From Trouble Sleeping?
Sleeping pills have become a way of life for an amazing number of women trying to survive and compete in today's world. Whether they're overworked short-order cooks with a family of five to support, Bluetooth-enabled businesswomen with the responsibility for multimillion-dollar companies, critical-care nurses in high-tech hospitals with patients' lives on the line, or graphic artists working an extra shift at the local grocery store to put their kids through college, the fact is that women are working harder than they ever have before. Unfortunately, sleep is one of those things that often doesn't get with the program.The trouble is, since there are so many sleep aids available -- benzodiazepines, non-benzodiazepines, melatonin agonists, and even antidepressants and antihistamines -- each with its own level of potency and side effects, it's important to find which one is best for you.
"Sleep meds can be quite beneficial," says Lawrence J. Epstein, M.D., recent president of the American Academy of Sleep Medicine, author of The Harvard Medical School Guide to a Good Night's Sleep, and medical director of the Harvard-affiliated Sleep HealthCenters. "They tend to be most helpful in people with short-term problems."
Your mother dies, you get fired from a job, you're going through a nasty divorce -- that's where they can help. Just for a night or two until you get on a more even keel. Unfortunately, that's not how most of us use them. Studies show that most people who take sleeping pills take them for two years. And a full third take them for five.
"People want a quick fix rather than a true fix," explains Dr. Epstein. Sleep hygiene strategies, like getting to bed at the same time every night, getting up at the same time every day, and only staying in bed while you're asleep are powerful. And studies show that cognitive behavioral therapy (CBT) is just as effective as a pill -- plus its effects last a lot longer.
"But CBT needs a commitment," says Dr. Epstein. To a series of meetings. To a series of lifestyle changes. And people don't want to do either.
"The hardest thing in medicine is to get someone to make a lifestyle change," he admits ruefully. But the thing is, you have to do it. "If no one else is going to bed or everyone else is going out dancing, you have to say, 'My biological clock says I need to sleep.' "
In a study of 277 teens, researchers found that 14.9 percent of kids ages 13 to 17 have used sleep meds at least once.
How to Use Sleep Meds Effectively
The four most important things for you -- and your doctor -- to know about a sleep medication is how quickly it starts to work, how long it lasts, what side effects it has, and whether or not it interacts with any other medication you may be taking.If you have trouble falling asleep, any medication you use should work fast and dissipate quickly, says Dr. Epstein. If you have trouble staying asleep or waking at the crack of dawn, any medication you use should last through the night, but not so long that you wake up groggy.
Benzodiazepines. That said, the sleep meds that are the most thoroughly tested and are the best tolerated belong to a family of chemicals called benzodiazepines, says Dr. Epstein. They basically knock you out, and some also reduce anxiety and seizures.
Non-benzodiazepines. A second group of sleep meds are the non-benzodiazepines. They're the new kids on the block that are advertised every third minute on American television -- Ambien, Lunesta, and Sonata. They work quickly to get you to sleep and don't last very long.
Melatonin. A third group, the newest, are the melatonin agonists. Only one is FDA-approved for sale in the United States so far, but more are on the way. The one that's been approved -- Rozerem -- works quickly, doesn't hang around, and the sedating effect is pretty mild. Essentially, it allows you to shift your biological clock. There's also over-the-counter melatonin, adds Dr. Epstein, but there's little information about its safety. Since it's an over-the-counter drug, its effectiveness and quality are not regulated by the FDA.