35 million Americans suffer from insomnia
The Salt Lake Tribune



Research has not found a cure-all for everyone

While many of her constituents slept soundly, former Utah Gov. Olene Walker often would wander the governor's mansion in the middle of the night, responding to e-mails, reading or watching TV.
Walker suffers from insomnia, which afflicts about 35 million Americans, according to the National Center on Sleep Disorders Research.
"I've kind of reached a formula," said Walker, who is now in New York City representing The Church of Jesus Christ of Latter-day Saints as an ambassador to other countries. "If after an hour of sleeplessness you can't fall asleep, get up and do something positive. I usually average four hours of sleep, but I'd like to get six hours."
Experts link sleeping problems to stress, anxiety, weight, consumption of caffeine or alcohol and sometimes to medical conditions such as depression. Lack of sleep can have serious consequences, including traffic accidents, difficulties with concentration and health conditions, such as heart disease and stomach disorders.
But researchers have come to no consensus over its causes, or exactly how to treat it.
In August, a National Institutes of Health [NIH] panel studying insomnia released a report with this murky conclusion: "There has been limited guidance for clinicians in choosing the best treatment for chronic insomnia due to the paucity of randomized clinical trials for many widely used treatments."
The study called for more research to better define the nature of chronic insomnia and the best ways to treat it.
Treatments used now include cognitive behavior therapy, which changes both patients' behavior and thinking patterns, and a range of medications - hypnotic, or sleep-inducing, drugs, antidepressants, antipsychotics and antihistamines.
Alan Leshner, chairman of the NIH panel, summed up his recommendations: "Start with the family physician, and then go to a specialist. People shouldn't self-medicate with alcohol or antihistamines."
For short-term relief, the panel said therapy and drugs called benzodiazepine receptor agonists, including Ambien, Lunesta and Sonata, are helpful. But the members agreed that those drugs have not been studied thoroughly enough for long-term use.

Medications and melatonin: The drugs bind to a specific receptor in the brain called omega-1, which induces sleep. Bob Farney, a physician who runs the sleep clinic at LDS Hospital, believes the class of drugs can be used safely for short-term and chronic insomnia.
"Some people are worried about becoming addicted or developing a tolerance to these medications, so they avoid taking them," he said. "People have this crazy phobia about sleeping pills. It's french fries at McDonald's that are more dangerous."
The newer class of drugs are different than barbiturates, which physicians formerly prescribed for sleeping disorders. Marilyn Monroe and Elvis' deaths have been linked to barbiturates.
"[Barbiturates] have a true addiction," Farney said. "The new medications don't."
Some people claim that benzodiazepines typically used to control anxiety, such as Ativan, Klonopin and Xanax, help them sleep, but Farney said he doesn't recommend that class of drugs for insomniacs.
Others turn to melatonin, sold at health food and vitamin stores. This over-the-counter sleep aid is not regulated or approved by the U.S. Food and Drug Administration.
Melatonin is secreted by the pineal gland, a pea-size structure at the center of the brain, as eyes register the fall of darkness. The body produces the hormone to help regulate sleep-wake cycles. The amount of it produced appears to lessen as people age, contributing to sleep problems.
Farney said there is no reliable research showing that melatonin supplements are a remedy for sleeplessness.
"The problem with melatonin is when you buy it, you don't know what it is or the purity," he said. "I think it's pretty harmless, but the way it's generally used is wrong."
Farney said people should take melatonin a few hours before they want to sleep, rather than the more common practice of taking it a half hour before bedtime.

Why aren't you sleeping? Whatever sleep aid people try, experts say it's important to get to the root of the disorder. Why? Psychological factors require far different treatment than sleep apnea or bad habits, such as excessively drinking alcohol or caffeine.
The good news is that doctors often can treat sleep apnea, which occurs when a person's breathing is interrupted during sleep. People with sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night, as the muscles of their throat relax and impede or block their airway.
It can lead to a host of health problems, including hypertension, stroke and heart attacks. Patients have had success with a number of methods: losing weight, using a continuous positive airway pressure (CPAP) machine that forces air through the upper airway, or most drastically, undergoing surgery.
For patients experiencing stress, depression or other psychological distress, research has found that cognitive behavioral therapy can work better than sleeping pills.
The treatment includes behavior therapy, which trains patients how to calm their mind and body, and cognitive therapy, which teaches how thought patterns can cause sleeplessness by distorting a patient's perceptions of his or her life.
In a study at the sleep disorder clinic of Beth Israel Deaconess Medical Center in Boston, researchers found insomnia sufferers got to sleep faster and more efficiently after the therapy than after taking Ambien.
Nearly 60 percent of the treated patients fell asleep just as fast as people without insomnia did - in 30 minutes or less.
The NIH panel said therapy was one of the most promising solutions for insomnia: "It has been found to be as effective as prescription medications . . . in contrast to [the benefits] produced by medications, [the benefits of therapy] may last well beyond the termination of active treatment. There is no evidence that such treatment produces adverse effects."
When it comes to bad habits, the experts advise against drinking alcohol or caffeine before bedtime. While alcohol makes some people feel sleepy, it also dehydrates the body, leading to breathing problems that can wake a person up or reduce the quality of their sleep.
Gregory Dupont, a physician who specializes in sleep disorders at Pioneer Valley Hospital in West Valley City and Salt Lake Regional Medical Center, tells his patients not to drink caffeine after 2 p.m.
He believes it is important to have a ritual before bedtime to help ease the mind into a relaxed state. He suggests reading or watching the news.
"Many people can function with five or six hours of sleep," he said. "But it's best to get seven or eight hours."
He prescribes sleeping pills for short-term use, but says therapy is the best avenue for chronic insomnia.
"Different people react differently to pills," he said. "I don't really think you're going to find a permanent good night's sleep in a pill bottle."
chamilton@sltrib.com
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The more depressed, I got in the end insomnia took over, and made Me even more depressed in the end. I even drank Myself to sleep for years though now I take Trazodone to help Me sleep and to improve My mood to in the end. Or I would be this

I had the same problem, Kevv. It must all be tied together. Doesn't it feel good to finally get things straightened out and be able to get routine good sleep?? :) That is still one thing I have to be really careful about!

Karen (ados, currently on as Admin)

i have insomnia, but its slowly getting better, and the worse my depresion got the worse my insomnia got to

I think I need a new before bed ritual... cause I'm still doing it and it's 4:16 in the AM.

That is a pretty bold statement - that cognitive behavioral therapy works better than Ambien! Has anyone here found that to be true?

Well, I hear that Sleeping Pills may be detrimental at times, like making the person dependent on them if they take them persistently or things like that, not to mention that it can get ugly if you overdose on them.

Ambien didn't work for me.

ive never tried any pills, but anytime the following day has anything out of the ordinary planned, its hell to fall asleep.

I take Amitryptaline for my Insomnia.
Its an antidepressive and a sleep aid.
It helps.