threshold for boring tasks. What to do when this kind of occasional insomnia strikes? Probably nothing. Hauri urges people not to be afraid of occasional insomnia because just worrying about it creates anxiety perpetuating the problem.

More frequent sleeplessness, however, may indeed merit concern as it can be costly to your well-being. Common symptoms of chronic insomnia include moodiness, irritability, depression, reduced physical and mental performance, lessened ability to bounce back from stress, impaired immune function and a tendency to be accident-prone. You should call your doctor if you routinely have difficulty sleeping or you feel anxious about falling asleep. Insomnia can be a symptom of medical, emotional or behavioral problems that need attention so don't be surprised if your doctor wants to do a physical exam and orders lab tests. You may even be referred to a sleep disorders clinic for a more sophisticated evaluation.

A CUSHION OF PILLS

Once serious medical disorders are ruled out, some doctors prescribe sleep medications. Sleeping pills are not, however, without risk. They disturb normal sleep patterns, cause "morning after" hangovers, amplify the effects of alcohol and impair coordination, increasing the risk of auto accidents. If that were not enough, you will probably need higher doses over time to experience the same effects, and withdrawal will cause a rebound in insomnia that can result in a vicious cycle of overdosing, addiction and even death. The safest, and therefore the most often prescribed sleeping pills are the benzodiazepines--Valium, Restoril, Prosom, Doral, Dalmane, Halcion--and Ambien, drugs that have been linked with temporary amnesia, a rare side effect.

Many people take over-the-counter sleeping medications, which usually have antihistamines as the main ingredient. While not as strong as prescribed sleeping pills, antihistamines (which are usually found in allergy medications) can cause side effects such as dry mouth, constipation, visual difficulties and agitation. Like sleeping pills sold by prescription, over-the-counter remedies don't work for very long because your body adapts to them.

Are sleeping pills ever warranted? Hauri says they may be appropriate when insomnia is acute or when it's very important you get a good night's rest, such as before a big presentation or exam. He urges people to use pills at their lowest effective dose and only for a few nights at a time.

MENTAL MASTERY: BEYOND COUNTING SHEEP

Almost all Chronic insomniacs need the help of some behavioral therapy, according to Sonia Ancoli-Israel, Ph.D., director of the Sleep Disorders Clinic at the Veterans Administration Medical Center in San Diego, Calif., and author of a new book, All I Want is a Good Night's Sleep (Mosby, 1996). The first step is to identify poor sleep habits and replace them with good ones. Beyond that, relaxation training seems to help many people, a observation supported by a growing body of clinical research.

One technique, progressive relaxation, involves tensing and relaxing groups of muscles sequentially, starting at the toes and working up to the head. Other mindbody techniques such as meditation, biofeedback, self-hypnosis and yoga also have been reported by scientists to be effective in evoking a restful state conducive to sleep. Ancoli-Israel is convinced that "In the long run, behavioral therapies work better than pills."