Mental Monday: Sleepless in America

Sleepless in America is the first blog post in a new series called Mental Monday. Every Monday, I will be discussing a new topic within the realm of mental health.

Sleep. We all need it but, not surprisingly, very few of us get enough of it. A 2002 National Sleep Foundation study revealed that about 74% of all American adults experience symptoms of insomnia a few nights a week, or more. Insomnia could mean a variety of things – not able to go to sleep within 15 minutes of laying down, getting up too early, waking up periodically through the night, and not feeling rested the next morning even after an adequate amount of sleep. The research indicated that 39% get less than 7 hours of sleep each weeknight and 37% are so sleepy during the day that it interferes with daily activities. 20% of Americans use sleep medications and 15% use sleep medications every night. Women make up the majority (63%) of the people who suffer most from insomnia.  In addition, 66% of people dealing with insomnia have children in the household.

Shocking? Not really.

It doesn’t take much to figure out why parents, and specifically women, have trouble sleeping. Parenting and anxiety tend to go hand-in-hand. There is so much to worry about – money, mortgage, marriage, soccer practice, homework, paying for college, will he get into college?, crazy people, pedophiles, car accidents, H1N1…whew! It’s enough to make any parent stay up with worry every night. But who has the time to worry about all that stuff during the day? We’re too busy being pulled in a million directions and thinking about the next thing we need to do…or just don’t have time to do. Often enough, our anxieties surface much more at night than during the day. As soon as we lay our tired bodies down to sleep, those anxious worries and thoughts may begin to ruminate. It’s hard to go to sleep and stay asleep when there are a billion worrisome thoughts racing around in our minds.

If anxiety is the key factor for restless and altogether sleepless nights, there are many options for people. We all know that medication is one of them. Have you ever taken sleep medication? Chances are you have. The number of people who have tried and/or regularly use sleep medication steadily increases each year. For one thing, there are a lot more options for the sleepless, from herbal and natural remedies such as Melatonin and Tryptophan to over-the-counter sleep aids such as Tylenol PM and Nytol to prescription drugs like Ambien and Trazodone. If you choose to take a sleep medication, whether it’s herbal or prescription, it’s important to do your homework beforehand. Just like any other medication, there can be side effects and possible interactions with other medications. And for prescription medication, especially, there is also a risk for dependence, lowered tolerance, and rebound insomnia.

I have an opinion on prescription sleep medication and it’s mostly based on personal experience. Like so many other people, I have experienced anxiety issues. Several years ago, over the course of about 6 months, I had trouble sleeping and staying asleep. I called my doctor and without even stepping foot in her office, I was prescribed a variety of drugs, including Xanax and Ambien. I didn’t take the Xanax, except to fly (a story for another blog) but within a few weeks, I became dependent on Ambien. What does that mean exactly? I was not able to go to sleep at all without popping an Ambien pill. This lasted for months. I attempted to quit Ambien several times, each time more difficult than the previous time. I suffered intense panic attacks at night and even a few during the day. I also went though bouts of rebound insomnia that seemed 100 times worse than the actual insomnia I originally experienced. It was one of the most physically and mentally excruciating times in my life.  I was finally able to quit Ambien with the help of cognitive behavioral therapy, a therapeutic model that is found to be the most useful for changing negative thought-processes. It was not an easy process, but it was a process that worked in the long run. I have not taken one sleeping pill, or any other type of prescription medication for anxiety, in over 3 years and my anxiety is largely under control.

My personal experience is not to say that I think prescription sleep medications are a bad thing. Each person is different and what worked (and failed) for me may or may not work for you. I just believe that sleep medication should be considered as a last-resort for insomnia when all else fails. I would be wary of a doctor that immediately prescribes sleep medication without first suggesting other non-medicinal or non-prescription remedies and alternatives. Any prescription drug should be taken seriously and with thoughtful consideration before heading to the pharmacy. I am also of the opinion that if insomnia is related to anxiety and/or another mental health issue, any prescription sleep medication taken should coincide with therapy as well.

Tips for a good night of sleep (adapted from the National Sleep Foundation):

• Avoid caffeine several hours before bedtime. For some people, avoid caffeine at least 8 hours before sleep.
• Avoid alcohol before bedtime as it can lead to disrupted sleep.
• Exercise regularly but complete your workout at least 3 hours before bedtime.
• Establish a regular relaxing bedtime routine, such as taking a shower or bath.
• Create a sleep-conducive environment that is dark, quiet, and preferably cool and comfortable. Use a sound machine or fan for white noise. Use a sleep mask to help block out light.
• Do not nap during the day as this will interfere with your body clock. If you must nap, make sure it is less than 30 minutes. 5-10 minutes is ideal.
• Don’t eat a large, heavy meal before bedtime as indigestion can interfere with sleep.
• Don’t drink too much liquid before bedtime.
• Don’t read or watch anything too excitable, stressful, or scary prior to bedtime. In other words, don’t read or watch the news.
• Use a sleep diary, which can help a therapist or doctor determine poor sleep habits.

Sweet Dreams!