ambien

I Know You Can't Sleep But Its Not Insomnia!

The word "insomnia" has become so ingrained in language and culture that even medical professionals have a difficult time telling the difference between what truly is insomnia and what is not. I have known many patients who came in to see me for insomnia that they have apparently had for many years, and treated often with multiple medications, but a short discussion later, they reveal the real problem.

The inability to fall asleep, stay asleep or wake up too early leading to the effects of insufficient sleep is defined as insomnia, and for it to be a medical diagnosis as a health disorder it is usually required to be of sufficient duration of at least a month. An individual with insomnia is unable to get sufficient sleep no matter what. Of course the word sufficient means the amount of sleep required by a person's body in order to feel fully rested. That number can also considerably vary by individual ranging from five to ten hours per day for an adult.

Herein lies the issue: First, how much sleep do you think you need, and are you really unable to sleep that much? Second, really, given the opportunity, can you really not get the amount of sleep you truly need? The differentiation is vital because it leads to the type of treatment that is most likely to help.

Many people have been stuck in a bad sleep routine for so long they have no idea how much sleep they need in a day. Young parents and middle age workers being a prime example of busy lives and responsibilities, find a short amount of time late in the evening to be by themselves to unwind from the day. They end up going to sleep late, wake up tired the next day and struggle through the day. They don't have insomnia. Send them on a vacation and they do just fine. In the busyness of life they often lose sight of how much sleep is necessary for them to feel charged up and function at their best, leading to excessive caffeine use.

Young adults and teens often report they can not fall asleep at a reasonable time, but given the chance they will sleep in, sometimes all day, to obtain the full amount of restful sleep they need. They stay up late and have to wake up early, struggling to make it to classes, then sleep till very late on weekends. They don't have insomnia. Given the opprtunity they sleep well and enough.

Retirees most often end up sleeping in fragments. My own mother for example, an eighty year old, has forever complained of not being able to sleep well at night. She falls asleep around ten, to wake up at two, then sleeps from four till about six. She will wake up, eat breakfast, then nap for an hour, spend a few hours sitting around then nap again for a couple of hours. The fragmentation of sleep, which is common biologically in the elderly anyway, gives the impression as if they have insomnia but in fact they are getting the amount of sleep they need, but only in fragments.

By any means, my implication is not that these are not real problems of real people. My point is that to solve these problems the answer is not in a prescription of Ambien or trazodone. And the argument here is not that these are bad medicines, but that it is the wrong answer simply because it does not address the real problem.

We shall continue this discussion.

 

Sehatu Sleep Granite Bay CADeep Relaxation Training at Sehatu Sleep, designed with sleep medicine and psychology principles, empowers people by giving them skills to turn the mind switch on and off on command and to relax when needed. Classes can be attended via Skype.

Sehatu Sleep and Yoga Studio, located in Granite Bay, CA,  also provides a variety of Yoga classes, including Yin, Gentle and Restorative Yoga, as well as Meditation classes, for individuals who are interested in practicing a healthy lifestyle at any age, starting at any time in their life at any skill level. 

 

The Magic of Melatonin! (Requires a Magic Wand)

People looking for over the counter sleep aids often find melatonin along side other supplements. Since it is easily available, considered a supplement and not a medicine, there is plenty of incentive to at least try it. There are dozens of melatonin products on the market, freely available at supermarkets, pharmacies, health food stores and online. People take it in increasing doses (I have known people to take as much as 15 mg in one night), combine it with Benadryl products or alcohol, with various vitamins and in combination with various herbal preparations. It may make you briefly drowsy. It may seem to help you fall asleep for a few days. Unfortunately, that's about it. So what about the magic?

The magic wand you need to unleash the powerful magic of melatonin is to know the science behind what the substance is and how it works, and most importantly what it works for. Melatonin works fantastically well for people with "delayed sleep phase syndrome", a medical term describing the inability to fall asleep at a socially acceptable time and wake up at a socially acceptable time in order to be productive. It is a very common sleep problem often misdiagnosed as insomnia. It is more common in adolescents, and in creative people, musicians and artists; and often runs in families.

These people are fully capable of getting sufficient sleep but end up not getting enough because they don't get sleepy until later in the night and have to wake up early to go to school or work. If they could sleep in every day and work started later in the day they would be fine.

If melatonin is taken in the smallest amount available, it works best. Take more and you will likely be groggy when you wake up. It should be taken no earlier than 8 hours after naturally waking up, and about an hour before intended bed time. The product has to come from a reliable manufacturer since no one is effectively regulating the quality of the product.

Most of all, if you expose yourself to bright sources of light after taking melatonin you will cancel out its effects. These bright sources include all kinds of handheld and electronic device screens that emit light. Its effect will also be reduced if you activate your mind, get busy thinking, worrying or performing mental tasks.

Lots of caveats, true. But the potion's magic has the potential to change countless lives, provided it is used properly, with wisdom and knowledge. It is typically inexpensive and works much better than sleeping pills, for the person with "delayed sleep phase". For everyone else, unless your sleep physician specifically recommended it, you are probably wasting your money.

 

Which one works best for insomnia: Ambien, Lunesta, Sonata ..... or a golf club?

 

 

"There is no difference between taking a sleeping pill or asking someone to club you on the head"

The inability to fall or stay asleep, or waking up too early and then feeling the effects of sleep deprivation is commonly termed insomnia. The cost of insomnia to the US economy is estimated at over $35 billion each year. There are many types and many causes of insomnia. The commonest problem by far, is a state of mind called "hyper arousal" in which the person feels their mind continues to work and be active, even if they are not worried about anything. The problem tends to run in families, affects millions of people and affects smart people more, should that be consolation to some.

Since doctors have few tools to work with besides medicine, they tend to offer their patients the least addictive of the sleeping pills they know of, but end up in a wild goose chase of changing doses, managing side effects and development of tolerance to the sleep inducing effects. The pharmaceutical industry has also found insomnia therapy to be a major money maker. Ambien, also known by its generic name Zolpidem is one of the most commonly prescribed sleeping pills. The ever present Lunesta commercial on TV has inspired many comedy show spoofs. Trazodone has been used for many years. Ativan, Valium, Seroquel, Risperdal, Restoril; there are so many . Never mind the dozens of so called "natural" remedies, supplements (a chemical is a chemical, call it natural or pharmaceutical), gadgets, even iphone apps. None of these however address the issue of hyper arousal of the mind or do so ineffectively over the long term.

Research has shown over and over that sleeping pills i.e. "clubbing your head", works for short periods of time only. Cognitive behavior therapy, relaxation training, stress management techniques including yoga and meditation work better, and work long term. The problem so far has been that trained therapists are hard to find and even harder to make health insurance companies pay for it.

Uniquely, Sehatu Sleep, a small start up company in Northern California, has taken up this challenge. They offer on site and online, "Deep Relaxation Training" to empower insomniacs, to calm their minds and get restful sleep. No chemicals, no gadgets, no gimmicks. This, is what we need, not clubs on our heads!