You Can Get Better Sleep

You may have discovered as you travel this weary road of life that you’re not sleeping quite as well as you did when younger. Gone are the glory days when you fell asleep next to Mom listening to a bedtime story, and then it was morning! “Why?”, you ask (and probably too often), “Am I lying here in the dark waiting to get to sleep (or back to sleep)? Other people are asleep. Why me?” No, they’re not.

Call your friends. They’re probably awake, just like you.

Actually, despite your worries, you’ll probably be less tired than you fear. You’ve fallen for that old myth about needing eight hours of uninterrupted sleep. A New York Times article summarized what sleep specialists have known for the past few years: that the human animal was never really intended to sleep steadily through an eight-hour block of time. Children, yes–eight, ten hours. But for adults, nearly half of us (myself certainly included) find it virtually impossible to experience this type of uninterrupted sleep regularly. I think of myself as a high energy sort of person and haven’t slept solidly through a night in decades.

Just 40% of us clamber into bed, are asleep within a half hour or so, and awaken refreshed the next morning. Our sleep abilities, by the way, steadily decline with age. Sixty-year-olds have more trouble than 40-somethings, who in turn sleep poorly when compared to teenagers who sleep like Egyptian pyramids. Another 40% of us sleep erratically, waking in the middle of the night, moaning as we glance over at the clock and see 2:30 AM or thereabouts. Once this was called being “sleep deprived”, but researchers have had second thoughts given that the allegedly deprived sleepers were often quite energetic and functioning well the following day…if they were able to get back to sleep in an hour or so.

Getting up between 1:30 AM and 3:00 AM is therefore not a moment for hand wringing despair.

A pattern of dividing sleep into two phases is unimaginatively called Sleep #1 and Sleep #2. For Sleep #1, you’re able to fall asleep fairly promptly and you actually sleep quite efficiently, but then you find yourself awake in the middle of the night. At this point, you can go down one of two paths. In the first, you lie awake worrying about getting back to sleep, agonizing over how tired you’ll be later in the day, complaining bitterly that it’s now too late to take a sleeping pill. On the second path you’re more accepting of the situation.

First, empty your bladder. Then, in total darkness (I’m a big fan of sleep masks as your brain makes more melatonin in the dark) try to recall your dream. Your brain wants to travel back there. If you can’t do that, visualize something delightful and concentrate on it: a vacation scene, a room from your childhood. Get the drift? Then, without being aware of it, you’ll then enter Sleep #2, a phase not as deep as the first, but if you can manage three or four hours in Sleep #2, you’ll do just fine the next day. And lo! It’s morning! (You’ll say “Hmm…I didn’t think I was asleep.”) That’s Sleep #2 for you!

The remaining 20% probably need sleep medications.

People endlessly agonize about sleep meds. In fact, many people worry so much that the worrying alone keeps them from getting to sleep. Are sleeping pills addictive? No, and you won’t go through withdrawal if you stop them suddenly. No 7-11 has ever been robbed by an addict seeking money for his Ambien. But are they habit forming? The other term for habit forming is “psychological dependence” and the answer is yes, they are habit forming. For example, if you’ve been using Ambien and you run out of pills, you’re likely to worry that your need for sleep won’t be fulfilled. If you stay off the Ambien you’ll experience a few days of what’s called rebound insomnia as your brain queries, “Hey, pal, where’s my Ambien?” before returning to your old sleep-deprived self.

We can be psychologically dependent on a lot of things that aren’t dangerous: coffee in the morning, a cocktail before dinner, jogging. Are you seeing the difference here between crystal meth and Ambien? I’m trying to help you over your fears.

There are two groups of medication-needing insomniacs:

Group one A lot of people, no matter how exhausted they are at bedtime, simply cannot fall asleep regularly. Most in this group can differentiate between a night when they’ll “probably” fall asleep on their own from a night when they’re certain sleep will elude them. For you in this group, I recommend having a sleep medicine (called a hypnotic) available. There is no more self-fulfilling a prophecy than lying in the darkness wondering if you’re going to fall asleep. Just take the Ambien (or Lunesta or whatever works), turn out the light, and go to sleep. Feeling guilty won’t help you relax. Since all three meds last just about three hours, you might try breaking the Ambien/Sonata (Lunesta is a capsule) in half, taking half at bedtime, and chewing the second half if you wake up at 2 AM. Yes, quite bitter, but you’ll get over it.

Group two People in this group fall asleep quite easily but then snap awake in the middle of the night and, instead of returning to Sleep #2, simply can’t get back to sleep. You’ve tried all the back-to-sleep tips without success. Now you’re awake and dawn is three or four hours away. You agonize over how sluggish you’ll be at work. For you, two medications are available that many patients don’t know exist, Sonata and Intermezzo. When Sonata (zaleplon) was introduced years ago, it was a flop because patients were taking it at bedtime and then waking up refreshed at 2 AM. Years later, it was recognized that Sonata’s short sleep effect was ideal for people who awoke as late as 3 AM, because the drug is virtually out of your body by 6:30 or 7:00 AM. Unfortunately, it was too late for the manufacturer to get FDA approval for “middle of night awakening” and Sonata quietly went generic (100 capsules cost about $50.00). Intermezzo is a newly released form of Ambien available in a much smaller dose (3.5 mg instead of the usual 10 mg) as an instantly dissolving lozenge, melting in your mouth and putting you to sleep within minutes. Intermezzo is definitely not generic but is covered by most health insurers.

We know that people who sleep enough so they’re not tired the next day do feel better and overall are healthier. It’s not so much the number of hours you’re sleeping, but how you feel the day after. Some people need six hours, some seven, some nine. And even though an average number for humans might be seven, those who feel great with six should leave well enough alone.

People who don’t get enough sleep feel dull and tired the next day. Ideally, they should be allowed daytime naps, but virtually no employer permits this luxury (except for Google, which encourages napping). If you feel dull and tired after a wakeful night, analyze your sleep pattern. If you simply can’t fall asleep, start by trying supplements like tryptophan, valerian, or melatonin. However, some patients report feeling groggier the next morning after using melatonin than using a prescription sleep med. Work with a sleep inducing website like calm.com can be very helpful as well. If you get nowhere with these, ask your doctor or WholeHealth Chicago practitioner for a sleep med. We won’t bite.

Life’s too short to feel guilty about taking a sleeping pill.

Be well,

David Edelberg, MD