When Pain Interrupts Your Sleep


WebMD Feature, July 12, 2011
By Elizabeth Shimer Bowers
Reviewed By Michael J. Breus, PhD



Whether it’s from a sore lower back or throbbing tooth, pain is hard enough to deal with in the light of day. But pain at night that robs you of your much-needed sleep can be downright exhausting.

“An individual simply cannot get comfortable to fall asleep due to the discomfort of pain,” says Frank. J. Falco, MD, who specializes in pain management and sleep problems in Newark, Del. Plus, pain causes anxiety, which disrupts sleep even more.

In addition to preventing a person from falling asleep, pain also results in difficulty staying asleep. And once pain keeps you awake one night, it is likely to do the same thing again and again. Pain-related insomnia gets worse over time.

If pain keeps you up, take comfort in knowing you are not alone. According to the National Sleep Foundation, two out of three people with chronic pain have trouble sleeping.

Many types of pain can interrupt sleep, from the chronic pain of arthritis to the acute pain that follows surgery.

“But no matter what the cause, it is the intensity and quality of the pain, not necessarily the type, that determines the impact on a person’s quality of life, including sleep,” says Falco, who heads Mid-Atlantic Spine and Pain.

The Relationship Between Pain and Sleep

“Pain is a sensation you feel when nerves are stimulated to an intense degree,” says Tracey Marks, MD, an Atlanta-based psychiatrist. Marks is author of Master Your Sleep: Proven Methods Simplified. “This stimulation activates the brain, which keeps you awake.”

Some of the ways pain causes insomnia include the following:

Pain at night disrupts sleep architecture.

“You need a certain amount of each stage of sleep to feel rested and for proper memory,” Marks says. These stages include light sleep, deep sleep, and REM (rapid eye movement) sleep. “We normally go through four to six cycles of these stages per night. But if pain wakes you up, you spend too much time in light sleep,” she explains. This reduced sleep — in particular, shortened REM — may increase sensitivity to pain.

Pain affects sleep position.

Certain types of pain, such as arthritis pain and orthopedic pain, may prevent you from getting comfortable at night, says Reena Mehra, MD, of University Hospitals Case Medical Center in Cleveland. The medical director of adult sleep services says joint and muscle pain usually results in problems staying asleep (called sleep maintenance insomnia) rather than falling asleep (called sleep onset insomnia).

Sleep deprivation makes you more sensitive to pain.

A study in the April 2009 issue of Sleep Journal showed that normal, healthy individuals are more sensitive to pain when they are low on rest. The reasons why aren’t known for sure. “Some research studies show that sleep deprivation causes increased production of inflammatory chemicals in the body called cytokines,” Marks says.

Pain medications interrupt sleep. Unfortunately, some of the medications prescribed for pain, such as codeine and morphine, can cause insomnia. These opioid pain medications can cause apnea, brief pauses in breathing, during sleep. “Therefore, people who take these kinds of medications for chronic pain are at a higher risk for sleep problems,” Falco says.

People with chronic pain may have trouble exercising. Lack of exercise leads to weight gain. Excess weight then restricts exercise, which leads to more pounds gained. “This vicious cycle can lead to sleep apnea, which prevents a restful night’s sleep,” Falco says.

Different Types of Pain

According to the National Sleep Foundation, the types of pain that most commonly cause insomnia are back pain; headaches; and temporomandibular joint (TMJ) syndrome, which causes pain around the ears and jaw muscles. Muscoloskeletal pain, including arthritis and fibromyalgia, can also cause sleep problems. Cancer pain, resulting from the disease itself and treatment, also leads to trouble sleeping. Pain that follows surgery can also prevent much-needed rest.

As Falco points out, current research shows that there are more commonalities than differences between types of pain when it comes to insomnia. A few of the nuances researchers have identified include the following:

  • The intense nature of pain after surgery and other acute pain seems to affect both the length and quality of sleep.
  • Chronic arthritis pain appears to interfere with circadian rhythms. A recent Japanese study found a relationship between a person’s body clock and arthritis symptoms. More specifically, researchers discovered that certain genes affecting circadian rhythms may activate a molecule that sparks inflammation in people with arthritis. The relationship between this molecule, called TNF-alpha, and circadian rhythms may explain why people with arthritis have worse joint pain in the morning.
  • In people with fibromyalgia, a chronic condition that causes joint and muscle pain, there are constant bursts of “awake” brain activity which prevents deep sleep. In a study published in the Journal of Rheumatology, people with fibromyalgia had two times as many awakenings per hour as people without the disease.


Managing Pain That Steals Your Sleep

The first step is to reduce the pain, Falco says. “Pain control reduces anxiety and depression, improves sleep, and makes for better overall quality of life.”

Falco adds that people with pain and sleep problems should undergo a diagnostic sleep study.

When it comes to medications, tell your doctor about the sleep problems you’re having as a result of your pain. Then follow his or her orders. Painkillers and/or sleeping pills can work for some people, but they should only be used under the supervision of a doctor.

And in terms of pain that follows surgery, banking up on sleep a few weeks beforehand may help. “People don’t intuitively think they need to rest up for surgery; but they really should as it can help with pain control,” Marks says. Research has shown that people who get enough rest before surgery require less pain medication afterward.


Once the surgery has taken place, narcotic pain medications can make the first few nights of sleep more restful. “Try to time your last dose around the time you go to bed so it will last through the night,” Marks says.

How to Get the Sleep You Need

Calm yourself with meditation and other relaxation techniques.

When done effectively, as little as 10 minutes of daily meditation can help your mind ignore the pain, Marks says. There are many different types of meditation, including guided meditation, tai chi, and yoga. But you can also improvise. “Use deep breathing exercises, progressive muscle relaxation, or focus on an object or scene,” Marks says.


Gentle massage is also beneficial for both insomnia and chronic pain. In a study published in the InternationalJournal of Neuroscience, participants who had two 30-minute massages a week for five weeks experienced better sleep and less lower back pain.

Exercise the right way.

Regular exercise can improve both pain and sleep issues, Falco says. However, activity within three hours of bedtime can keep you up, so the earlier in the day you work out, the better. For pain, the best exercise is moderate and low-impact. Try walking, yoga, or swimming.

Additional tips for improving sleep include:

  • Forgo daytime naps or limit yourself to a brief 10- to 20-minute nap in the afternoon.
  • Take a warm bath or shower before bed to wind down.
  • Lull yourself to sleep with relaxation CDs that play a babbling brook, gentle waves, or other soothing sounds.
  • Remove all light-producing appliances from your bedroom, including the TV; if you must have them, choose ones that emit red rather than blue light.
  • Abstain from alcohol in the evening; it may help you fall asleep, but the effects of a cocktail quickly backfire, disrupting sleep cycles a few hours into the night.
  • Run a fan or other non-specific white noise machine in your bedroom to dampen street or other sounds.
  • Avoid caffeine, which disrupts sleep patterns; if you must have a caffeine boost, enjoy it before noon.
  • Do not exercise or eat within three hours of going to bed.

If pain is preventing you from getting a good night sleep, it’s time to see a doctor.

There are a number of treatments available, including medication, physical therapy, and talk therapy. Consider tracking your sleep habits in a sleep journal. This simple tool can give your doctor valuable information about your quality of sleep and how many hours you log each night.

Credit: MedicineNet.com




WebMD Feature, July 12, 2011
By Elizabeth Shimer Bowers
Reviewed By Michael J. Breus, PhD



In our 24/7 society, far too many Americans see sleep as a luxury rather than a necessity. We have no problem spending long hours at work and then adding other activities that can turn a busy day into a positively grinding experience. Something’s got to give, so we delay our mental and physical recharge and skimp on sleep. When we finally do lie down, our busy minds aren’t always so willing to rest.

“Insomnia is a complex condition often caused by a number of factors,” says Qanta Ahmed, MD, a sleep specialist at the Winthrop-University Hospital Sleep Disorders Center in Mineola, N.Y. “Addressing those factors often requires lifestyle and environmental changes.”

No matter what its cause, insomnia is the most common sleep complaint among Americans. According to the National Sleep Foundation, 30% to 40% of adults say they suffer from occasional insomnia. And 10% to 15% of Americans say they have trouble sleeping all the time.

When insomnia strikes, one option is to try prescription sleep aids. But there are a number of other effective natural sleep remedies available to you. Lifestyle changes, as well as foods, supplements, and herbal supplements may help you get restful sleep.

Here are a few to try when you’ve counted your last sheep:

Natural Insomnia Remedies: Foods, Herbs, and Supplements

Melatonin. Melatonin is a hormone that helps regulates the sleep/wake cycle, an internal pacemaker that regulates the timing and our drive for sleep in humans. It causes drowsiness, lowers body temperature, slows metabolic functions, and puts the body into sleep mode.

Research on melatonin in people with insomnia is mixed. One study showed that taking melatonin restored and improved sleep in people with insomnia. Other studies show that melatonin does not help people with insomnia stay asleep. Melatonin is not regulated by the FDA and can have problems with purity. It is only advised for people with circadian rhythm issues, and it should never be given to children or taken by someone on other medications. You should only use melatonin under close supervision by a doctor.

Warm milk. You can put a tasty spin on your grandmother’s natural insomnia remedy by sipping warm milk before bed. Almond milk is an excellent source of calcium, which helps the brain produce melatonin. Plus, warm milk may spark pleasant and relaxing memories of your mother helping you fall asleep.

Sleepy-time snacks. Harris says the best sleep-inducing foods include a combination of protein and carbohydrates. She suggests a light snack of half a banana with a tablespoon of peanut butter or a whole wheat cracker with some cheese. Eat one of these snacks about 30 minutes before hitting the hay.

Magnesium. Magnesium apparently plays a key role in the regulation of sleep. Research has shown that even marginal magnesium deficiency can prevent the brain from settling down at night. One of the most absorbable forms of magnesium is magnesium citrate powder, available in health food stores. Try taking two doses, following label directions, a day, with the second dose right before bed. You can also get magnesium from food. Good sources include green leafy vegetables, wheat germ, pumpkin seeds, and almonds.


Lavender. Research has shown that lavender oil is calming and can help encourage sleep in some people with insomnia. “Try taking a hot bath with lavender oil before bed to relax your body and mind,” Harris says.

Valerian root. The medicinal herb valerian root has been used to treat sleep problems since the time of ancient Rome and Greece. “Valerian can be sedating and may help you fall asleep,” Marks says. Research on the effectiveness of valerian for insomnia are mixed, however. Marks says if you try valerian as a sleep remedy, be patient. It can take a few weeks for its sedating properties to take effect. Talk to your doctor before taking valerian and follow label directions.

L-theanine. An amino acid found in green tea leaves, L-theanine can help combat anxiety that interferes with sleep. A 2007 study showed that L-theanine reduced heart rate and immune responses to stress. L-theanine works by increasing production of the feel-good hormone serotonin. It also induces brain waves that correlate with relaxation. Before taking L-Theanine, talk to your doctor about possible drug interactions.

Natural sleep remedies: Lifestyle changes

The following changes to your lifestyle and environment can also help combat sleep problems:

Turn off the TV.

In some people, night time light can inhibit melatonin and create “social jetlag,” which mimics symptoms of having traveled several time zones. To keep your sleep surroundings as dark as possible, Ahmed recommends moving the TV out of your bedroom and using a DVR or TIVO to record favorite late night shows for later viewing.

Put other appliances to bed, too.

If you want a good, restful sleep, turn your appliances away from your bed. Or better yet, turn them off altogether. If you must use bedroom electronics, choose those illuminated with red light, which is less disturbing to melanin production than blue light.

Give it up.

If you don’t fall asleep within 30 minutes, sleep specialists recommend you get up and leave your bedroom or read. Then return to your bed to sleep when you feel tired again.

Exercise early.

It’s no secret that exercise promotes restful sleep and good overall health. However, a study published in the journal Sleep showed that the amount of exercise and time of day it is done makes a difference. Researchers found that women who exercised at a moderate intensity for at least 30 minutes each morning, seven days a week, had less trouble sleeping than women who exercised less and/or later in the day. Morning exercise seems to affect body rhythms that affect sleep quality.

One of the reasons for this interplay between exercise and sleep may be body temperature. Your body temperature rises during exercise and takes up to 6 hours to drop back down to normal. Because cooler body temperatures are associated with better sleep, it’s important to give your body time to cool off before bed.  


Keep your slumber surroundings tranquil.

Your bedroom should feel like a sanctuary. Piles of clothes thrown on your bed, stacks of bills staring at you, or other random clutter will hamper you emotionally and lead to sleep problems. A tranquil and organized space will help you feel more relaxed. To create the perfect sleep environment, try the following:

  • Wear pajamas to bed. This can be your birthday suit, but it signals your mind that it’s bedtime.
  • Keep your room cool, between 65 and 72 degrees — the optimal temperature range for sleep.
  • Make your room dark. Consider installing room-darkening shades. Or wear eye covers to block light from the street or LED displays.
  • Purchase a good mattress. You spend 1/3 of your life in your bed, so it’s worth the investment.
  • Use a pillow that supports your head and neck. Give the pillow the bend test; if you bend it in half and it stays in position, it’s too floppy.
  • To filter unwanted sounds, use a white noise machine. Your brain still hears things when you sleep.
  • Sleep on breathable linens. They will reduce sweat, body odor, and skin irritation — all of which can disrupt sleep.

Natural sleep remedies can do wonders for the occasional bout of poor sleep. However, they shouldn’t be used for chronic sleep problems, Harris says. If you have insomnia that lasts for a few weeks or more, be sure to consult your doctor.

Credit: MedicineNet.com



An Overview



WebMD Medical Reference, July 12, 2011
Reviewed By Michael J. Breus, PhD



If you have insomnia, you may have trouble falling asleep, staying asleep, waking too early, or getting good quality sleep that leaves you feeling rested. Instead, you don’t feel refreshed when you wake up. During the day, you’re sleepy and tired and have trouble functioning.

Many Americans struggle with sleep problems. In the 2008 National Sleep Foundation poll, 44% of respondents complained that they endured sleep problems almost every night, including difficulty falling asleep, waking during the night, and waking up feeling unrefreshed.

Insomnia can be acute, meaning short-term. Or it can come in a long-lasting, chronic form. When insomnia comes at least three nights a week for one month or longer, doctors consider it chronic.

Insomnia can also come and go, with periods when you have no sleep problems.

Types of Insomnia

Two kinds of insomnia exist:

Primary insomnia: Sleep problems are not directly connected with any other health problem. Instead, major stress, emotional upset, travel, and work schedules can trigger this type of insomnia. Even after such causes go away, the insomnia may persist. You can also develop primary insomnia because of certain habits, such as taking naps or worrying about sleep.

Secondary insomnia: Sleep problems occur because of another issue, such as a health condition or disease, chronic pain from arthritis or headaches, medications, or alcohol, caffeine, and other substances.

What Are the Causes of Insomnia?

Many factors can cause acute or chronic insomnia:

  • Stress (including job change or loss, moving, death of a loved one)
  • Medical condition or disease (including depression, anxiety, post-traumatic stress disorder, asthma, cancer, heartburn, heart failure, overactive thyroid, Alzheimer’s and Parkinson’s disease, and other health problems)
  • Pain or physical discomfort
  • Medications
  • Noise, light or extreme temperatures
  • Interference with one’s regular sleep schedule (including jet lag or switching work shifts)
  • Substance abuse

What Are the Symptoms of Insomnia?

If you have insomnia, you may have some of these symptoms:

  • Difficulty falling asleep
  • Difficulty staying asleep
  • Waking up too early
  • Feeling tired and irritable
  • Daytime sleepiness
  • Mood changes
  • Lack of motivation
  • Attention, concentration, or memory problems
  • Making errors at work, school, or while driving
  • Tension headaches or stomach aches
  • Frustration or worry about sleep

How is Insomnia Diagnosed?

To diagnose insomnia, your doctor will ask about your sleep patterns and habits, stress levels, medical history, level of physical activity, and use of medications, alcohol, caffeine, tobacco, and illegal substances. He or she might also ask you to keep a detailed log of your sleep habits, including sleep and wake times, napping, and any specific problems with sleeping.

Your doctor will also do a physical exam to look for health disorders that can cause insomnia.

If your insomnia persists even after treatment, your doctor may refer you to a sleep disorders specialist for an evaluation. If the specialist suspects a disorder, such as sleep apnea or restless legs syndrome, you may need to do an overnight sleep study at a special sleep center.


How is Insomnia Treated?

If you have short-term insomnia, you may not need treatment. Often, good sleep habits and self-care can cure a mild case.

If you have trouble functioning during the day because of poor sleep, your doctor may prescribe sleeping pills for a few weeks. Commonly used sleep aids include sedatives, minor tranquilizers, and anti-anxiety drugs. Most are safe if a doctor supervises their use. Some sleep aids can become habit-forming or pose the potential for overdose if not used as directed. Newer sleep aids can be taken for longer periods without losing effectiveness.

If you use an over-the-counter sleep aid, take it exactly as directed. An OTC product may help with an occasional sleepless night, but it is inappropriate for chronic insomnia. Chronic insomnia could be a sign of a serious, underlying disorder, so see your doctor. If you decide to try an OTC sleep aid, keep in mind that these products often contain antihistamines, which can cause nervousness, agitation, falls, confusion, urinary difficulties, and daytime sleepiness, especially in older people.

If you have chronic insomnia, getting treatment for any underlying health condition or other problem may help you to sleep better. If you still have insomnia, your doctor may suggest behavioral therapy, which is frequently used when insomnia stems from the mind or body being unable to relax. Behavioral therapy teaches a person how to alter behaviors that worsen insomnia and learn new ways to promote sleep.

Steps to Manage Your Sleepless Nights


Step 1: Make lifestyle changes to improve your sleep.

  • Try not to worry about sleep when you go to bed.
  • Avoid clock-watching. Turn your clock around and use only the alarm.
  • Make your bedroom comfortable for sleep. Keep it dark, quiet, and not too cold or warm. Use a sleeping mask to block light or earplugs or a fan to block noise.
  • Relax before bedtime by reading, listening to relaxing music, bathing, or doing another relaxing activity.
  • Don’t eat a heavy meal late in the day; a light snack before bedtime may help with sleep, though.
  • If you can’t sleep and don’t feel drowsy, avoid lying in bed. Get up and read or do something that’s not stimulating until you feel sleepy.

Step 2: Keep a sleep diary.

If you’ve made lifestyle changes and still have sleep problems, write down in a journal:

  • Time you went to bed
  • Approximate time you fell asleep
  • Time you woke up
  • Number of times you woke up during the night
  • Amount of time you stayed awake during the night
  • Total amount of sleep you log per night
  • Any grogginess upon waking in the morning or during the day
  • Naps and duration
  • Any daytime incidents of dozing off and where it happened
  • Any comments about particular sleep problems or quality of sleep


Step 3: Create an action plan with your doctor.

Share your sleep diary with your doctor. Together you and your doctor will try to address and treat your sleep problem or any underlying cause.



Questions and Answers for Your Doctor



WebMD Medical Reference
Reviewed By Michael J. Breus, PhD


If you have insomnia, good communication between you and your doctor is crucial to helping you to get a better night’s rest. Your doctor will ask about your sleep problems, sleep habits, and medical history, among other things.

Assist your doctor by keeping a sleep diary. That way, you can provide accurate information on how long it takes you to fall asleep, how often you wake up during the night, how much you nap, and other important details.

To get the most from your visit, be sure to ask your own questions about what may be causing your insomnia, as well as treatment options and lifestyle changes.

Questions That Your Doctor May Ask You

  • How often do you have trouble sleeping? How long has the problem lasted?
  • On your work days and days off, when do you go to bed and get up?
  • How long does it take you to fall asleep? How often do you wake up at night, and how long does it take to fall back asleep?
  • How refreshed do you feel when you wake up? How tired are you during the day?
  • How often do you doze off or have trouble staying awake during routine tasks, such as driving?
  • Do you snore loudly and frequently or wake up gasping or feeling out of breath?
  • Do you have any new or ongoing health problems?
  • Do you have any health conditions or injuries that cause pain, such as arthritis?
  • Do you take any over-the-counter or prescription medications?
  • Do you use alcohol, tobacco, caffeine or any other substances?
  • Do you exercise?
  • Do you travel long distances or experience jet lag?
  • Do you have any new or ongoing stresses related to work, personal problems, or any other issue?
  • Do you have any family members with sleep problems?
  • Do you worry about falling asleep, staying asleep, or getting enough sleep?
  • What do you consume (food, drinks, medications) before bedtime? What routine do you follow before going to bed?
  • What are the noise level, lighting, and temperature like in your sleeping area?
  • Do you have any distractions in your bedroom, such as a computer or TV?


Questions to Ask Your Doctor

  • How do I know if I have insomnia?
  • What may be causing my insomnia?
  • How do I know if I’m getting enough good sleep?
  • How can I prevent insomnia?
  • What’s the best treatment for me?
  • How can I manage my other health conditions, along with the insomnia?
  • Do any of my medications put me at higher risk for insomnia? Are there alternatives that are less likely to cause insomnia?
  • Where can I get help with depression, anxiety, or psychological problems?
  • How can I learn to reduce stress?
  • Is behavioral therapy a good option for me?
  • Can sleeping pills or other medications help my insomnia? What are the benefits and side effects of the drugs? Are there any drug interactions to be aware of?
  • Can any complementary or alternative therapies help me?
  • Should I exercise? During what time of day?
  • Are there activities that I should avoid that could disturb my sleep?
  • How can I make my bedroom better for sleeping?
  • Should I stop or limit caffeine, alcohol, or nicotine?
  • How can I get help to quit smoking?
  • Will my sleep improve if I lose weight?
  • Is it all right to nap during the day?
  • Do I need to see a sleep doctor?

These days, medical appointments can be brief. But you and your doctor will have plenty to discuss because so many factors can contribute to insomnia; among them, stress, lifestyle, poor sleep habits, health problems, and medications. Being proactive is important. Come well-prepared for your visit by jotting down your questions and concerns and anticipating the questions that your doctor might ask you. Consider taking notes during the appointment to help you recall any recommendations.



WebMD Feature, July 12, 2011
By Jennifer Soong
Reviewed By Michael J. Breus, PhD



Many Americans suffer from insomnia and commonly turn to prescription medications and over-the-counter sleeping aids for relief. About one in four Americans report taking some type of medication every year to help them sleep.

If you find yourself struggling after a few restless nights of sleep — perhaps trouble falling asleep, repeated awakenings, or waking up feeling tired, you may decide to try over-the-counter sleeping pills or consult your doctor about prescription sleep medications.

But before you do, you should be aware of the different types of over-the-counter and prescription sleeping medications, potential side effects, safety concerns, and alternatives.

OTC vs. Prescription Drugs

The most common agent in over-the-counter sleeping aids is diphenhydramine, an antihistamine. It usually has a relaxing effect that makes you feel drowsy, but it may cause some grogginess the next day. Some popular OTC sleep aids also include pain relievers, which you may not need to take for insomnia or sleep problems.

Although over-the-counter sleep medications are available without prescription and are generally considered safe, you should check with the pharmacist about any potential side effects or adverse drug interactions with other drugs you are taking for other health conditions like high blood pressure.

You should be careful to take them only as directed especially if you’re taking other drugs that also contain antihistamines, like cold or allergy medications. Also, antihistamines can cause confusion in the elderly.

“The over-the-counter stuff can work in a pinch, but it’s generally not good for long-term use,” says Tracey Marks, MD, psychiatrist in Atlanta and author of Master Your Sleep.

If you’re having a sleep problem that lasts a few days, talk to your doctor about your concerns. You may have an underlying health problem, like a sleep disorder or depression.

Depending on the cause of your sleeping problem, he or she may prescribe a sleep medication, which is the most common treatment for insomnia.

One group of sedative-hypnotics is called benzodiazepine agonists, which are divided into benzodiazepines or nonbenzodiazepines. Developed in the 1960s, they carry some risks of addiction. A newer class of sleep drugs, known as gamma-aminobutyric acid (GABA) medication, is thought to be less addictive.

One concern with benzodiazepines, says Marks, is that they may interfere with slow-wave sleep, the kind of deep sleep you need to feel physically restored.

Another group of hypnotics is known as melatonin agonists. They are not a knockout drug, the kind that makes you feel drowsy, says Marks. These compounds work with your circadian rhythm, or body clock, as a sleep maintenance medication taken daily.

Taking prescription sleep medication is only recommended under the close supervision of your doctor. You should discuss all the risks and potential side effects and ask your doctor to review the dosage instructions with you. And remember, you should never take medication prescribed for someone else, even once.


Know the Risks and Side Effects

There are a number of safety concerns regarding prescription sleep drugs. In March 2007, the FDA issued warnings for prescription sleep drugs including Ambien, Lunesta, Rozerem, and Sonata because they may cause allergic reactions, sleep walking, and even sleep driving.

The FDA recommends taking the following precautions when using sleep drugs:

  • Don’t take them with alcohol.
  • Don’t take more than the prescribed dose.
  • Don’t take with other sedating medication.


Getting a Good Night’s Sleep

Most sleeping pills are not designed for long-term use, says Marks. The goal is to get off of them and get at the root of what’s actually interfering with your sleep.

There are other strategies to improve sleep, such as using meditation or exercise to decrease stress. The National Sleep Foundation suggests that sleeping aids are most effective when used in conjunction with other kinds of treatment, such as cognitive behavioral therapy.

Credit: ScienceDaily.com



WebMD Medical Reference
Reviewed By Michael J. Breus, PhD



Have you been tossing and turning at night? Perhaps you’re having trouble falling asleep because you’re lying in bed worrying about work and finances. Or, you wake up in the middle of the night and can’t fall back asleep. Or, you wake up feeling more tired, not refreshed, in the morning and are excessively tired during the day.

You’re certainly not alone if you’re suffering from any of these symptoms of insomnia. Forty-eight percent of Americans report insomnia occasionally, while 22% experience insomnia almost every night, according to a National Sleep Foundation survey.

So, how do you tell if you’ve simply hit a rough patch that will pass, or if you have a chronic sleep problem?

There isn’t a hard number, says Tracey Marks, MD, psychiatrist in Atlanta and author of Master Your Sleep. A good marker is to look at a week or month and add up whether you’ve had trouble sleeping more nights than not.

Acute insomnia, which lasts for a few days, can be connected to a particular event like a work deadline or examination.

Sleep usually gets better when the stressor goes away, says Deirdre Conroy, PhD, clinical assistant professor of psychiatry and clinical director of Behavioral Sleep Medicine Program, University of Michigan in Ann Arbor, Mich.

It’s common to have temporary insomnia, says William Kohler, MD, medical director of Florida Sleep Institute in Spring Hill, Fla. You don’t need to be overly concerned about a couple nights of restless sleep. But if insomnia persists and interferes with your functioning, then it’s time to evaluate the nature of the problem.

Chronic insomnia, which lasts for longer than three weeks, can affect your daytime functioning. You may notice changes in your mood, difficulty concentrating, or decreased productivity.

Identifying a Probable Cause

A lot of times sleep problems are tightly related to mood problems, says Conroy. So you should ask yourself: Has my mood changed? Do I feel more depressed? Am I more irritable than usual?

If you’re prone to worry, anxiety can be making your sleep worse. But sleep problems also develop without any associated mood problems.

Sometimes you can point to a primary stressor like losing a job or worrying about the mortgage. But there doesn’t have to be a particular stressor associated with insomnia. Just worrying about sleep can snowball over time, says Conroy.

Other underlying reasons for insomnia include pain, medications, sleep disorders, and poor sleep habits.

What You Can Do

If you’ve noticed signs of insomnia and the problem has been going on for a few weeks, set up an appointment with your doctor to discuss your sleep concerns. If your doctor suspects an underlying sleep disorder like sleep apnea or restless legs syndrome, he or she may refer you to a sleep specialist.


Keep a sleep log to see if you can identify any patterns to discuss with your doctor. Track when you go to bed, how long it takes you to fall asleep, how many times you awake at night, what time you get up, how you feel when you wake up, and if you take a nap during the day.

Depending on the cause of insomnia, your doctor may prescribe a sleep medication to provide short-term relief. He or she may also refer you to cognitive behavioral therapy techniques and offer strategies to improve your sleep hygiene.

Sleep is important for your overall health and lack of sleep has been shown to contribute to illness, including heart disease.

“We hear so much about diet and exercise,” says Conroy. “Sleep is as important as your nutrition…”

Boost Your Sleep Hygiene

Many Americans have poor sleep habits. Tracey Marks, MD, psychiatrist in Atlanta and author of Master Your Sleep, shares her tips to improve your sleep hygiene:

  • Keep your bedtime the same each night (even on the weekend) for consistency’s sake.
  • Cut out caffeine, cigarettes, and alcohol 4-6 hours before bedtime.
  • Don’t exercise right before bed.
  • Only use your bed for sleep and sex. Don’t bring work or gadgets into bed.
  • Adjust your thermostat to a comfortable temperature, usually 68-74 degrees.
  • Turn the lights off and use eye covers to keep the room dark.
  • If it’s taking more than 30 minutes to fall asleep, don’t stay in bed. Go to another quiet room and engage in relaxing activity until you feel drowsy.
  • If your mind is busy, write down your thoughts on a problem-solving worksheet.

Exercise Helps Some People to Get a Better Sleep
Photo: MedicineNet.com



WebMD Feature, july 12, 2011
By Stephanie English
Reviewed By Michael J. Breus, PhD



You’re wide awake at 2 a.m. and trying to remember the last time you had a good night’s sleep. You remember sleeping well — and a lot — when you were young. Since then, you started working, had children, and perhaps moved into menopause. Having trouble sleeping is just part of getting older, right?

Well, yes and no. How much sleep you need, your ability to get enough sleep, and the quality of your sleep changes a lot throughout your life. But you shouldn’t compromise your sleep habits just because you’re getting older.

General Sleep Needs

“Sleep needs vary from individual to individual, and changes can occur at any stage in the lifespan,” says Michael Vitiello, professor of psychiatry and behavioral sciences at the University of Washington in Seattle. The amount of sleep you need is the number of hours necessary to wake up without an alarm, refreshed and alert.

But many adults find themselves stealing only a few hours of sleep each night during busy work weeks. Is that OK?

“A big myth is that people can learn to adapt to only five or six hours of sleep and they’re functioning ‘fine,’” says Donna Arand, PhD, clinical director of the Kettering Sleep Disorder Center in Dayton, Ohio and a spokeswoman for the American Academy of Sleep Medicine. “People aren’t functioning fine with five or six hours of sleep. You really don’t adapt to that. Most adults need between seven and eight hours of sleep.”

It’s not clear yet whether adults 65 years and older need seven to eight hours of sleep. One poll found that seniors felt like they needed more sleep than that. There’s no evidence that older people can function well on less, but some recent studies indicate that they might.

“There is probably a small reduction in total sleep time that occurs across the lifespan,” Vitiello says. “Most of that probably occurs after puberty and by retirement age, say in the 60s. If you make it into your 60s or 70s and you stay healthy, your sleep probably doesn’t change as much.”

Are you getting the sleep you need? You might require more sleep if you:

  • Need a stimulant like coffee to wake up or get going
  • Feel down, irritable, or tense after not getting enough sleep
  • Have poor short-term memory
  • Have a hard time staying focused and productive after you’ve been sitting for awhile

What Affects Your Need for Sleep

In addition to age, your sleep needs change due to:

  • Gender
  • Genetics
  • Internal clock (circadian rhythm)
  • Quality of sleep
  • Recent lack of sleep

Gender. Women undergo more sleep changes and challenges than men because of their reproductive hormones. Women who are pregnant need more sleep in the first trimester. Pregnant women also struggle to get enough sleep because of heartburn, snoring, and uncomfortable sleep positions. Arand says that once women become mothers, they tend to have problems sleeping because their children wake them up or cause them to worry.



What Affects Your Need for Sleep

Later in life, as women enter menopause, they face new sleep challenges. These come from drops in hormone levels, hot flashes, night sweats, and insomnia. “Women tend to report difficulty with insomnia more than men,” Arand says. “We don’t know if it’s a social issue or if women are more willing to report it than men.”

Genetics. Genes may play a role in some sleep disorders, such as narcolepsy and insomnia. There hasn’t been enough research to know how your family tree affects your sleep. Arand thinks that the treatments for sleep problems will work despite any genetic flaws.

Biological clock. Each of us has an internal clock, which makes some people “night owls” or “early birds.” A process in the brain called circadian rhythm controls this. This process influences when we wake up and go to sleep. It also determines how sleepy and alert we are. (It’s because of teenagers’ circadian rhythms that they’re geared to stay up later and to wake up later.)

Our internal clock makes us drowsy naturally between midnight and 7 a.m. and between 1 p.m. and 4 p.m. [As people age, changes in circadian rhythm eventually make older people feel sleepy earlier in the evening and wake up earlier in the morning.

Quality of sleep. The type of sleep people get changes most between ages 19 and 60. Children and teens experience a lot of deep sleep, which is believed to restore the body. This also fuels their growth. Arand says that children spend about 50% of their night in deep sleep. By the time they’re 20 years old they get half that amount. She said some people as young as 40 may lose the ability to go into that restorative sleep. Older people spend little time in that sleep stage. As a result, they are more easily awakened.

The most obvious change in sleep to older people is how light their sleep becomes. They also notice how broken up sleep is because of waking during the night and staying awake awhile before going back to sleep. Half of seniors complain of these changes as well as waking early in the morning and feeling sleepy during the day. “The problem for this age group is that it’s very difficult to get an uninterrupted seven to eight hours of sleep,” Arand says.

Recent lack of sleep. If you haven’t been sleeping well or have had insomnia, the lack of sleep affects how much sleep you need. If you’re over 65, the chance for poor sleep and insomnia is high. “The older people get, the more common insomnia becomes,” Arand says. A National Sleep Foundation poll found that 44% of older people had at least one symptom of insomnia two or more nights a week.


Sleep Challenges for Older Adults

Seniors have certain sleep changes due to aging, but sleep problems aren’t part of getting older. Vitiello says the key for better sleep when you’re older is staying healthy. Most seniors’ sleep problems are because of an illness or a medication. Seniors have poor sleep due to:

  • Illness, such as arthritis or another condition that causes pain, heart or lung disease, enlarged prostate, acid reflux, or depression. In people aged 65 to 84, 20% have four or more medical conditions. Eighty percent of them say they have problems sleeping.
  • Medications, especially those for high blood pressure and asthma.
  • Sleep disorders such as insomnia, sleep apnea, or restless legs syndrome.
  • Behavioral or social changes: retirement, lifestyle change, death of a loved one, napping, using social drugs.
  • Sleep environment: Noise, heat, bright lighting, or bothersome bedding in the bedroom; moving to a new home or a nursing home.

An older person in excellent health will still probably have a harder time falling asleep and staying asleep than when they were younger. Otherwise, they can expect to sleep fairly well. Vitiello studies older adults in good physical and mental health. “None of them sleep the same as they did when they were 18. I know that their sleep is radically different than younger people’s,” he says. Yet most of the healthy aging group has no sleep complaints.

Meeting Your Sleep Need

For older people with health problems, napping during the day may be the only way to get enough sleep because their sleep at night may be disrupted. For healthy older adults, napping isn’t a great idea. It might make falling asleep or staying asleep at night more difficult.

Vitiello says people assume all older people nap because of their age. “While napping does increase with age, it never penetrates more than one third of the population – even out into the 80s,” he says.

If you have a medical condition and have trouble sleeping, tell your doctor. Your doctor can determine whether you have a sleep disorder, such as insomnia, or if your health condition or other medical treatment is affecting your sleep. For example, if one of your medications makes you sleepy during the day, talk to your doctor about changing the time you take it. Or ask if there’s a different medication that would work. (Never change your medication without talking to your doctor.)

Know the Basics

At any age, good sleep habits are important for quality sleep. These include sticking to a regular bedtime, having little or no caffeine, and sleeping in a cool, dark, comfortable room.

“Probably around age 60 or so, adults really need to be careful about having good sleep hygiene and watching side effects of medication, what they’re eating and drinking in terms of stimulating beverages or foods,” Arand says.

Arand and Vitiello agree that staying physically and mentally active is vital for a good night’s sleep. “After the age of 40, or especially after the age of 60, individuals who are very physically active can tend to sleep deeper and have better quality sleep at night than individuals who may not be very active,” Arand says.


Kick Insomnia Out of Bed

If you’ve had difficulty sleeping for more than a month, the problem has become chronic.  Be sure to tell your doctor, who may refer you to a sleep clinic. If you have insomnia, you need to act. It usually doesn’t go away on its own.

You may not have realized all the changes that can affect your sleep. Now that you know what to expect, you can work on getting the best sleep possible.

Some doctors say, “Don’t Nap”

Photo: MedicineNet.com



WebMD Medical Reference
Reviewed By Michael J. Breus, PhD


Most people know the dangers of drinking and driving, but think nothing of getting behind the wheel after a sleepless night.  The daytime effect of no sleep can hinder your driving skills to the point where you’re impaired the same as if you’ve had too much to drink.

According to experts, chronic insomnia affects one in 10 people. And while insomnia can affect your safety and the quality of life during the hours you’re awake, it can also increase your risk for a variety of other health problems.  In addition to causing daytime fatigue, insomnia increases your risk for other health problems, including:

  • Heart disease
  • High blood pressure
  • Infections
  • Obesity
  • Diabetes
  • Depression
  • Pain
  • Intestinal problems
  • Early death

People with insomnia are twice as likely as well-rested people to have a car crash due to fatigue. They’re eight times more likely to have an accident at work. If they have an injury, insomnia can slow their recovery. In addition, people with insomnia are more likely to:

  • Miss work
  • Make bad decisions
  • Take more risks
  • Have trouble concentrating
  • Be irritable
  • Be depressed
  • Eat foods high in calories


You Don’t Know What You’re Missing

Sleep affects our ability to think, react, remember, and solve problems. One study showed that people who slept six hours or fewer at night for two weeks did just as poorly on mental tests as people who hadn’t slept at all for two nights.  The catch is that we may develop some tolerance to lack of sleep and aren’t aware how much our alertness and performance is really suffering.

“Fatigue” vs. “Sleepiness”

It’s important to distinguish insomnia-related daytime fatigue from excessive daytime sleepiness (EDS).  The terms are often used interchangeably, even among medical researchers. There are distinct differences, however.

People with EDS feel very drowsy during the day. They’ll typically fall asleep during the day if they’re in a boring or sedentary situation. They might fall asleep while stopped at a stoplight or sitting in a waiting room. EDS is usually caused by sleep apnea, sedatives, or narcolepsy.

People with daytime fatigue don’t fall asleep during the day, but they are very tired. They struggle to get through a normal day’s activities. Symptoms of daytime fatigue include:

  • Weariness, weakness, and/or depleted energy
  • Lack of motivation
  • Poor performance
  • Memory problems
  • Lack of productivity
  • Prone to errors and mistakes
  • Depression
  • Low interest in being social

Fatigue is a more accurate description of what people with insomnia experience. Although they’re sleep deprived, they tend to feel more tired than sleepy. If you have insomnia, you might find it hard to nap. People with insomnia usually see a doctor because of fatigue and poor daytime functioning, not because they have trouble falling or staying asleep.

Put Fatigue to Bed

Your first step to getting rid of daytime fatigue is to figure out what’s causing it. In addition to insomnia, many other health problems can cause fatigue. These include other sleep disorders, diabetes, arthritis, asthma, and chronic fatigue syndrome.

Fatigue is also a side effect of certain medications. Make an appointment with your doctor so that he or she can assess your symptoms. If you have trouble going to sleep or staying asleep, tell the doctor. There are effective treatments for insomnia including cognitive behavioral therapy and medication. These can greatly improve how you feel and function during the day.