Disturbed sleep and the solution.

[Guest guest]

Rethinking Sleep Source: Daily Health News. Here's a statistic that might surprise -- or even shock -- you: In the past five years, use of sleep medications has risen some 60%. Frankly, it appalled me. Has modern living turned us into a nation of insomniacs who are desperate for a good night's sleep? Or is this rise perhaps due to the bevy of TV commercials that promise a peaceful sleep followed by waking up the next morning so peppy and alert (no drug hangover for you) that you go out for an early morning run? Or is the cause a little of both? I took these questions to psychiatrist Richard A. Friedman, MD, director of psychopharmacology and a specialist in treating mood disorders at the New York-Presbyterian Hospital Weill Cornell Medical Center in New York City. He immediately established

that there is no reason to think insomnia is on the rise. The base numbers haven't changed, he says, but people increasingly misunderstand the nature of sleep. Many people assume sleep is something you can turn on almost at will and if that doesn't happen, they take a pill to "fix" it. But Dr. Friedman cautions that medicating for sleep is seldom the answer. Instead, he says, it is time to rethink how we sleep and why sometimes we can't. DIFFERENT PEOPLE -- DIFFERENT SLEEP PATTERNS Many people have trouble falling asleep after they turn off the light. This generally has to do with lifestyle habits, he says, including too much caffeine, exercising too late in the day or not separating yourself from the stress of the day before you go to bed. Fragmented sleep -- waking up fleetingly during the night but returning to sleep -- is yet another common problem. This is often

a byproduct of menopause with its shifting hormones and symptoms... of diabetes... and of certain medications, such as diuretics, that wake people up in the night to use the bathroom. Sometimes fragmented sleep is associated with age, though Dr. Friedman says that older adults who remain healthy are less likely to have this or any other sleep issues. Mood disorders are another reason for several kinds of sleep problems. For example, people who suffer from depression tend to habitually wake up early in the morning unable to return to sleep. Those who suffer from anxiety and generalized stress more typically wake up in the night for one or more hours. Another common problem for middle-of-the night wakefulness is consuming too much alcohol or drinking it too close to bedtime. The alcohol makes it possible to go to sleep quickly, but it wears off in a few hours and when that happens, says Dr. Friedman, it's as if a light bulb goes on and tells

the body to wake up. And there is yet another reason for middle-of-the-night sleeplessness that may surprise you. Sleeping in two cycles of three or four hours each with one or two hours in between (called bimodal sleep) is perfectly normal for some people. In fact, it is a natural sleep pattern that shows up in studies concerning the history of sleep and in anthropological studies of societies without artificial light. A study in 1992 of healthy adults done by the National Institute of Mental Health found that when allowed to sleep as much and as long as they wanted many of the subjects evolved a pattern of bimodal sleep with an hour or two of, as the study described it, peaceful wakefulness. MAKING THE BEST OF CHALLENGING SITUATIONS Dr. Friedman recommends anyone who worries about sleep to investigate and resolve the basis of the problem. Those who may be suffering

from a mood disorder, whether depression or anxiety, should seek counseling right away to obtain treatment and appropriate medication if necessary. A more common problem is those lifestyle habits. Be sure you: Avoid caffeine after 2 pm. (Note: So-called "smart drinks" are loaded with caffeine.) Don't exercise in the evening. Keep alcohol consumption to a minimum. Read, take a warm bath, listen to restful music and have other activities that will relax you before bedtime. Even with good lifestyle measures, though, some people still become so concerned about falling asleep that they turn the bedroom into an anxiety zone. Worried that they won't fall asleep, their anxiety actually prevents them from doing so. Why: People who experience what should be a temporary problem falling sleep, perhaps a short-lived stress, can become so fearful that it turns into a

deep-seated negative association with bed. The advice on this is a familiar one -- reserve the bed only for sleeping or sex. If you can't sleep, go to another room and read, watch TV or listen to music. When you become sleepy, return to bed, but if sleep still eludes you, get up again -- and again if necessary -- until you finally fall asleep. This pattern will eventually break the cycle, says Dr. Friedman. For truly stubborn sleep issues, cognitive therapy is available in a six-week course. It has had impressive results for even the most difficult sleep problems. (Ask your doctor to refer you to a local sleep clinic for more information.) But for those people whose natural pattern is bimodal sleep, the best advice is to relax and enjoy it. If possible, establish a sleep schedule that allows time for lying awake in the night and take advantage of the quiet to read, think, do whatever you would like. As a last reminder for

everyone who worries if sleep doesn't come, Dr. Friedman observes that an occasional night or two of tossing and turning isn't the end of the world. It won't hurt you to be tired now and then. When it needs it, your body will let you sleep. If you're part of that 60% increase in sleeping pill use, you may want to rethink your use of it. Do you really need it? Is it really making a difference? Are there other, non-pharmaceutical ways to address your problem? Daily Health News contributing editor Andrew L. Rubman, ND, adds that a frequent component of sleep problems stems from nutrient deficiency... and metabolite mismanagement, or inappropriate or incomplete processing of naturally occurring breakdown products, can contribute significantly to the problem. A naturopathic physician can help you in this area. Be well, Carole Jackson Bottom Line's Daily Health News "Our ideal is not the spirituality that withdraws from life but the conquest of life by the power of the spirit." - Aurobindo.

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