Special Report. Sleeping well. Supplement to MAYO CLINIC HEALTH LETTER. Say goodnight to insomnia

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1 Special Report Supplement to MAYO CLINIC HEALTH LETTER Sleeping well Say goodnight to insomnia It s unclear why we need it so much, but people have long touted the restorative, recuperative qualities of sleep. Seventeenth century poet Thomas Dekker referred to sleep as the golden chain that ties health and our bodies together. Perhaps you sleep on decisions so that you can awake refreshed and ready to meet challenges that seemed too much for you the night before. A good rest also helps you look and feel better. But now, you find yourself awake for a while before you nod off. Or, you awaken in the middle of the night more often than you once did. Sometimes, you re still a little foggy in the morning. Perhaps you catch up with a nap during the day or take something to help you sleep better at night. Patterns of sleep do change as you age, but you don t necessarily have to live with restless nights. Most sleep difficulties are treatable, and addressing them often leads to a better night s sleep. The healing qualities of sleep Sleep used to be viewed as a passive, coma-like state when your whole body shuts down for a time. But thanks to modern technology, firing neurons and brain activity can be recorded and evidence from these studies suggests the exact opposite. Studies using electroencephalograms (EEGs) reveal sleep as a dynamic state that involves different areas of the brain forming complex feedback loops. Evidence suggests that brains are hard at work during sleep, possibly forming the pathways necessary for learning, making new memories and insights, and coming up with creative solutions to problems. Sleep is necessary to think and function clearly. Research shows you re more likely to be depressed or irritable, make bad decisions and take unnecessary risks when you re deprived of adequate sleep. On the other hand, people react quicker and perform mentally challenging tasks better after sleeping well. In addition to the mental boost, your body benefits in a host of other ways from being well rested. Quality sleep gives your heart and vascular system a much-needed rest, reducing your heart rate and blood pressure by about 10 percent during the night. According to some studies, if your blood pressure doesn t dip during sleep, you re more likely to have high blood pressure (hypertension), a stroke, chest pain (angina), an irregular heartbeat, a heart attack, and a buildup of fats in and on your artery walls (atherosclerosis). Inadequate sleep has also been linked to diabetes and weight problems and a tendency to crave foods that are higher in calories and carbohydrates. During sleep, your body also produces healing proteins called cytokines that fight infectious diseases or chronic inflammation. These cytokines may prompt you to sleep more than usual to help you save the energy needed to fight an infection and recover. Studies confirm that being well rested improves your body s responses to infection. Undeniably, adequate sleep is as important as adequate nutrition and exercise. And because sleep consumes about one-third of your life, it makes sense that your slumber be as golden as possible.

2 2 Special Report Bright light therapy As you age, your circadian rhythm, or sleep-wake cycle, begins to shift and your internal clock starts to reset. You may find yourself getting sleepy earlier and waking earlier. This internal clock is actually a bundle of cells in your brain that responds to light signals received through your eyes. As darkness falls, your internal clock triggers the production of the hormone melatonin. Melatonin makes you feel drowsy as it continues to increase throughout the night. Between midnight and 7 a.m., melatonin makes you feel the sleepiest. It spikes again between the hours of 1 and 4 in the afternoon not coincidentally a common time for naps. Older adults often try to stay awake in the evenings, despite feeling sleepy, yet still awaken earlier anyway. Light exposure late in the day can delay the onset of your sleep cycle by suppressing melatonin production. Studies show a reduction in nighttime awakenings with the use of bright light therapy. Home-based light therapy requires a light source sufficiently bright enough to affect your circadian rhythm. Light boxes are available from online sources, and the cost is comparable to the cost of one month s supply of prescription sleep aids. It s important that you don t fall asleep during treatment though, as the light needs to fall onto the retina to influence your circadian shift. Light therapy should be used only if prescribed by a physician. Stages of sleep All through the night, your brain s electrical activity occurs in organized, recurring cycles. First, you move through three stages of nonrapid eye movement (NREM) sleep. These stages range from initial drowsiness (stage N1) through light sleep (stage N2) and into deeper sleep (stage N3). People awakened from stage N1 sleep typically don t even realize they were asleep. Stage N2 sleep accounts for 40 to 50 percent of sleep time. Stage N3 is considered to be the most physically restorative, when your brain waves slow considerably. These are the stages when it s most difficult to be awakened. The fourth stage is rapid eye movement (REM) sleep R4 so-called because the eyes dart quickly back and forth under your lids. Dreaming occurs during this stage of sleep. Your brain is so active during REM sleep that your brain waves resemble awake patterns. Breathing becomes more rapid, irregular and shallow, and your heart rate and blood pressure increase. Your arm and leg muscles are temporarily paralyzed. This stage of sleep plays an essential, but not fully understood function. It s known that REM sleep stimulates the regions of the brain responsible for learning and forming memories. If REM sleep is disrupted during one night, you ll need to make up for it, so REM sleep time is typically longer than normal on subsequent nights until catch-up occurs. The average adult experiences four to five full sleep cycles over an eight-hour period, with each cycle lasting around 90 minutes. Sleep needs vary, depending on genetics, habits, amount of physical activity and health. Optimal sleep is seven to eight hours a night. While some people need less, too little sleep affects memory, concentration and decision making. Sleeping less than five hours a night has been shown to be bad for your physical health. Sleep quality is as important as quantity. If you feel alert, are functioning well, and don t feel tired even when you sit down and relax for a few minutes during the day, you re probably getting enough sleep. For many, sleep patterns begin to fragment with age. Your circadian rhythm, or internal clock, shifts slightly, and you may find yourself getting sleepy earlier, waking earlier, waking more frequently during the night and taking longer to fall asleep. It s commonly believed that the required amount of sleep drops substantially with aging. Rather, data suggests a slighter decrease of only 30 to 60 minutes a night is normal. Any more may result in more daytime sleepiness. Deep-wave, restful sleep (stage N3) also decreases as you get older, dropping from around 20 percent for a young adult to less than 10 percent after age 70. Older adults spend more time in stage N2 sleep, when it s much easier to be awakened. And frequent interruptions can deprive you of your full night s sleep. Although more than 50 percent of men and women 65 and older report sleep difficulties, disturbed sleep and waking up tired need not be normal parts of aging. Factors that can come between you and a good night s sleep Only a small percentage of people with sleep problems look to their doctors for help. Yet, sleep difficulties can often be traced to health issues that can be treated and resolved. In fact, the prevalence of sleep problems in healthy older adults is quite low.

3 Special Report 3 Depression and sleep Insomnia and depression often go hand in hand. Many people develop insomnia prior to being depressed, and studies show unresolved insomnia can put you at greater risk of depression. It s not clear if one causes the other, but each can worsen if untreated. Deciding on a course of treatment may be easier if you can remember when your insomnia or depression began. Lifestyle changes such as retirement and the routine changes that accompany it, new living situations, the death of a partner or loved one, physical limitations, or becoming a caretaker can affect your social life, activity level and, consequently, your sleep-wake cycle. This decreased daytime activity can adversely affect nighttime sleep. Your doctor may recommend taking sedating antidepressants, such as trazodone (Desyrel), which are often used to treat insomnia anyway. Hypnotics such as benzodiazepines may help too, beginning with the lowest dose possible and increasing if needed. Be aware of the fact that certain antidepressants, such as bupropion (Wellbutrin), may have stimulating properties and interfere with sleep. Also, medications in the selective serotonin reuptake inhibitor (SSRI) class may cause teeth grinding or worsen primary sleep disorders, such as restless legs syndrome (RLS) and periodic limb movement disorder (PLMD). Examples of SSRI prescription drugs are fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft). Factors that could be the cause of your sleep difficulties include: Pain Conditions that cause chronic pain are notorious for interrupting sleep. Poor pain control often leads to sleep difficulties, such as having a hard time falling asleep and frequent waking throughout the night. You may never reach the deeper stages of sleep. Common conditions that affect sleep are heartburn, arthritis, back pain, cancer pain and headaches, just to name a few. Nighttime urination (nocturia) Waking up to use the bathroom is the most common reason older adults wake at night, which poses a double hazard disturbed sleep and increased risk of nighttime falls. Illness Many conditions, such as coughing, shortness of breath, chronic pain and even itching, have symptoms that can interfere with your sleep. Medications Some medications associated with sleep disruption range from nonprescription decongestants to many commonly prescribed drugs, such as bronchodilators, stimulating antidepressants, corticosteroids and calcium channel blockers. Beta blockers, used to treat high blood pressure and heart disease, can cause vivid dreams, nightmares, increased waking and insomnia. Menopause In general, women complain more about their sleep than do men, despite fairly few differences in sleep studies. Postmenopausal hormones may be a factor, as hot flashes, night sweats and disturbed sleep are the primary complaints in this stage in life. Research shows that balance in menopausal women may be impaired, possibly as a result of estrogen deficiency. In one study, women who slept less than seven hours a night also had a 30 to 40 percent greater risk of falls. This combination of poor balance and less sleep could be serious when it comes to fall prevention for women especially preventing falls that occur at night. Alzheimer s disease or caring for someone with Alzheimer s Some people with Alzheimer s sleep too much, others not enough. Some wake up many times during the night. Others may wander and yell. Caregivers may lose just as much sleep as those they care for, leaving them too tired to face the challenge the following day. Good sleep habits In some cases, simple changes in your daily and nightly habits may result in better sleep. Try these sleep tips: Unwind If you lead a busy life, slow the pace of your activities in the evening. An alert mind may make relaxing for sleep difficult. Keep it quiet Close your bedroom door or create a subtle background sound, such as a running fan, to help mask other noises. Get comfy Make sure you have a bed that s comfortable and keep your bedroom comfortably cool. Research shows that a new mattress can improve sleep quality and reduce back discomfort. Limit time in bed Too much time in bed can promote shallow, unrestful sleep. Contrary to expectations, spending too much time in bed usually disrupts sleep in the middle of the night. Don t try to sleep The harder you try, the more awake you ll become. Read or watch TV until you become drowsy, and then go to your bedroom to fall asleep naturally. But don t shift your rising time in

4 4 Special Report Alcohol and sleep Your evening nightcap may not deserve its quaint nickname alcohol can interfere with a solid night s sleep. Alcohol prevents the deepest, most restful stages of sleep. You ll tend to wake up in the middle of the night when its effects wear off and waken earlier in the morning. Another hazard of drinking alcohol before bedtime is the increased risk of nighttime falls. You ll be more likely to get up to use the bathroom as well as be affected by the drinking, posing a twofold risk. Be aware that there s an increased risk associated with drinking alcohol within six hours of your bedtime. Alcohol also may increase risk of obstructive sleep apnea. Natural remedies The body naturally produces melatonin, a hormone that plays a role in the control of circadian rhythms, or sleepwake cycles. Melatonin secretion is lower in older adults particularly the surge in melatonin that occurs during nighttime sleep. For some, melatonin given several hours before retiring may be helpful. Melatonin therapy also appears effective for circadian rhythm disorders such as jet lag, but there s not as much evidence that it will work for insomnia. Melatonin, is under limited regulation by the Food and Drug Administration, so quality and the amount of active ingredients can vary. the morning just because you had a bad night. Try to maintain a firm time for going to bed and for rising. Hide the clock Visible evidence of how long you ve been unable to sleep may make you needlessly anxious. Place clocks where they aren t visible or reachable so that you won t keep checking the time. Avoid caffeine, nicotine and alcohol before bedtime Caffeine and nicotine are stimulants and can keep you from falling asleep. That late afternoon cup of coffee can keep you awake at night. And though alcohol is a depressant and may help you doze off, it can cause unrestful sleep and frequent awakenings once you do fall asleep. Exercise and stay active Aim for at least 20 to 30 minutes of vigorous exercise earlier in the day, such as brisk walking and moderate resistance training. Physical activity enhances deep, refreshing sleep and improves sleep in people with insomnia. However, for some people, exercising too close to bedtime may make it harder to fall asleep. Avoid or limit naps Studies are mixed on the issue of naps. Some find no significant nighttime interference with naps, while others don t recommend them. The best solution depends on your individual needs. If you can t get by without one, experiment with nap lengths and times to settle on what works best for you. Find ways to relax A warm bath, a glass of milk or some light reading may help prepare you for sleep. Various relaxation techniques also can teach you to relax tense muscles and reduce mental stress. Tai chi, a form of exercise focusing on gentle, fluid movements, is a relaxation technique that may help ease stress and promote sound sleep. Don t put up with pain If you re bothered by a pain, make sure the pain reliever you take is effective enough to control your night pain. Behavior therapies to help you sleep Sometimes, just thinking about your sleep or lack of it can become a sore spot for you. Cognitive behavioral therapy (CBT) aims to change negative associations with sleep and your bedroom, restoring a sense of calm and peace to your nightly ritual. This approach can replace negative thinking related to sleep, such as I ll never fall asleep without sleeping pills, with more realistic, positive thinking. Studies have proved that the long-term effectiveness of CBT is at least equal to medications alone. Some benefits of CBT, among many, are its durability you can practice it indefinitely with no side effects. Often, the most effective approach for better sleep is a combination of these therapies, plus practicing good sleep habits. Benefits can take two weeks or longer to appear, and the techniques may require regular practice. Instruction can be performed by qualified, trained nurse practitioners, psychologists or medical personnel. Although the following therapies all differ, they fall under the collective umbrella known as CBT: Stimulus control therapy This approach aims to strengthen your emotional association to the bedroom with sleeping, rather than insomnia. This is often taught in a hospital or clinic setting. Afterward, it s best when reinforced with repetition at home and keeping in contact with your instructor. Basic tenets of stimulus control include: Going to bed only when you re sleepy Establishing a standard wake-up time and sticking to it

5 Special Report 5 To nap or not to nap Some people swear by a daily nap, but many studies claim they can adversely affect your nighttime sleep. On the other hand, some studies show that napping can improve your memory as well as performance on tasks with reaction times, not only right after the nap, but the next day too. There s also some evidence that short naps up to an hour can make up for some of the sleep you lost on the previous night. What should you do? When it comes to naps, the only right answer is what works for you. If you re having trouble with nighttime sleep, but evening time is too hard to slog through without an afternoon refresher, then try adjusting the length and timing of your nap. If your nap lasts longer than an hour, you may have a hard time waking up entirely. Don t take your naps after 3 in the afternoon, when they may infringe on your evening sleepiness. If you suspect your naps are sabotaging your nighttime sleep, try to have a concrete plan to keep you occupied, active and awake during daytime. Meeting with a friend, a long walk or another type of physical activity in the afternoon may be helpful, especially if it keeps you away from the couch. Getting out of bed if you re awake longer than 15 minutes Using the bedroom for sleep and intimacy only Avoiding watching TV, reading, eating, worrying and other sleepincompatible behaviors in your bed and in your bedroom Relaxation techniques If you struggle with an overactive mind or anxiety about sleeping, relaxation approaches may be for you. These types of therapies aim to decrease your heightened physical and emotional responses to sleep by replacing anxious feelings with serenity. Some relaxation techniques include electromyographic biofeedback, meditation, guided imagery and progressive relaxation. Typical forms of relaxation therapy involve calming devices to prompt a slowing down period before sleep, such as focusing on breathing deeply or progressively tensing and relaxing each of the muscle groups in your body. These methods frequently require between two and eight sessions with a therapist to accomplish your objectives. Sleep restriction therapy The goal of this approach is to limit your time spent in bed to actual sleeping. Treatment begins by having you maintain a sleep log on which you record each night s sleep for two weeks. After two weeks, your average total sleep time is calculated from your entries and an initial prescription of sleep time is calculated. Because your initial prescription will be limited, a mild sleep debt will develop, which in turn is expected to enhance your tendency to sleep on subsequent nights. Later, your prescription will be adjusted up or down in small increments until a restorative sleep pattern is established. Avoid driving a car or operating dangerous machinery during sleep restriction therapy until you ve obtained adequate nighttime sleep. Sleep apnea If you ve been told you snore loudly, if you wake up with a headache or if you feel excessively sleepy during the day, you may have a sleep disorder called sleep apnea. Sleep apnea doesn t cause insomnia, but it does cause excessive daytime sleepiness, despite apparently sound sleep at night. It s estimated that 12 to 18 million Americans have this potentially serious disorder, with a marked increase in people ages 60 to 80. For many, the problem remains undiagnosed. There are two kinds of sleep apnea obstructive sleep apnea (OSA) and central sleep apnea. Central sleep apnea is less common and occurs when the brain fails to send proper signals to the muscles that keep you breathing adequately. As a result, you may awaken within 10 to 60 seconds for lack of air. OSA is caused by a blockage in the back of the throat that prevents enough air from reaching your lungs while you sleep. In OSA, the muscles that normally keep your airway open relax and sag during sleep, causing your tongue, palate or uvula to repeatedly block your breathing for about 20 to 30 seconds each time. This lowers the level of oxygen in your blood. Your brain senses this decrease and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don t remember it. You resume breathing, usually with a loud snort or gasp. This pattern can repeat itself up to hundreds of times a night. You re rarely able to reach deep, restorative phases of sleep and will probably feel sleepy the next day.

6 6 Special Report Parasomnias Parasomnias are disorders in which certain actions or behaviors occur during sleep that are normally suppressed, such as walking and talking and other body functions. Also, the paralysis or vivid images usually experienced during dreaming may persist after awakening. Sleep deprivation can prompt parasomnias, which include talking in your sleep, sleepwalking and nightmares. Potential side effects, though rare, of some sedative-hypnotic sleep medications such as zolpidem (Ambien) and eszopiclone (Lunesta) include sleep eating, sleep driving and sleep sex. A common serious parasomnia in adults is rapid eye movement (REM) behavior disorder (RBD). For most people, the REM phase of sleep is accompanied by near-total paralysis, except for the eye muscles. For some reason, people with RBD have full use of their muscles during this phase, and they act out their dreams. Often, this dream phase becomes frenzied and violent, and those with RBD can cause injury to themselves and their partners. RBD is much more common in men over 50. It s also been associated with withdrawal from alcohol or sedatives and the use of tricyclic antidepressants. It can be associated with Parkinson s disease and related conditions. RBD can be successfully treated with clonazepam (Klonopin), though several small trials also support the effectiveness of melatonin. In addition to the decline in well-being and the dangers associated with major sleep deprivation, sudden drops in blood oxygen levels during apneas may increase blood pressure and strain the cardiovascular system. About half of all people with OSA develop high blood pressure (hypertension), which increases the risk of stroke and heart failure. People with OSA may also complain of memory problems, mood swings or feelings of depression, a need to urinate frequently at night (nocturia), and impotence. Gastroesophageal reflux disease also may be more prevalent in people with OSA. Certain factors put you at increased risk of OSA, including: Excess weight This is especially true if you have a thick neck circumference, as excess fat narrows the airway in your throat. Being older The occurrence of OSA increases with age. Use of alcohol, sedatives or tranquilizers, including sleeping pills These substances relax the muscles in your throat. Smoking Smokers are three times more likely to have OSA than are people who ve never smoked. Early treatment is important If you think you might have sleep apnea, it s important to be evaluated and treated. Your doctor may refer you to a sleep disorder center for further testing, which may include overnight monitoring of your breathing and other body functions during sleep. Tests to detect sleep apnea include nocturnal polysomnography, which is done in a lab, or home portable monitoring devices that measure your heart, lung and brain activity, breathing patterns, leg movements, and blood oxygen levels while you sleep. If you have sleep apnea, the test results will show drops in your oxygen level during apneas and subsequent rises with awakenings. For moderate to severe OSA, your doctor may recommend more involved treatment, such as: A continuous positive airway pressure (CPAP) device Through a mask placed over your nose, a CPAP machine delivers air at a pressure somewhat greater than that of the surrounding air to keep your upper airway open. Oral appliances CPAP is more effective than oral appliances, but oral appliances may be easier for you to use. They are designed to open your throat by bringing your jaw forward, which can sometimes relieve snoring and mild obstructive sleep apnea. Surgery Though surgical outcomes for people over 50 often aren t as favorable, your doctor may recommend surgery if other methods aren t working. The most common procedure is uvulopalatopharyngoplasty (UPPP), during which tissue is removed from the back of your throat. If your jaw or nasal structures are contributing to a blocked airway, your doctor may recommend surgery to remove nasal polyps, straighten a deviated septum, or move your jaw and tongue forward. Sleep medications When it comes to taking something to help you sleep, there are many options available. However, it s important to be aware of the risks involved with any medication prescription, nonprescription or

7 Special Report 7 Movement disorders Restless legs syndrome (RLS) severe enough to be bothersome affects 2 to 4 percent of Americans and becomes more common with age. RLS is an urge to move the legs associated with a tingling, crawling sensation commonly felt in your calves that s only relieved by moving them. RLS typically occurs while you re lying down or sitting still for long periods and is most prevalent in the evening or at night. RLS can make it more difficult to fall asleep or may cause you to wake up. Diagnosis relies on a description of the symptoms. RLS is often associated with periodic limb movements of sleep, when your legs twitch or jerk every 20 to 40 seconds during sleep. Twitching episodes can last from a few minutes to several hours each night. The twitching itself isn t harmful, but it can disturb sleep. RLS can be successfully treated, but it s generally not curable. Self-care remedies include gently stretching your calf muscles for several minutes and taking a warm bath or massaging your legs about 30 minutes before bedtime. You might also try starting an exercise program that uses the legs and avoiding caffeine, nicotine and alcohol. Because RLS is associated with iron deficiency, your doctor may test your iron and prescribe iron supplementation. These disorders can also be successfully treated with medication, such as those increasing the chemical dopamine in the brain. Tongue Soft palate Uvula Blocked airway In obstructive sleep apnea, the muscles that normally keep your airway open relax and sag during sleep, causing your tongue, palate or uvula to repeatedly block your breathing for about 20 to 30 seconds each time it occurs. herbal supplement. Most sleep aids are meant to be taken for only a short time, as they can lead to dependence or their effects wear off. Talk with your doctor before taking any sleep aids to be sure they don t conflict with other medicines you may be taking or aggravate a health condition you have. Your doctor may recommend prescription sleeping pills until you notice benefits from improved sleep habits or other behavioral sleep therpies. Known as hypnotics, these drugs have a wide range of acting times. If you have taken prescription sleeping pills over a long period of time, you might want to work with your doctor to gradually reduce the dosage. Tapering the dosage can help prevent insomnia from recurring. For years, the most commonly prescribed sleep medications were a group of anti-anxiety drugs called benzodiazepines. These include alprazolam (Xanax), diazepam (Valium), temazepam (Restoril) and estazolam. Some benzodiazepines have a longer duration of action and may be more likely to reduce your mental alertness the following day. Some also have the potential to build up in your system, and this is especially true in older adults. This buildup can cause increasing sedation, confusion and amnesia, and can greatly increase your risk of falls. Other prescription drugs are used exclusively for insomnia, rather than anxiety or other disorders. These medicines act on the same brain receptors as do benzodiazepines, but they differ chemically. They are shorter acting than drugs related to the benzodiazepine group, ranging from one to nine hours. Zaleplon (Sonata) is a short-acting nonbenzodiazepine that can kick-start a good night s sleep by helping you fall asleep faster, or can be taken in the middle of the night, yet still wear off by morning. Zolpidem (Ambien), also relatively short acting, should be taken before sleep, with the expectation that its effects will last through the night.

8 8 Special Report Keeping a sleep diary Before you visit your doctor for sleep problems, it may be helpful to keep a sleep diary for a week or more. Write down your sleep habits and your daily schedule. Include your time to bed, time of sleep onset, any nightly trips to the bathroom, time of final awakening, number of awakenings and daytime naps. Add to that your intake of alcohol, caffeine and medications include sleeping medications as well as any exercise or any pain you re having. If you have a sleeping partner, it may be helpful to ask that person to fill in any blanks for you, like loud snoring, breathing pauses or movements. What is insomnia? Insomnia is defined as having trouble falling asleep, staying asleep or having unrefreshing sleep. Many people have occasional, temporary insomnia. Chronic insomnia is defined as having symptoms at least three nights a week for more than a month. Most cases of chronic insomnia are secondary, meaning insomnia is caused by another disorder or by medications. Primary chronic insomnia is a distinct sleep disorder whose cause isn t yet fully understood. People with primary chronic insomnia have a tendency to be more revved up and have higher body temperatures and faster heart rates than normal. Many options available Continuous positive airway pressure (CPAP) masks and headgear come in many styles and sizes to comfortably treat your sleep apnea. Everyone has different needs and face shapes, so you may need to try a variety of CPAP masks before finding the right one for you. And just because you re a certain size in some styles of CPAP masks doesn t mean you ll be the same size in others. Eszopiclone (Lunesta) and zolpidem extended release (Ambien CR) are intermediate-acting drugs in this group. Their effects last the longest. Ramelteon (Rozerem) is a newer, milder prescription sleeping drug that works by affecting the melatonin receptors in your brain. Melatonin is the hormone in your body known for regulating your sleep-wake cycle. Ramelteon differs from the benzodiazepine groups in that it s not known to be habit-forming and doesn t depress respiration, so it doesn t adversely interact with narcotics and may be used by people with chronic obstructive pulmonary disease (COPD). Your doctor may consider prescribing antidepressant drugs to treat your insomnia, even if you aren t depressed. Trazodone (Desyrel) is often prescribed at low doses. Nonprescription sleep aids typically contain antihistamines to induce drowsiness. They re approved by the Food and Drug Administration (FDA) for only occasional sleeplessness and not intended to be used for more than a few nights or for severe insomnia. Some may help you fall asleep, but leave you feeling unrefreshed, groggy and still tired in the morning. In addition, a commonly used antihistamine, diphenhydramine, can cause difficulty urinating for men with enlarged prostates. A restful reward If a good night s sleep seems to be eluding you, there are many options to help you get the rest you need. Your sleep patterns may be changing, but that doesn t have to mean a change for the worse. If you d like a more refreshing sleep experience, it may take some sleuthing, experimenting and strategy on your part, but a better night s sleep is likely within your reach Mayo Foundation for Medical Education and Research, Rochester, MN All rights reserved. To inquire about your subscription, call Customer Services at ISSN MC T Printed in USA

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