The world looks very different at 3 a.m. when you’re lying in bed staring at the ceiling – or worse, the clock.
If you often have trouble falling asleep or staying asleep, you might have thought about trying sleeping pills. Although these medicines can help you drift off to sleep, they also can have side effects, including an increased risk for falls and morning drowsiness that can make next-day driving dangerous. That’s why the U.S. Food and Drug Administration earlier this year began requiring manufacturers to lower the recommended dosage of hypnotic sleep aids containing zolpidem (such as Ambien).
Before turning to medication, it’s important to identify whether you even have a sleep problem.
“Some people are bothered that they wake up at all, but they wake up, go to the bathroom, and go right back to sleep. There’s nothing wrong with that,” explains Dr. Hadine Joffe, associate professor of psychiatry at Harvard Medical School. Taking 20 minutes to fall asleep also doesn’t necessarily mean you have a sleep issue, she says.
If you regularly can’t get to sleep or stay asleep and it’s affecting you during the day, then you may have insomnia. But before you take medicine to help you sleep, Joffe recommends trying lifestyle interventions – such as avoiding caffeine and sticking to a regular sleep schedule. It can also be helpful to see a doctor so you can find out whether a medical condition is causing your sleep troubles.
COMMON PROBLEM AMONG WOMEN
There are several reasons why sleep problems are especially common in women, says Dr. Julia Schlam Edelman, clinical instructor in obstetrics and reproductive biology at Harvard Medical School and author of “Harvard’s Successful Sleep Strategies for Women.”
“One is the obesity rate. Sixty-five percent of women are overweight. And overweight women are more likely to have sleep-disordered breathing,” she says. Sleep-disordered breathing often refers to obstructive sleep apnea, a condition in which the airway becomes periodically blocked during the night. This blockage temporarily cuts off airflow, leading to snoring and frequent sleep interruptions. Health issues such as a thyroid condition, anemia, menopausal hot flashes, heartburn, incontinence and depression can also affect both the quality and quantity of sleep. And the medicines you take to treat health conditions – including beta blockers for high blood pressure, cold remedies containing alcohol, and migraine remedies with caffeine – can all disrupt sleep.
WHEN YOU DO NEED SLEEPING PILLS
Sometimes insomnia is so severe that you want to try medicine. Before grabbing a bottle of sleeping pills off the drugstore shelf, however, try the steps below, outlined in “Sleep Problems and Solutions.” If these steps don’t work, see your doctor, who can rule out any medical causes for your sleep issues.
You can start by trying a natural sleep aid, such as melatonin, a hormone that helps regulate the body’s sleep-wake cycle.
“Melatonin tends to be effective for women over 55,” Edelman says. It’s also safe, with few side effects. Valerian root is another herbal sleep remedy. It can have side effects, though, including headaches.
You may need to turn to over-the-counter or prescription sleep medicines if insomnia is having a real impact on your health and daily function, says Joffe. Check with your doctor before taking any sleep aid – even ones you purchase without a prescription.
“Over-the-counter sleep aids can be addictive, and they can interact with other medications,” Edelman says.
Only use prescription sleep aids such as eszopiclone (Lunesta), ramelteon (Rozerem), zaleplon (Sonata), or zolpidem (Ambien) as a last resort. Because these medicines can worsen sleep apnea, discuss with your doctor whether you might have sleep apnea.
To take prescription sleep aids safely, “You always need to be cautious about dosing,” Joffe says. Ask your doctor whether you can start on the lowest-dose, shortest-acting sleep aid possible. As you get older, your body processes and removes medicine more slowly than it did when you were younger. Also make sure you have the number of hours recommended on the package available to sleep, so you’re not groggy the next morning.
SLEEP PROBLEMS AND SOLUTIONS
Here are some common sleep problems and how to treat them:
Problem: I’m tired, but I just can’t fall asleep.
Solution: Try lifestyle changes. Limit caffeine and alcohol, especially before bedtime; make sure your bedroom is cool, dark and comfortable; and turn off all electronics (including the book you’re reading on your tablet computer) one hour before bed.
Problem: I get seven or eight hours of sleep a night, but when I wake up I’m exhausted. Also, my partner says I snore.
Solution: See your doctor, who might order a sleep study to test you for sleep apnea.
Problem: My joints ache so much that I can’t fall asleep.
Solution: Ask your doctor about arthritis pain relievers, such as non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.
Problem: I’m too stressed out to sleep.
Solution: Try stress-relieving techniques, such as meditating, taking a warm bath, or listening to music. Joffe suggests writing down a “worry list” of everything that’s on your mind before you go to bed. Once the worries are on paper, it can be easier to put them aside.
Problem: My legs twitch, tingle, and itch so uncontrollably that I can’t fall asleep, and once I do fall asleep I keep waking up.
Solution: You could have restless legs syndrome. Your doctor might suggest stretching or massaging your legs before bed. You can also take a warm bath. If lifestyle interventions don’t work, there are medicines available.
Problem: I keep waking up in the middle of the night to use the bathroom.
Solution: Limit caffeine and alcohol, which can increase the urge to urinate. Stop drinking fluids a few hours before bedtime. And use the bathroom right before you get into bed. If you’re taking diuretic medicines, talk to your doctor, because they could be contributing to the problem.
Problem: My heartburn is keeping me awake.
Solution: Try raising the head of the bed 4 to 6 inches. Eat dinner at least two to three hours before bedtime, and don’t eat anything too heavy. Avoid foods that can trigger heartburn, such as chocolate, coffee, caffeinated drinks, spicy foods and fatty foods.