Today the Food and Drug Administration will start requiring the manufacturers of several sleeping pills to list complications such as sleep walking in the information about the drug. As most people know, numerous reports of abnormal behavior such as eating or walking or driving occur after use of certain medications. This is especially clear for Ambien because it is the most prescribed agent, but can occur with many other medications such as Lunesta, triazolam, and temazepam.
I have personally had negative, embarrassing, and upsetting experiences with the problem of sleep walking after Ambien use, and I am happy to see a little backlash on what has been years of marketing and increased prescriptions. As the New York Times article from Stephanie Saul states, prescriptions are up 60 % in the last 6 years.
My first experience was presenting a case to colleagues. At our weekly conference I talked about a 55 year old woman whose family reported that she “sleep walked” after taking Ambien and would walk to the kitchen. Because they were still awake, they would lead her back to bed. Two of my senior colleagues in essence said that this was impossible and that the woman needed psychiatric help. This was back in 1995 when Ambien was fairly new but even at that time there were isolated case reports. In the next year, a physician friend told me that he ate a chicken one night during his sleep after taking Ambien and he stopped taking it
More recently, I had a tragic case of a woman who lived alone and got up in the night after taking Ambien and took a bath. She left the water running and totally flooded her condo and did not have flood insurance. She is probably losing her home. Another very nice lady aged 60, drove from San Diego to Temecula (about 50 miles) during a night after taking Ambien, parked her car in a closed bank, and then woke up near morning. She had no idea of how she got there. Obviously neither woman takes it anymore.
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In The Habit Of Being Awake At Night
Most instances of long-term insomnia begin with a stressful life problem. In the case of a nice 50 year old woman I met yesterday, the problem began with her neighbors 3 years ago. She had always slept pretty well before then and she had no medical disease, major anxiety or depression. Then, her next door neighbor began to make a lot of noise at night.
Every night for a couple of months she was awakened by the noise of cars, music, talking, and general activity, usually between midnight and 2 am. This was very upsetting to her, partly because of having to get up at 530 am for work, and partly because her relationship with the neighbor became so unpleasant. A few times, she called the police.
After a little while, she asked her doctor for a sleeping pill. Eventually, she began taking clonazepam 1 mg and zolpidem 10 mg every night, which helped quite a bit. She found another house on a quiet street and moved. After a total of 6 months the noisy neighbor problem was history.
Unfortunately, the insomnia continued. If she didn't take the sleeping pills she would lie awake for hours and she couldn't stand the frustration of being awake at night. She worried about her job performance and her dependence on the sleeping pills. Even with the pills she was waking up in the night, and began to go to bed earlier so as to get extra chances at sleep.
Her type of insomnia is called by various names: primary insomnia, conditioned insomnia, or psychophysiologic insomnia. Once the brain is in the habit of being frustrated, awake, or upset while in bed trying to sleep, the habit can last forever. After all, the brain's main function is to learn, and her brain learned that the bed at night was an unpleasant place. Many sleep specialists believe that this negative conditioning process between the passive act of falling asleep and the bed environment is the cause of most insomnia.
Our nice lady needs to slowly discontinue the sleeping pills under a doctors direction, and re-train her brain to sleep. This is a long process for most people, involving sleep restriction, cognitive behavioral therapy, relaxation techniques, daytime bright light, and a healthy daytime lifestyle. Most people can get better sleep by using a combination of these therapies and a lot of encouragement and motivation.
Every night for a couple of months she was awakened by the noise of cars, music, talking, and general activity, usually between midnight and 2 am. This was very upsetting to her, partly because of having to get up at 530 am for work, and partly because her relationship with the neighbor became so unpleasant. A few times, she called the police.
After a little while, she asked her doctor for a sleeping pill. Eventually, she began taking clonazepam 1 mg and zolpidem 10 mg every night, which helped quite a bit. She found another house on a quiet street and moved. After a total of 6 months the noisy neighbor problem was history.
Unfortunately, the insomnia continued. If she didn't take the sleeping pills she would lie awake for hours and she couldn't stand the frustration of being awake at night. She worried about her job performance and her dependence on the sleeping pills. Even with the pills she was waking up in the night, and began to go to bed earlier so as to get extra chances at sleep.
Her type of insomnia is called by various names: primary insomnia, conditioned insomnia, or psychophysiologic insomnia. Once the brain is in the habit of being frustrated, awake, or upset while in bed trying to sleep, the habit can last forever. After all, the brain's main function is to learn, and her brain learned that the bed at night was an unpleasant place. Many sleep specialists believe that this negative conditioning process between the passive act of falling asleep and the bed environment is the cause of most insomnia.
Our nice lady needs to slowly discontinue the sleeping pills under a doctors direction, and re-train her brain to sleep. This is a long process for most people, involving sleep restriction, cognitive behavioral therapy, relaxation techniques, daytime bright light, and a healthy daytime lifestyle. Most people can get better sleep by using a combination of these therapies and a lot of encouragement and motivation.
Can’t sleep? Quit trying !
There have been so many questions about insomnia, and insomnia is such a huge topic (the most common sleep disorder), that today we will consider one little aspect of primary insomnia. Primary insomnia is insomnia not caused by a medical, sleep, or psychiatric disorder.
To understand in more detail the symptom of insomnia, the many possible causes of insomnia, the association of insomnia with medical conditions, sleep disorders, mental health conditions, medications, and other factors, visit http://tinyurl.com/mds9p6.
Many people with insomnia develop a vicious cycle of trying to sleep, becoming frustrated or anxious about not sleeping, trying harder to sleep, getting more frustrated, etc. This cycle is so common that it occurs in almost all persons with insomnia to some extent, but in some, it is the major factor that causes the insomnia to continue for months and years.
The act of falling asleep cannot be forced. It is a passive--not an active—event. It occurs if the “stage is set,” which means that the body/brain is sleepy, the time of night is right, and the environment is right. Falling asleep is partly natural but also partly learned, and the brain needs the proper connection (or training) in the person’s past experience between trying to fall asleep and actually falling asleep.
This means that when a person has bad experiences in bed trying to sleep the brain learns this, and the next time the person is in bed, the same thing will tend to happen. The anxiety becomes associated with trying to sleep, and the cycle continues. Imagine if someone was abused or tortured in bed; even years later after being otherwise better, it would be impossible to relax and fall asleep in that same bed. It is extremely important to avoid frustration, anxiety, negative thinking, rumination, and other strong emotions when trying to fall asleep.
Which brings me to the title of this blog. Yes, if you can’t fall asleep, you should quit trying. That doesn’t mean giving up seeking the help and answers you need—in fact just about everyone with insomnia can be helped with a combination of therapies.
BUT, it means that at the time, stop trying to sleep, relax, maybe get up and have a tea, stay calm, accept the situation, maybe meditate or pray, and later go back to bed and see if sleep comes. This might or might not help sleep during that night, but it should help your attitude, and it helps prevent the insomnia-frustration cycle from worsening with time.
Has anyone found that it helps to fall asleep by not trying to fall asleep? We’ll continue discussing any and all sleep disorders in upcoming blogs.
To understand in more detail the symptom of insomnia, the many possible causes of insomnia, the association of insomnia with medical conditions, sleep disorders, mental health conditions, medications, and other factors, visit http://tinyurl.com/mds9p6.
Many people with insomnia develop a vicious cycle of trying to sleep, becoming frustrated or anxious about not sleeping, trying harder to sleep, getting more frustrated, etc. This cycle is so common that it occurs in almost all persons with insomnia to some extent, but in some, it is the major factor that causes the insomnia to continue for months and years.
The act of falling asleep cannot be forced. It is a passive--not an active—event. It occurs if the “stage is set,” which means that the body/brain is sleepy, the time of night is right, and the environment is right. Falling asleep is partly natural but also partly learned, and the brain needs the proper connection (or training) in the person’s past experience between trying to fall asleep and actually falling asleep.
This means that when a person has bad experiences in bed trying to sleep the brain learns this, and the next time the person is in bed, the same thing will tend to happen. The anxiety becomes associated with trying to sleep, and the cycle continues. Imagine if someone was abused or tortured in bed; even years later after being otherwise better, it would be impossible to relax and fall asleep in that same bed. It is extremely important to avoid frustration, anxiety, negative thinking, rumination, and other strong emotions when trying to fall asleep.
Which brings me to the title of this blog. Yes, if you can’t fall asleep, you should quit trying. That doesn’t mean giving up seeking the help and answers you need—in fact just about everyone with insomnia can be helped with a combination of therapies.
BUT, it means that at the time, stop trying to sleep, relax, maybe get up and have a tea, stay calm, accept the situation, maybe meditate or pray, and later go back to bed and see if sleep comes. This might or might not help sleep during that night, but it should help your attitude, and it helps prevent the insomnia-frustration cycle from worsening with time.
Has anyone found that it helps to fall asleep by not trying to fall asleep? We’ll continue discussing any and all sleep disorders in upcoming blogs.
Women more stressed by insomnia
Whether it's due to partners snoring, nagging consciences or the stresses and anxieties of modern life, new research has revealed that women are almost 20 per cent more likely to suffer insomnia than men.
A year-long investigation by the National Sleep Foundation (NSF) into the sleeping habits of more than 2,000 women aged from 18 to 64 has found that almost two-thirds had between one and three disturbed nights every week. Almost 70 per cent said they frequently experience a sleep problem.
This compares to 52 per cent of men who say they suffer insomnia a few nights a week or more.
The study reflects research in a new book by the founder of the American Academy of Sleep Medicine, Dr Meir Kryger, author of Can't Sleep, Can't Stay Awake: A Woman's Guide To Sleep Disorders. 'Unlike men, women have sleep problems related to hormonal and bodily changes from menstruation, pregnancy and menopause,' he said.
'Unfortunately, too often it is women whose sleep disorders are undiagnosed or misdiagnosed because of a lack of education among doctors about these unique problems. This failure by doctors to correctly diagnose female sleeplessness is meaning sufferers are putting their health at risk while contributing to dramatic rises in obesity and diabetes.
'Women lose sleep because of their role in the family and the demands of today's 24/7 world,' he added.
Kryger said that women's disorders are often missed because, although they have the same sleep disorders as men, the way they react to sleeplessness is very different. 'The problem is compounded by the likelihood that women will not even realise symptoms in themselves indicating that they have sleep disorders,' he said. 'For example, women with sleep apnea - temporarily stopping breathing while asleep - have symptoms of depression more often than men with apnea.'
Kryger claimed that female sleeplessness is frequently misdiagnosed by doctors because of a widespread belief that women rarely suffer sleep problems, combined with the fact that insomnia manifests itself differently in women to how it does in men.
Richard Gelula, the chief executive of the NSF, said: 'The NSF study found that women's sleep problems can affect virtually every aspect of their lives, leaving them late for work, stressed out, too tired for sex and little time for their friends.'
'Women of all ages are burning the candle at both ends and as a result they are sleepless and stressed out. Poor sleep [affects] every aspect of a woman's life, as well as her health. In fact, more than one half of the women polled reported that they felt sad or depressed in the past month and one third reported they recently felt hopeless about the future.'
The study revealed, however, women refuse to succumb to the strain of sleeplessness. Almost 80 per cent said that, when they experience drowsiness during the day, they just accept it and keep going. Two thirds said they achieved this by drinking caffeine-rich drinks, with one third admitting consuming three or more such drinks every day in an attempt to escape their exhaustion. Just 8 per cent admitted missing work at least once a month due to tiredness.
'While most women refuse to put work on the back burner when they run out of time or are too sleepy, they admit choosing instead to cut back on healthy activities as they struggle through their daily lives,' said Gelula.
Half of the women admitted that sleep and exercise are the first things they sacrifice. In addition, more than one third said they also reduce the amount of time spent with friends and family, stop eating healthily and don't participate in sexual activity when feeling tired.
'Worryingly, women admit driving while feeling exhausted,' said Gelula. 'More than one quarter said they have driven while feeling drowsy at least once a month in the past year, 10 per cent of whom said they drove in this state while a child was in the car.'
A year-long investigation by the National Sleep Foundation (NSF) into the sleeping habits of more than 2,000 women aged from 18 to 64 has found that almost two-thirds had between one and three disturbed nights every week. Almost 70 per cent said they frequently experience a sleep problem.
This compares to 52 per cent of men who say they suffer insomnia a few nights a week or more.
The study reflects research in a new book by the founder of the American Academy of Sleep Medicine, Dr Meir Kryger, author of Can't Sleep, Can't Stay Awake: A Woman's Guide To Sleep Disorders. 'Unlike men, women have sleep problems related to hormonal and bodily changes from menstruation, pregnancy and menopause,' he said.
'Unfortunately, too often it is women whose sleep disorders are undiagnosed or misdiagnosed because of a lack of education among doctors about these unique problems. This failure by doctors to correctly diagnose female sleeplessness is meaning sufferers are putting their health at risk while contributing to dramatic rises in obesity and diabetes.
'Women lose sleep because of their role in the family and the demands of today's 24/7 world,' he added.
Kryger said that women's disorders are often missed because, although they have the same sleep disorders as men, the way they react to sleeplessness is very different. 'The problem is compounded by the likelihood that women will not even realise symptoms in themselves indicating that they have sleep disorders,' he said. 'For example, women with sleep apnea - temporarily stopping breathing while asleep - have symptoms of depression more often than men with apnea.'
Kryger claimed that female sleeplessness is frequently misdiagnosed by doctors because of a widespread belief that women rarely suffer sleep problems, combined with the fact that insomnia manifests itself differently in women to how it does in men.
Richard Gelula, the chief executive of the NSF, said: 'The NSF study found that women's sleep problems can affect virtually every aspect of their lives, leaving them late for work, stressed out, too tired for sex and little time for their friends.'
'Women of all ages are burning the candle at both ends and as a result they are sleepless and stressed out. Poor sleep [affects] every aspect of a woman's life, as well as her health. In fact, more than one half of the women polled reported that they felt sad or depressed in the past month and one third reported they recently felt hopeless about the future.'
The study revealed, however, women refuse to succumb to the strain of sleeplessness. Almost 80 per cent said that, when they experience drowsiness during the day, they just accept it and keep going. Two thirds said they achieved this by drinking caffeine-rich drinks, with one third admitting consuming three or more such drinks every day in an attempt to escape their exhaustion. Just 8 per cent admitted missing work at least once a month due to tiredness.
'While most women refuse to put work on the back burner when they run out of time or are too sleepy, they admit choosing instead to cut back on healthy activities as they struggle through their daily lives,' said Gelula.
Half of the women admitted that sleep and exercise are the first things they sacrifice. In addition, more than one third said they also reduce the amount of time spent with friends and family, stop eating healthily and don't participate in sexual activity when feeling tired.
'Worryingly, women admit driving while feeling exhausted,' said Gelula. 'More than one quarter said they have driven while feeling drowsy at least once a month in the past year, 10 per cent of whom said they drove in this state while a child was in the car.'
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