Getting a good night's sleep is one of lifes’ great pleasures and health enhancers.
However, a large number of us are challenged by difficulty in falling asleep, staying asleep or unrefreshing sleep. These are different components of insomnia, which affect 10 percent of adults on a chronic basis.
Over the past few years a number of new prescription agents for insomnia have become available, and their use has skyrocketed. While 47 million prescriptions for these medications were written in 2006, 60 million were written last year. However, a report in the Feb. 27 issue of the British Medical Journal raises concern about this trend.
Authors from the Scripps Institute did a comparison study of patients who were prescribed sleep medications versus those who were not by going through an electronic data base. The results showed that hypnotic prescription use was associated with a higher risk of death. The study has received criticism, particularly with the concern that patients prescribed such medications are more likely to have underlying medical conditions which in themselves would be expected to be associated with a higher death rate. The authors tried to “control” for factors such as smoking, obesity and alcohol use, and found that adjusting the data to take health status into account did not change their conclusions.
The basis for good sleep is good “sleep hygiene”; if you suffer from insomnia you should not nap during the day, do not lie in bed before you are ready to go to sleep, avoid alcohol, caffeine, exercise, nicotine and spicy food in the hours before sleep. However, morning exercise and good eating habits are healthy as are modalities such as meditation, yoga and tai chi.
If insomnia persists then, as with any medical condition, the issue should be approached through a partnership with your primary care physician and your medical home. Whereas short term insomnia (less than one month duration) is most often caused by stressors such as loss of a loved one, recent illness, job insecurity, etc., longer term insomnia is more likely to be associated with mental health problems (i.e. depression, anxiety and post traumatic stress disorder), medication or drugs, primary sleep disorders (such as sleep apnea), or a wide range of medical problems.
If your insomnia is of one month duration or longer, your primary care physician will want to take a careful history, perform a physical examination, and do basic blood tests. In some cases a formal sleep evaluation is important. Called polysomnography, the test is done overnight in a special center where you are monitored during sleep for body movement, brain activity, breathing and other parameters. This has become a basic tool in the diagnosis of persistent insomnia.
After the complete evaluation, you and your physician can then discuss the best plan for your sleep, whether that includes medication or not.
So exercise this morning, relax after dinner, go to bed when you are ready to nod off, and have a good night’s sleep!
