Non-drug strategies work best for insomnia
DEAR DOCTOR K:
I am 70 and have always had sleep problems. I've started to take a prescription nonbenzodiazepine sleeping pill every night. It's working very well. Is it OK if I keep on taking it?
To answer your question, I consulted with my colleague, geriatrician Suzanne Salamon. She told me that she is reluctant to prescribe sleeping pills to her older patients. They lead to daytime grogginess and may contribute to cognitive problems, poor balance and falls.
The type of sleeping pills you mentioned include Ambien (zolpidem), Sonata (zaleplon) and Lunesta (eszopiclone). These drugs are effective, particularly in helping you fall asleep.
But many people are like you: Once they start taking the medication, they don't want to give it up. However, these sleeping pills are not supposed to be used long term. Smaller doses eventually become less effective, so people have to go to a higher dose. That's when the side effects really become apparent, especially in older people.
There are several non-drug strategies you can try to help improve your sleep. They really work, as well as or better than sleeping pills. I suggest that my patients of any age try them, particularly people older than 65 who are more likely to have side effects from pills.
One strategy is called "reconditioning." My colleague, sleep expert Dr. Lawrence Epstein, describes reconditioning in his excellent book "The Harvard Medical School Guide to a Good Night's Sleep." (To learn about the book, go to www.AskDoctorK.com.) Dr. Epstein divides reconditioning into six parts:
-- Go to bed only when you're sleepy.
-- Use the bed only for sleeping or sex. Don't read, watch TV, eat or lie there worrying.
-- If you can't fall asleep quickly, get out of bed, go into another room and stay up until you're sleepy, and then return to bed.
-- If you still can't fall asleep, repeat step 3 as often as necessary throughout the night.
-- Set your alarm to get up at the same time every morning, regardless of how much sleep you got during the night.
-- Don't nap during the day.
This reconditioning program may cause you to be pretty tired for the first several days, but you'll find that it will "reset your sleep clock" and cause you to fall asleep faster, stay asleep and get more hours of sleep at night.
Two other hints: First, caffeine interferes with sleep for 12 hours after you drink it. So consume little, or none, after noon. Second, don't use alcohol as a "nightcap": It does make you sleepy, so you fall asleep more easily, but it acts as a stimulant after several hours and causes you to awaken repeatedly during the night.
I'm not saying never take sleeping pills. On occasion, I use them myself. Prescription sleep medications can be useful, but they should be used at the lowest dose and for the shortest possible time. More natural methods, like the sleep reconditioning program described above, are at least as effective as pills, and don't have the side effects that unfortunately are fairly common in people your age.
(Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information.)
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