In my office, people who are taking many sleep medications for long-term use often come in looking for alternatives. In naturopathic practice there is a place for medications in the ‘Therapeutic Order.’ In naturopathic medicine the ‘least force’ treatment is used which will be effective. For instance, behavioral medicine will be used for insomnia first. Of course, behavioral strategies may not work for each person, so then herbal or nutrient therapy may be used next, and then pharmaceuticals.
Recently a person came in who had been using a combination of four sleep medications over the last 10 years. He had been alternating the medications on his own schedule as they became ineffective, and to avoid the need to increase dosage. Here was his regimen:
Alprazolam (Xanax) at 4am at his early am wakening to get another 3 hours of sleep. Alprazolam is a benzodiazepine hypnotic. Side effects include an increase in depression. When stopping the medication rebound insomnia can occur. Most of the hypnotics should not be taken with alcohol.
Zolpidem (Ambien) or Eszopiclone (Lunesta) Both are non-benzodiazepine hypnotics. Ambien is long-lasting, and people should be sure to have a full 7-8 hours in bed after taking it. Lunesta is one of the few medications approved for use on long-term basis.
Clonazepam (Klonopin) which is a long-acting benzodiazepine.
Even with these medications he was having interrupted sleep and found his sleep to be unrestful.
Our approach was to first use behavioral strategies to make his sleep robust and restful. Once he was sleeping well, we designed a schedule in collaboration with his PCP to taper down off the medications slowly. In this way we were able to avoid rebound insomnia and other withdrawal symptoms.
So, if you are struggling with insomnia, use the ‘least force’ treatment strategy that will solve your sleep problem. If you are recommended a sleep prescription, find out how long that medication can be safely used, any drug interactions to be aware of, and the typical withdrawal symptoms.
Pretty regularly, women who are desperate for sleep come to me. These women say things like “I’m losing it,” “I’m going to go insane if I don’t get some sleep” or “I can’t take this anymore.”
Most of them are mothers whose sleep is being regularly disrupted by their children. You may think of mothers with infants or toddlers, but this isn’t always the case. Just last week it was a mom of 3 tweens who was being interrupted in the night, and felt completely frazzled because of it.
If this is describes you, or someone close to you – Take It Seriously! When people are so sleep deprived that they are “desperate for sleep” they need help, and soon. Professional sleep help may be needed, however, sometimes a few nights for a ‘Sleep Holiday’ can do wonders.
What do I mean by ‘Sleep Holiday?’ Arrange a few (2-3) nights when the mom can sleep completely uninterrupted. This can make a huge difference helping her feel more emotionally calm, rested, and better able to problem solve and stick to a plan to help her children sleep more independently. (Note – although it’s typically mothers who I see in this situation, it could easily be fathers, or anytone in the position of caregiving in the night).
For those 2-3 nights, arrange for the mother and children to sleep in different places – assign mom the guest room on another floor, better yet, have the children go to grandmas, or mom to go sleep at a hotel or a quiet friends house. The mother should go to bed at her earliest usual time, and sleep until she is done, without an alarm. Do all the things we’ve talked about to make the bedroom an ideal place to sleep, and turn off all phones and alarms.
For mothers who are breastfeeding, it may not be possible to have such long breaks from night-time caregiving, but is just as important. Figure out a strategy that will work for your family to get mom some long periods of uninterrupted sleep. Possibly mom can do the first feeding of the night, then dad can give a bottle later in the night. Even just using this strategy on weekends will result in a better rested mom.
Again, if you or your loved one is feeling ‘desperate for sleep’ take it seriously, and make a plan for them to have a ‘Sleep Holiday’ with less interruptions immediately, starting tonight.
Sadly, my special grandma died Friday night. I will miss her, and remember all the great times we had, and the things she taught me over the years.
Having learned on Saturday morning about her passing, it was on my mind as I settled in to sleep Saturday night. My thoughts were on Grandma, flitting from one memory to another, I was upset. So it took a long time to fall asleep, then I was in and out of sleep through the night, disturbed by the high winds, thinking about the next days’ activities, and even wondering what time it was, if it was time to get up.
This was acute insomnia, which is really typical when people have some type of life-event. Fortunately, I have a long history of robust sleep, so this one night won’t throw me off. On the other hand, for people who have recovered from chronic insomnia, even an understandable acute insomnia in response to an identified stressor can bring up worries about their sleep. That worry about sleep makes sleep more elusive, and can trigger another episode of chronic insomnia.
So what to do? First of all, if an identifiable life-event has happened, keep in mind that it is normal for sleep to be disturbed as we are processing our emotions. As best you can, take time each day to sit and reflect on your experience, allow your emotions to come up, and express them either to a friend, by journaling, or other way. Do this during the day, at least 2 hours before bed, and then in the night tell yourself “I’ll have time to think about this more tomorrow, now is time to rest.” Second of all, don’t begin to worry about your sleep, knowing that as you recover from the event, your sleep will improve. During this emotional time, keep in place all those healthy sleep habits mentioned in other posts – regular bedtime and wake routine, getting out of bed if awake long in the night, saving the bed just for sleep, regular exercise, etc.
Use these strategies. If a time comes that you are no longer feeling emotionally charged about the event, but your sleep is still disturbed, then it is time to get sleep help.
So . . . how many of you are driving to work at 6:30ish? Ever see a kid suddenly caught in your headlights as they are waiting for the bus?
Over the last months the Start School Later movement has been gathering steam as almost 3,000 people across the nation have signed the petition, and the media has discussed the research showing that students do better when school starts later.
This week, on Thursday January 26th, the Meet us at the Bus Stop event is happening across the country to highlight how early children have to get up for school, so early that they are often waiting in the dark, on cold winter mornings, to catch the bus. Please join in by posting photos or video interviews of your children as they are waiting for the bus on Thursday morming. You can post them on Facebook at https://www.facebook.com/events/279393105455960/
See video from the previous Winter Solstice 2011 event at http://www.youtube.com/watch?v=rl0zvs43wjQ&feature=youtu.be
Sign the Start School Later petition at http://signon.org/sign/promote-legislation-to.fb1?source=s.fb&r_by=1521139
We’ve talked in other posts about sleep and emotional well-being. It’s well established that sleep problems contribute to depression, anxiety, anger, poor ability to read other’s emotions, among other contributions to emotional well-being. We also know that REM sleep in particular consolidates memories. Bring these two areas together, and now new research is showing that sleep right after a negative experience ‘fixes’ that memory and emotion in your mind.
The new study, reported in the Journal of Neuroscience, had people look at disturbing photographs then rate arousal (calm/excited) and emotional response (happy/sad). After 12 hours, the participants saw a mix of the same photos with some new ones. The photos were rated again, and categorized as old or new. Some people first saw the photos in the evening so they slept between viewings, and others saw the photos in the morning and again in the evening after their regular daytime activities.
The big difference between how the photos were remembered was whether the person had slept between viewings. Those who had slept reported similar negativity and emotional charge, while those who had stayed awake rated the pictures as more neutral. There was also a trend for those who had the most REM sleep to have the least amount of change in negativity and emotional charge.
So what does this mean for us? First off, probably none of us should be watching the scary 10 o’clock news. Going to sleep right afterward is going to help us remember anything upseting, and also lock in those negative emotions. We also want to have that hour of quiet wind-down before sleep that we’ve talked about before. And forget discussing any bad news or addressing any conflicts with our spouse during that time, unless we want the bad feelings to linger in the morning. These are all things we knew to avoid on some level before, but now science is backing up common sense.
To make a perfect ‘Sleep Cave’:
1. Dark. Should be as dark as a cave, this allows your natural melatonin levels to soar at night and help you sleep.
2. Quiet. Ever sleep in a basement and have a better night’s sleep because it was so quiet? Turn off everything that makes a sound, thus asking for your attention. Do what you can to keep the dog from barking, or his collar from jingling. If there are irregular sounds, a soft white noise machine might be helpful.
3. No electronics. Did a caveman have little lights flashing, or sales texts chirping in the night? Research this last year shows that many people are woken multiple times each week by the phone. Make sure you are not one of these folks by putting your electronics to bed in another room.
4. Comfy. Sleeping surfaces vary widely around the world. What’s most important is that the bed is comfortable for you. Unfortunately bedpartners can prefer different firmness in the mattress. Modify it with extra padding so it’s softer for one, or put a firm board under the mattress so it’s firmer for the other person.
5. Cool. People sleep better when it is cooler than 65, or even cooler at 60 degrees. Adjust both the temperature of the room, and the covers so you aren’t waking up too hot. Many patients tell me they like the bed to be warm when they get into it in the evening, but then get too hot in the night. You can use a heating pad, electric blanket, or hot water bottle to warm the bed beforehand, but then turn it off once you are in bed.
6. Minimal ‘stuff’. Back to those cavemen, they didn’t have so much stuff in their sleeping quarters, did they? Remove all the things from your bedroom that are thought provoking or call for action. You want the bedroom to be a place that you are ‘off-duty’ from the responsibilities of the day.
Although none of these recommendations are high tech, they are based on solid research, and make a huge difference in how well you sleep. Making these changes will be worth it as you get optimal sleep and all its’ daytime benefits!
Over the last several months national efforts to start school later have been growing, and it’s about time! For over 2 decades it’s been well established by medical research that there is a shift of the internal body clock during puberty. This causes teens to become sleepy later than younger children, and wake up later. This is a physiologic change, and not simply a preference for later socializing or “laziness” in the morning as was sometimes described.
Terra Snider, PhD, has created a national petition calling for legislation to prevent high schools from starting before 8am. When students go to school at times when they are most alert their performance improves, including improved test scores, decreased absenteeism, and increased graduation rates.
This issue is very close to my heart, and of utmost importance. Right out of college, in the early 1990’s, I worked in the research lab of Dr. Mary Carskadon, the leading researcher on children’s sleep/alertness patterns. After a couple years my impression was that a lot was known about this among researchers, but wasn’t being used to make children’s lives better. So although I’m interested in research, I decided to become a physician and help people with sleep problems. Now in my private practice it is striking how many adults say their sleep problems started as teens. For this reason I love to help children with sleep problems in hopes of improving their sleep before they’ve had problems for 20+ years.
Over the last newsletters we’ve talked about many behavioral skills and strategies to help ourselves sleep well naturally. Sometimes though, we do everything in our power to sleep well, but without success. At that time, other therapies are in order.
One of the options is supporting neurotransmitters with specific nutrients. Neurotransmitters are brain chemicals which help us sleep at times and be alert at others. Some of the ones we think of which promote sleep include serotonin, dopamine, GABA, histamine, glutamate, and norepinephrine.
In the clinic, neurotransmitter levels can be tested by doing urinary analysis. This test has been used by holistic physicians for the last 12 years.
When neurotransmitter levels are out of balance, the nutrients which are their building blocks can be used to increase their levels. These are primarily amino acids (parts of proteins) and the vitamins and minerals to help form the neurotransmitters. This can be a very effective treatment for people whose sleep hasn’t improved with other strategies.
Because this is a powerful therapy, it is not a treatment to try on your own. If you would like to try amino acid therapy for yourself, go to a licensed holistic healthcare provider. They will get a detailed history of your sleep problem and current medications, do testing as appropriate, then recommend the right combination of amino acids and other nutrients.
Recently I spoke with journalists at ‘Whole Living’ along with other sleep specialists. It’s a great article, filled with information and skills that adults need to sleep well. Here’s a few highlights:
– Go to bed at your ideal bedtime
– Create a great place to sleep
– Avoid alcohol, the snooze button and oversleeping
– Learn to calm yourself back to sleep
More information on the many ways sleep impacts your health (think weight gain, heart disease, and wrinkles) can be found in the full article in the October issue. http://www.wholeliving.com/