Non-drug strategies work best for insomnia

ASK DOCTOR K

By Anthony L. Komaroff, M.D.

DEAR DOCTOR K: I am 70 and have always had sleep prob­lems. I’ve started to take a pre­scrip­tion non­ben­zo­di­azepine sleep­ing pill every night. It’s work­ing very well. Is it OK if I keep on tak­ing it?

DEAR READER: To answer your ques­tion, I con­sulted with my col­league, geri­a­tri­cian Suzanne Sala­mon. She told me that she is reluc­tant to pre­scribe sleep­ing pills to her older patients. They lead to day­time grog­gi­ness and may con­tribute to cog­ni­tive prob­lems, poor bal­ance and falls.

The type of sleep­ing pills you men­tioned include Ambien (zolpi­dem), Sonata (zale­plon) and Lunesta (eszopi­clone). These drugs are effec­tive, par­tic­u­larly in help­ing you fall asleep.

But many peo­ple are like you: Once they start tak­ing the med­ica­tion, they don’t want to give it up. How­ever, these sleep­ing pills are not sup­posed to be used long term. Smaller doses even­tu­ally become less effec­tive, so peo­ple have to go to a higher dose. That’s when the side effects really become appar­ent, espe­cially in older people.

There are sev­eral non-drug strate­gies you can try to help improve your sleep. They really work, as well as or bet­ter than sleep­ing pills. I sug­gest that my patients of any age try them, par­tic­u­larly peo­ple older than 65 who are more likely to have side effects from pills.

One strat­egy is called “recon­di­tion­ing.” My col­league, sleep expert Dr. Lawrence Epstein, describes recon­di­tion­ing in his excel­lent book “The Har­vard Med­ical School Guide to a Good Night’s Sleep.” (To learn about the book, go to www.AskDoctorK.com.) Dr. Epstein divides recon­di­tion­ing into six parts:

— Go to bed only when you’re sleepy.

— Use the bed only for sleep­ing or sex. Don’t read, watch TV, eat or lie there worrying.

— If you can’t fall asleep quickly, get out of bed, go into another room and stay up until you’re sleepy, and then return to bed.

— If you still can’t fall asleep, repeat step 3 as often as nec­es­sary through­out the night.

— Set your alarm to get up at the same time every morn­ing, regard­less of how much sleep you got dur­ing the night.

— Don’t nap dur­ing the day.

This recon­di­tion­ing pro­gram may cause you to be pretty tired for the first sev­eral days, but you’ll find that it will “reset your sleep clock” and cause you to fall asleep faster, stay asleep and get more hours of sleep at night.

Two other hints: First, caf­feine inter­feres with sleep for 12 hours after you drink it. So con­sume lit­tle, or none, after noon. Sec­ond, don’t use alco­hol as a “night­cap”: It does make you sleepy, so you fall asleep more eas­ily, but it acts as a stim­u­lant after sev­eral hours and causes you to awaken repeat­edly dur­ing the night.

I’m not say­ing never take sleep­ing pills. On occa­sion, I use them myself. Pre­scrip­tion sleep med­ica­tions can be use­ful, but they should be used at the low­est dose and for the short­est pos­si­ble time. More nat­ural meth­ods, like the sleep recon­di­tion­ing pro­gram described above, are at least as effec­tive as pills, and don’t have the side effects that unfor­tu­nately are fairly com­mon in peo­ple your age.

(Dr. Komaroff is a physi­cian and pro­fes­sor at Har­vard Med­ical School. Go to his web­site to send ques­tions and get addi­tional information.)

Posted by Guest 1 Columnist on Apr 18 2012. You can follow any responses to this entry through the RSS Feed. Both comments and pings are currently closed.