Sleep and money

Don’t you wish you could make money by sleeping? I suppose we all do. Unfortunately, right now, many people are losing sleep over money issues. For anybody with a stock portfolio, or any body with a job that could be down-sized, you are probably worrying about money.

Of course sometimes we worry about money in the day. But we get so busy doing things that we kind of forget about it for awhile. By the end of the day we are so tired we go to bed, only to wake up thinking about how to pay for the kids college, or how to pay for the rent, or how to pay for the car insurance, or whether or not we’ll even have a job in another couple of months. Thoughts like these can cause real anxiety and even panic attacks, and can really ruin sleep.

Someone once said that everything seems more gloomy in the night because being afraid at night made our ancestors stay huddled in their caves—safe from harm. In other words, it is normal for things to seem worse in the night, and it might even be a good thing.

When you are stressed, it is extra important the you follow good sleep habits, such as we post on the Goal of the Can’t Sleep Café. Sometimes people do the opposite—when they are stressed out, they quit all the good habits, and maybe start drinking a little more alcohol before bed, or lying in bed calculating accounts rather than sitting up and reading. Or worse—they go to be extra early because they are stressed, and allow themselves to sleep in late in the morning, since maybe they are a little depressed also. These kind of behaviors are called mal-adaptive, because they actually make sleep worse, both in the short term and in the long term.

Tough times are the times to be sure that you don’t spend excessive amounts of time in bed; that you take care of your body and eat right and drink right; that you set aside extra time for exercise and other relaxing activities; that you double up your Church time, prayer time, or meditation time; that you don’t try to sleep when your mind won’t—get up and do something else—or get up and worry in the kitchen, not the bed. Don’t overuse sleeping pills. Review my main tips on how to sleep better.

Lastly, remember, the stock market goes up and down, but if you get into bad sleep habits now, you might never recover. Enjoy your sleep.

Sleep disorders

Sleep disorders is a field that can cover just about any human condition—imagine if there was a field a “wake disorders.”

Usually though, the bladder and sleep are used in the same sentence only in regards to older men with larg prostates.  That is, waking up to urinate 1 to 3 times per night is quite common in this age group because the prostate makes it difficult to fully empty the bladder, so it fills up again more quickly.  

A worse problem is NOT waking up to urinate.  I saw JC again today, a 14 year old boy who has wet the bed almost every night of his life since being out of diapers.  He has seen his pediatrician and worked with a urologist.  He has had tests on his bladder—it is normal in all ways—and taken several medications.  These medications are of various types to decrease bladder tension, increase tension in the bladder outlet, and to decrease the amount of urine made.  Nothing has helped.  The “bell and pad” method, wherein a mattress pad beeps as soon as it gets wet has not helped.  Have any of you parents had experience with treatments for bedwetting?  Have medications like imipramine, amiytriptyline, or DDAVP been successful?  

Although most kids outgrow enuresis—and JC probably will in the next year or so—it is unusual to persist into teen age years, and JC looks even older than 14.  It can be considered a sleep disorder because the urination occurs during the deepest stages of sleep—stages 3 and 4, also called slow wave sleep, or delta sleep.  It’s kind of like sleep walking—there is a disconnect between the physical activity and the state of mind.  The body just does it’s thing, even though the brain remains awake.  JC snores, and sometimes snoring produces brain (EEG) arousals that trigger activities like sleep walking.  We’ll see if treating snoring stops the bedwetting in this nice young man.  It would be very interesting to know if others have had success with enuresis by treating snoring in children. 

Sleeping pills in the night

A new study published in SLEEP reports the results of a new formulation of Zolpidem (Ambien) which is placed under the tongue for people who have middle of the night insomnia. This is a patented lozenge which is said to dissolve quickly and have acid-base buffers that enhance its rapid absorption into the blood stream.

People were recruited who complained of trouble getting back to sleep in the middle of the night, but those with sleep disorders or depression were not allowed into the study. They were allowed to sleep for 4 hours, awakened by the researchers, took the lozenge, sat up for 30 minutes, and then tried to sleep again for 4 more hours. Each subject did this on two separate nights, once with the drug and once with placebo. Those taking the zolpidem lozenge fell asleep more quickly and had more sleep in the coming four hours. They are said to have had no morning side effects such as sleepiness or trouble doing a math task.

This study is important because people who only have insomnia in the last half of the night have few options for medication treatment. All of the older benzodiazepine medications take too long to take effect and also take too long to be eliminated by morning. The only real option is Sonata (zaleplon), which can take effect in as little as 30 minutes and be pretty much eliminated in 2 or 3 hours. It is approved by the FDA to take with four or more hours of planned sleep, but it suffers from eratic absorption (food and fat delay it), and it has not been tested extensively in the middle of the night. Similarly, taking regular zolpidem (Ambien) in the night is a problem due to the time of absorption and the longer elimination period. About 7 hours of planned sleep is suggested for oral Ambien.

I know of patients and colleagues who use a sublingual (under the tongue) method for regular zolpidem and zaleplon. For zaleplon, you have to open the capsule, and dump the powder out and for zolpidem you have to crush the pill or wait for it to dissolve. The current study used a low dose of zolpidem (about 3 to 4 mg), and the best dose to be recommended remains to be determined. These problems will be much less when further studies of the lozenge are released.

In general, I favor the shortest acting sleeping pills so that there is less chance of residual effect and less total time of the drug in the body. The sublingual form allows for very rapid absorption, so the drug can get straight to work, and the liver and kidney can immediately metabolize it. Someone should have thought of this before !