Sleeping Well
2:45 am
Mon December 16, 2013

Healthful Habits Can Help Induce Sleep Without The Pills

Originally published on Mon December 16, 2013 3:23 pm

About one-third of American adults say they have problems falling asleep. And prescriptions for sleeping medications are on the rise, with about 4 percent of people using the drugs, according to the Centers for Disease Control and Prevention.

But sleep specialists say people should exercise caution before deciding to take medication to help them sleep.

Take the case of Nancy Sherman, a woman in her 60s who lives in Seattle. Sleepless nights started about four years ago when she lived directly above an "end of the line" bus stop. "The buses would leave their motors on all night long, and I developed insomnia just listening to all that noise," she says. Dozens of emails to officials didn't help. So Sherman went to see her doctor, who prescribed the most popular prescription sleep medication, zolpidem.

Sherman started taking the pill, which is sold as Ambien, Sublinox and other brand names. The first night, she fell asleep at her computer, waking up with her hands still on the keyboard.

The second night, she awoke in the morning to a pile of potato chips strewn across her bed. "I must have gotten up and eaten a whole bunch of potato chips," she says. "I had no recollection of that at all."

But most bizarre of all was the night when she appears to have cooked in her sleep. "I woke up the next morning and came into my kitchen, and my kitchen was absolutely full of dishes, pots, pans, sour cream, hot sauce, jalapeno peppers, grated cheddar cheese. I'd had this Mexican food bonanza, apparently."

Sherman says she's willing to put up with these experiences in order to get a good night's sleep. And sleep experts say they're rare. But sleeping pills can act quickly and unpredictably.

"I tell everybody that I prescribe a sleeping pill to that they should take it in bed," says Dr. John Winkelman, a psychiatrist in the sleep disorders clinical research program at Massachusetts General Hospital in Boston. "Why? Because if they are doing a load of laundry or if they're on email and the medicine abruptly takes effect, and they may not even recognize it at the time. Then they could act in ways that they'll regret afterward."

Most sleep medications work by binding to receptors in charge of thinking. So cognition is slowed, coordination interfered with and memory impaired. The medication is "working in all different parts of the brain, in many different systems and in particular on the system that is most important for inhibition," says Winkelman.

Health officials also worry that medication levels can remain high enough in the blood that people can have trouble driving the next morning. Earlier this year, the Food and Drug Administration ordered companies that make zolpidem to cut the recommended dose for women in half because they metabolize the medication more slowly than men and it stays in their bodies longer.

While there's no evidence that sleeping pills are addictive, Winkelman says people can become psychologically dependent on them. "They weren't sleeping before they started it, and now they can sleep with it, and they start to rely on this idea of reliable sleep," he says.

That's what happened to Lori Peters, a woman in her 40s who lives in Thousand Oaks, Calif. She was under a lot of stress, couldn't sleep and started taking zolpidem. But she soon felt she was relying on it too much. "I didn't want to be taking anything, quite honestly. I just wanted to be able to fall asleep. My husband says 'good night' and he's gone. I'm like 'aarrgggh — I can't believe you!' "

Peters stopped taking sleeping pills and started changing her habits. She stopped eating late in the evening. And she decided on a fairly rigid bedtime.

"My husband and I go to sleep pretty much the same time every night, and we wake up at the same time every morning, even on weekends," she says. "We try to have a rhythm." That means getting up at 5 a.m., when they enjoy getting out to exercise and walk the dogs.

Peters also turns off her computer a couple of hours before bedtime. She doesn't want the extra stimulation and opts instead to read. "I find reading is really relaxing for me," she says. "It helps me stop twisting things around in my mind."

In the end, Peters achieved her goal; she's sleeping well without medication. And it turns out that the changes she made are exactly what sleep experts recommend: a routine bedtime that cues the body when it's time to sleep.

"We want [people] to have a cool, dark, quiet sleep environment," says Dr. Nathaniel Watson, a neurologist and co-director of the University of Washington Medicine Sleep Center in Seattle. He's also an official with the American Academy of Sleep Medicine. "We want it to be devoid of screens. No televisions, computers, things like that."

People should have regular sleep and wake times on weekdays and weekends, Watson says. "Having a rhythmicity to sleep and wake patterns is crucial to having healthy sleep."

And healthful sleep is critical for both physical and mental health. That's why sleep experts recommend people consult with their doctor and weigh the risks and benefits of sleep medication.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

LINDA WERTHEIMER, HOST:

This is MORNING EDITION from NPR News. I'm Linda Wertheimer.

DAVID GREENE, HOST:

And I'm David Greene.

Today in Your Health, as many of you are just waking up, we're focusing on a good night's sleep. In a moment, the importance of regular sleep schedules for kids. First, about a third of American adults say they have trouble getting shut-eye. And prescriptions for sleeping medications are on the rise. But experts say patients should exercise a lot of caution before taking these pills.

Here's NPR's Patti Neighmond.

PATTI NEIGHMOND, BYLINE: For Nancy Sherman, sleepless nights started about four years ago, when she lived directly above an end-of-the-line bus stop.

NANCY SHERMAN: And the buses would leave their motors on all night long and I developed insomnia just listening to all that noise.

NEIGHMOND: Dozens of e-mails to Metro officials didn't help. So Sherman went to see her doctor who prescribed the most popular sleep medication, zolpidem. She started taking the pill. And then one night she had a bizarre experience.

SHERMAN: I woke up the next morning and I came into my kitchen and my kitchen was absolutely full of dishes and pots and pans; sour cream, hot sauce, jalapeno peppers, grated cheddar cheese. I mean, I'd had this Mexican food bonanza apparently, and just must have eaten it and then gone to bed.

NEIGHMOND: Sherman is not alone. There have been reports of people cooking, eating, texting, even driving their cars while in a sort of nether-land after taking zolpidem. Even so, there are no scientific studies showing these experiences are common. In fact, experts agree they're rare. The problem for Sherman could have been when she took her pill. She was working on her computer.

Psychiatrist John Winkelman heads the Sleep Disorders Research Program at Massachusetts General Hospital.

JOHN WINKELMAN: I tell everybody that I prescribe a sleeping pill to that they should take it in bed. Why? Because if they are doing a load of laundry or if they're on e-mail and the medicine abruptly takes effect - and they may not even recognize it at the time - they could act in ways that they'll regret afterwards.

NEIGHMOND: Like using the stove, leaving the house, or saying something in an e-mail they wouldn't normally say.

WINKELMAN: This is because their brain is not working well, because it's under the influence of this medication that's working in all different parts of their brain. And in particular, on the system that is the most important for inhibition.

NEIGHMOND: Sleep medications sedate the brain by binding to receptors in charge of thinking; so cognition is slowed, co-ordination interfered with and memory impaired. And health officials worry people can wake up still sleepy. In fact, the FDA recently required companies that make zolpidem to cut the recommended dose for women in half because they metabolize the medication more slowly than men and it stays in their bodies longer.

While there's no evidence sleeping pills are addictive, Winkelman says people can become dependent on them.

WINKELMAN: They weren't sleeping before they started it. And now they can sleep with it and they start to rely on this idea of reliable sleep.

NEIGHMOND: That's what happened to Lori Peters. She was under a lot of stress, couldn't sleep and started taking zolpidem. But she felt she was relying on it too much. She made changes to help her get to sleep naturally. She stopped eating late in the evening and decided on a fairly rigid bed time.

LORI PETERS: My husband and I go to sleep pretty much the same time every night. And we wake up at the same time every morning, even on the weekends.

NEIGHMOND: Peters also turns off her computer a couple of hours before bedtime.

PETERS: I read. I find reading is really relaxing for me.

NEIGHMOND: Peters achieved her goal. Today, she's sleeping well without medication. And the changes she made are exactly what sleep experts recommend. A routine bedtime that cues the body when its time to sleep.

Dr. Nathaniel Watson is a sleep specialist and official with the American Academy of Sleep Medicine.

NATHANIEL WATSON: We want them to have a cool, dark, quiet sleep environment. We want it to be devoid of screens. So no televisions or computers or things like that. You know, we want people to have a regular bedtime and wake time, on weekdays and weekends. Having a rhythmicity to sleep and wake patterns is crucial to having healthy sleep.

NEIGHMOND: And a healthy sleep is critical for both physical and mental health. That's why sleep experts recommend people consult with their doctor and weigh the risks and benefits of sleep medication.

Patti Neighmond, NPR News. Transcript provided by NPR, Copyright NPR.