I found a blog today talking about sleep walking and Ambien. But instead of talking about the problem as a problem, the blog dismisses and belittles the problem. The writer, with considerable sarcasm, says that the scale of the problem is extremely small, that reports of sleep eating, sleep driving, and sleepwalking are overblown, that the FDA overreacted, and actually says "Personally, I'd blame the lawyers before I'd blame Ambien for sleep walking." Even worse for those who seek unbiased advice on health care and medications, this site suggests that they are there to help with sleep problems. They are there to sell you Ambien on the Internet, at about 2.49 per pill, at sweetdreamsadvice.
First, the problem of doing things in your sleep after taking Ambien is NOT overblown. Most of us do not report our cases, so the WHO estimates are far to low. I would say that I see about one case every three months. The most recent lady was 50 years old and lived alone. She thought that she might be sleep eating because she would sometimes find food wrappers in her bedroom, and since starting Ambien about one year ago she had gained 20 pounds. Recently she went to a casino-hotel with some girlfriends for the weekend.
They had a great time sharing a room, especially taking picture of my patient. What was she doing? About one hour after going to sleep she got up, went over to the mini-bar area where there was a bowl of crackers. She took the bowl, sat down, and slouched over it shoveling crackers into her mouth. Then she went back to bed.
In the past I have told you about some of my other patients, including two who drove their car in the night, woke up in a parking lot, and did not remember it. And another who took Ambien on a plane and had to be arrested upon landing for acting out of line.
Second, Ambien is a fine drug. I have nothing against its proper use. It appears to be one of the safest sleeping pills ever, in terms of its low addictive potential, lack of morning hangover, and low interactions with other drugs. But it absolutely can cause things like sleep walking. And thus the decision to take it occasionally or regularly is a decision you should make with your doctor who can help you weigh the pro's and the con's.
When starting out, I do recommend that the person tell their bedpartner that they are taking a new medicine, just in case they do something weird. For those who live alone, I start with a super-low dose and slowly increase.
Third, don't buy your medicine on the internet unless you and your doctor agree to it. Enjoy your sleep.
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How to sleep better
Recently I updated the most important 6 basic activities that everyone who has trouble sleeping should follow. They are in the Sleep Goal of the Can't Sleep Café.
I'd like to briefly explain them here.
1. Get 30 minutes of outdoor time each day. This is the easiest way for most people to get bright light. Getting some bright light helps to set your body clock and stimulates portions of the sleep-wake rhythm generators in the brain. Try to get the bright light at about the same time each day.
2. Take only one serving of caffeine each day, only in the morning. Caffeine taken after lunch lingers in the system and can worsen sleep. Too much caffeine in the morning can cause a rebound of drowsiness later in the day.
3. Practice a relaxation technique such as meditation for at least 20 minutes each day. This could also be exercise, prayer, or biofeedback. Prayer and meditation have the advantage that you can also do them when you might be awake in the night.
4. Get up at the same time each day. This is the most important rule, and it is best to move the time a little earlier than you might naturally wake up. Somewhere near sunrise is also ideal if you can manage it.
5. Plan your bedtime based on your wake-up time; for most people about 7 hours before the wake up time. The worst mistake for most people is to go to bed too early, hoping for 9 hours of sleep.
6. Lastly, if you cannot sleep during the night, it is vitally important that you stop trying for a while. Get up, go sit in a recliner, and spend 20 to 30 minutes there before trying to sleep again. Then go into bed and try it again.
So there you have it—a little sunlight, only a little caffeine, a regular morning wake up time, some daily stress reduction, planning for 7 hours in bed, and if you still can't sleep, get up for a while and stop trying.
I'd like to briefly explain them here.
1. Get 30 minutes of outdoor time each day. This is the easiest way for most people to get bright light. Getting some bright light helps to set your body clock and stimulates portions of the sleep-wake rhythm generators in the brain. Try to get the bright light at about the same time each day.
2. Take only one serving of caffeine each day, only in the morning. Caffeine taken after lunch lingers in the system and can worsen sleep. Too much caffeine in the morning can cause a rebound of drowsiness later in the day.
3. Practice a relaxation technique such as meditation for at least 20 minutes each day. This could also be exercise, prayer, or biofeedback. Prayer and meditation have the advantage that you can also do them when you might be awake in the night.
4. Get up at the same time each day. This is the most important rule, and it is best to move the time a little earlier than you might naturally wake up. Somewhere near sunrise is also ideal if you can manage it.
5. Plan your bedtime based on your wake-up time; for most people about 7 hours before the wake up time. The worst mistake for most people is to go to bed too early, hoping for 9 hours of sleep.
6. Lastly, if you cannot sleep during the night, it is vitally important that you stop trying for a while. Get up, go sit in a recliner, and spend 20 to 30 minutes there before trying to sleep again. Then go into bed and try it again.
So there you have it—a little sunlight, only a little caffeine, a regular morning wake up time, some daily stress reduction, planning for 7 hours in bed, and if you still can't sleep, get up for a while and stop trying.
Women, sleep, and disease
A new research study has shown some interesting connections between sleep problems, psychologic stress, and risk factors in the blood for certain diseases. The researchers at Duke University studied over 200 normal people.
The subjects kept track of various aspects of their sleep for about one month. They also filled out various questionnaires about their psychologic state and stress levels. Blood samples were taken and tested for a number of markers of inflammation and heart disease. All of the subjects were non-smokers and the women were not on hormones of any type.
Previous studies have demonstrated connections between various measures of poor sleep and increased risk of coronary artery disease, type 2 diabetes, and high blood pressure. This study tried to assess the reason for this and also to understand the difference between men and women.
The results indicated that less more frequent sleep problems, less nightly total sleep time, and difficulty falling asleep were connected with increased psychologic distress and with increased blood markers including higher fasting insulin, fibrinogen and certain inflammatory biomarkers. It is likely that these markers in the blood are examples of HOW poor sleep seems to be linked with heart disease. It is not proven the extent to which these changes are due to the sleep problems itself or to the stress.
But the connection only occurred in WOMEN, not in men. That is, men who had similar sleep complaints did not exhibit the blood changes or the psychologic distress as much as the women did. The reason for this is not clear, but it confirms that physical responses to sleep problems can differ between the genders and have implications for who is likely to get sick from sleep problems. We also know that insomnia is much more common in women than in men.
So is possible that this sleep-health connection will be particularly important for women as more research is done. The study is also reviewed here.J. Steven Poceta MD is a licensed practitioner of neurology and sleep disorders who has been engaged by Revolution Health. No information in this blog is intended to diagnose or treat any condition. The opinions expressed here are Dr. Poceta's own and do not necessarily reflect those of Revolution Health.
The subjects kept track of various aspects of their sleep for about one month. They also filled out various questionnaires about their psychologic state and stress levels. Blood samples were taken and tested for a number of markers of inflammation and heart disease. All of the subjects were non-smokers and the women were not on hormones of any type.
Previous studies have demonstrated connections between various measures of poor sleep and increased risk of coronary artery disease, type 2 diabetes, and high blood pressure. This study tried to assess the reason for this and also to understand the difference between men and women.
The results indicated that less more frequent sleep problems, less nightly total sleep time, and difficulty falling asleep were connected with increased psychologic distress and with increased blood markers including higher fasting insulin, fibrinogen and certain inflammatory biomarkers. It is likely that these markers in the blood are examples of HOW poor sleep seems to be linked with heart disease. It is not proven the extent to which these changes are due to the sleep problems itself or to the stress.
But the connection only occurred in WOMEN, not in men. That is, men who had similar sleep complaints did not exhibit the blood changes or the psychologic distress as much as the women did. The reason for this is not clear, but it confirms that physical responses to sleep problems can differ between the genders and have implications for who is likely to get sick from sleep problems. We also know that insomnia is much more common in women than in men.
So is possible that this sleep-health connection will be particularly important for women as more research is done. The study is also reviewed here.J. Steven Poceta MD is a licensed practitioner of neurology and sleep disorders who has been engaged by Revolution Health. No information in this blog is intended to diagnose or treat any condition. The opinions expressed here are Dr. Poceta's own and do not necessarily reflect those of Revolution Health.
Only 4 hours of sleep
This week I heard a lecture by the remarkable Mr. S.N. Goenka.
Mr. Goenka has been teaching a type of meditation called Vipassana meditation for almost 40 years. This type of meditation is the closest in technique to that which the Buddha himself taught, and is based on awareness of bodily sensations as a tool to develop concentration of mind, equanimity, and happiness.
Mr. Goenka, in an off hand statement during the lecture, said that people who regularly practice Vipassana find that they need less sleep. He said that on average it might be one hour less of sleep each day. Interestingly, he said that sometimes only 3 or 4 hours of sleep is necessary in order to feel rested the next day.
The key to getting by with less sleep was practicing meditation during the night if one could not sleep. His technique is one in which the person focuses on bodily sensations but does not react to them. Practitioners keep a calm and focused mind, but accept the situation as it is, knowing that it will change sooner or later.
This reminded me of some of the advice we give patients with insomnia. In fact, a key aspect of cognitive behavioral therapy (CBT) for insomnia is to re-assess your beliefs and attitudes about sleep. For example, part of the therapy involves spending less time in bed when you are sleeping poorly, with the knowledge that such behavior will improve sleep in the long run. In addition, some type of mental or physical relaxation training is suggested in order to deal with stress and anxiety.
Do people who meditate really require less sleep? I don't know, but I do know that this type of mental activity is an important part of the treatment of insomnia. I have mentioned several places to learn more about relaxation techniques in previous blog posts.J. Steven Poceta MD is a licensed practitioner of neurology and sleep disorders who has been engaged by Revolution Health. No information in this blog is intended to diagnose or treat any condition. The opinions expressed here are Dr. Poceta's own and do not necessarily reflect those of Revolution Health.
Mr. Goenka has been teaching a type of meditation called Vipassana meditation for almost 40 years. This type of meditation is the closest in technique to that which the Buddha himself taught, and is based on awareness of bodily sensations as a tool to develop concentration of mind, equanimity, and happiness.
Mr. Goenka, in an off hand statement during the lecture, said that people who regularly practice Vipassana find that they need less sleep. He said that on average it might be one hour less of sleep each day. Interestingly, he said that sometimes only 3 or 4 hours of sleep is necessary in order to feel rested the next day.
The key to getting by with less sleep was practicing meditation during the night if one could not sleep. His technique is one in which the person focuses on bodily sensations but does not react to them. Practitioners keep a calm and focused mind, but accept the situation as it is, knowing that it will change sooner or later.
This reminded me of some of the advice we give patients with insomnia. In fact, a key aspect of cognitive behavioral therapy (CBT) for insomnia is to re-assess your beliefs and attitudes about sleep. For example, part of the therapy involves spending less time in bed when you are sleeping poorly, with the knowledge that such behavior will improve sleep in the long run. In addition, some type of mental or physical relaxation training is suggested in order to deal with stress and anxiety.
Do people who meditate really require less sleep? I don't know, but I do know that this type of mental activity is an important part of the treatment of insomnia. I have mentioned several places to learn more about relaxation techniques in previous blog posts.J. Steven Poceta MD is a licensed practitioner of neurology and sleep disorders who has been engaged by Revolution Health. No information in this blog is intended to diagnose or treat any condition. The opinions expressed here are Dr. Poceta's own and do not necessarily reflect those of Revolution Health.
Sleep, tigers, afraid in your cave
I came across the nightworrier blog today--obviously a blog written by someone with insomnia. Not just insomnia, but worry as well. In fact, worry in the night is the major feature of this person's insomnia.
Many times I have been awake at night and worried. Let me count the ways—my work the next day; the kids driving at night; paying for lessons, the house, college; whether to move; the argument from yesterday.
Somewhere along the line I had a realization that most of the things I was worrying about did not seem as bad the next day. I mean I would be just plain freaked out in the night and positive that something bad was going to happen and I had no idea how to deal with it. Then, when morning came, I was able to deal with it, forget it, and it didn't seem so bad. How could that be? I was the same person just a few hours later, but my perspective and reaction to the problem was very different. This happened enough times that the pattern was obvious. Kind of like "the darkest hour is just before the dawn" perhaps.
So one evening I'm giving a lecture on sleep in some fancy restaurant to a group of doctors. Doctors are a tough audience, but smart and usually interested in the topic or they wouldn't come. We're talking about insomnia and I mention to the audience that things look really bleak to me during the night, but then during the day the same problem seems manageable. "I wonder why that is."
A hand shoots up and the doctor says "It is good to be scared in the night—it keeps us hiding in our cave." This was brilliant, and the more I thought about it the more obvious it became. Clearly, for primitive humans, there would be an evolutionary advantage to staying quiet and still and hidden in the night. I mean, anybody who wanted to go whistling through the jungle at night probably didn't survive very long in the world of sabre tooth tigers and pythons. Those who did survive passed on the nighttime scardy-cat gene.
So think of this the next time that you are awake at night. You are hard wired to be anxious at night, and it helped your ancestors survive, and it might even still be good for you. Comfort yourself with the knowledge that this is normal, and that things will seem better come the dawn.
Many times I have been awake at night and worried. Let me count the ways—my work the next day; the kids driving at night; paying for lessons, the house, college; whether to move; the argument from yesterday.
Somewhere along the line I had a realization that most of the things I was worrying about did not seem as bad the next day. I mean I would be just plain freaked out in the night and positive that something bad was going to happen and I had no idea how to deal with it. Then, when morning came, I was able to deal with it, forget it, and it didn't seem so bad. How could that be? I was the same person just a few hours later, but my perspective and reaction to the problem was very different. This happened enough times that the pattern was obvious. Kind of like "the darkest hour is just before the dawn" perhaps.
So one evening I'm giving a lecture on sleep in some fancy restaurant to a group of doctors. Doctors are a tough audience, but smart and usually interested in the topic or they wouldn't come. We're talking about insomnia and I mention to the audience that things look really bleak to me during the night, but then during the day the same problem seems manageable. "I wonder why that is."
A hand shoots up and the doctor says "It is good to be scared in the night—it keeps us hiding in our cave." This was brilliant, and the more I thought about it the more obvious it became. Clearly, for primitive humans, there would be an evolutionary advantage to staying quiet and still and hidden in the night. I mean, anybody who wanted to go whistling through the jungle at night probably didn't survive very long in the world of sabre tooth tigers and pythons. Those who did survive passed on the nighttime scardy-cat gene.
So think of this the next time that you are awake at night. You are hard wired to be anxious at night, and it helped your ancestors survive, and it might even still be good for you. Comfort yourself with the knowledge that this is normal, and that things will seem better come the dawn.
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