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Overcoming insomnia may take more than a pill: sleep aids can provide fast relief but sharpening your sleeping skills will provide long-lasting benefits.

Over-the-counter and prescription sleep aids might seem like an easy fix for your insomnia. Who wouldn't want to get a better night's sleep by taking a pill?

Trouble is, many sleep medications may cause unwanted side effects, especially in older adults. So, sleep experts like Nancy Foldvary-Schaefer, DO, encourage judicious use of these medications, while advocating greater use of non-pharmaceutical alternatives.

"Don't get caught in the trap of just using sleep aids," says Dr. Foldvary-Schaefer, Director of Cleveland Clinic's Sleep Disorders Center. "Instead of relying on a sleeping pill, empower yourself by learning some strategies and having more control over how you sleep."

If you have insomnia, talk to your doctor about using sleep aids wisely, and explore non-drug treatments that can help you "get your ZZZs."


When used properly, sleep medications are generally safe, Dr. Foldvary-Schaefer says; however, they may be problematic for certain patients, especially older users, who tend to be more sensitive to the sedating effects of the medications. Some patients may experience morning grogginess, decreased reaction times, or impaired driving abilities that linger into the next day.

"We worry more so about people who are older, who may have a sluggish metabolism and have sleep medicines accumulating in their system," Dr. Foldvary-Schaefer explains. "So, if they get up in the middle of the night, they might stumble and hurt themselves."


The U.S. Substance Abuse and Mental Health Services Administration reported in August 2014 that the number of emergency department visits involving zolpidem (Ambien[R]), nearly doubled from 2005-2006 to 2009-2010.

In rare cases, sleep aids may cause unusual nighttime behaviors, such as walking or driving while asleep. And, particularly with long-term use, some people may develop a physical or psychological dependence on the drugs. "It's like a security blanket," Dr. Foldvary-Schaefer says. "They get anxious if they know their prescription is running out."


In August 2014, the U.S. Food and Drug Administration approved a first-of-its-kind sleep aid, suvorexant (Belsomra[R]), which is taken 30 minutes before bedtime in preparation for at least seven hours of sleep. While widely used sleep aids such as zolpidem and eszopiclone (Lunesta[R]) work by slowing brain activity to promote sleep, suvorexant alters the action of chemicals that keep you awake. Studies that led to suvorexant's approval compared the drug only with a placebo, so it's unclear how its safety profile compares with that of other sleep aids. Studies have found that suvorexant users are unlikely to develop dependence, but like other sleep medications, the drug may cause daytime sleepiness, foggy thinking, or unusual sleep behaviors.

The choice of sleep aid depends on the nature of your insomnia. Some medications, such as triazolam (Halcion[R]) and zaleplon (Sonata[R]), only help you fall asleep, while drugs such as eszopiclone, suvorexant and extended-release zolpidem help you fall asleep and stay asleep.

If pain or restless legs syndrome (RLS) is causing insomnia, your doctor might recommend a medication like gabapentin (Horizant[R]), pramipexole (Mirapex[R]), or ropinirole (Requip[R]), all of which can improve symptoms and also help you sleep. Similarly, if your insomnia is accompanied by depression, antidepressants such as mirtazapine (Remeron[R]) and trazodone (Oleptro[R]) may be prescribed.

"We'll figure out what's driving the insomnia," Dr. Foldvary-Schaefer says. "Talk with your doctor because there are other conditions that can produce insomnia, and treatment of the underlying problem is what's needed to improve the insomnia." She says supplements of the hormone melatonin (available without a prescription) may help with insomnia associated with problems with the sleep/wake cycle and shifting sleep times, such as jet lag. However, she cautions, the supplements must be used properly--they should be taken about four to six hours before bedtime--in order to be effective.

She recommends against using over-the-counter sleep aids containing diphenhydramine or doxylamine, found in products like Benadryl[R], Nyquil[R] and Unisom[R]. (Tell your doctor if you use any over-the-counter sleep aids.) And, she cautions against consuming alcohol with any prescription or non-prescription sleep aids, or imbibing to help you fall asleep. "It's a good sleep inducer, but as it metabolizes, it fragments sleep significantly," she says. "Some of that has also been seen with over-the-counter sleep aids."


Sleep aids may provide short-term insomnia relief, but for more permanent benefits, Dr. Foldvary-Schaefer recommends cognitive behavioral therapy for insomnia (CBT-I).

"Most patients don't get long-term benefit from sleep aids," she explains. "What's almost always the case is that cognitive behavioral issues need to be addressed."

CBT-I teaches you skills to improve your sleep, such as ways to manage stress or avoid negative thoughts or fears that keep you awake. You'll learn relaxation techniques or decrease the time you spend in bed, which may help make you more sleepy. Among other things, CBT-I teaches you about the importance of sleep hygiene (for examples, see What You Can Do).

Cleveland Clinic offers an online program, GO![R] To Sleep, that includes CBT-I and other strategies to help combat insomnia lasting one to six months. For information, visit Programs/Pages/Sleep.

"The hope is treating people more effectively and, hopefully, without medication use," Dr. Foldvary-Schaefer says. "Studies have found that people who go through a course of cognitive behavioral therapy, with or without a sleep aid, do better in the long term than those who rely on sleep aids alone."


Consider these recommendations to improve your sleep hygiene and combat insomnia:

* Get exposure to bright light in the morning, and avoid bright lights at night.

* Find ways to unwind--reading, taking a warm bath--before you go to bed.

* Keep your bedroom dark, and remove any noise sources that could disrupt your sleep.

* Turn off the TV and computer at least two hours before bedtime, and don't eat or exercise at least four hours before bedtime.

* Take all electronics, such as cell phones and computers, out of the bedroom.

* Use your bedroom only for sleep or sex. Leave the bedroom If you can't fall asleep within 15 to 20 minutes.

* Minimize your caffeine intake, and avoid caffeinated beverages or alcohol after 2 p.m.

* Limit daytime napping to an hour or less.

* Put your clock out of sight. Fixating on the clock will just make things worse.

* Ask your doctor if your medicines are making you sleepy or keeping you awake.


Doxepin          Helps you stay asleep;      Drowsiness; potential for
(Silenor[R])     does not cause dependence   abnormal sleep behaviors *

Eszopidone       Helps you fall asleep       Drowsiness; foggy
(Lunesta[R])     and stay asleep             thinking; potential for
                                             abnormal sleep behaviors;
                                             can cause dependence

Ramelteon        Helps you fall asleep;      Drowsiness; dizziness;
(Rozerem[R])     does not cause dependence   nausea; worse insomnia;
                                             potential for abnormal
                                             sleep behaviors

Suvorexant       Helps you fall asleep       Drowsiness; foggy
(Belsomra[R])    and stay asleep             thinking; potential for
                                             abnormal sleep behaviors

Temazepam        Helps you fall asleep       Drowsiness; dizziness;
(Restoril[R])    and stay asleep             weakness; headache;
                                             potential for abnormal
                                             sleep behaviors; can cause

Triazolam        Helps you fall asleep       Drowsiness; dizziness;
(Halcion[R])                                 weakness; headache;
                                             potential for abnormal
                                             sleep behaviors; can cause

Zaleplon         Helps you fall asleep       Drowsiness; dizziness;
(Sonata[R])                                  potential for abnormal
                                             sleep behaviors; can cause

Zolpidem         Helps you fall asleep       Drowsiness; dizziness;
(Ambien CR[R])   and stay asleep             headache; diarrhea;
                                             potential for abnormal
                                             sleep behaviors; can cause

* Abnormal sleep behaviors may include driving, sleepwalking, eating,
talking on the phone, or having sex while asleep, with no memory of
these events.
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Title Annotation:General health
Publication:Men's Health Advisor
Date:Mar 1, 2015
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