After a long day of work and study, sleep should come easily. But for many — even those who lay off the Red Bulls and fall-spiced espresso drinks — sleep remains a distant dream.
The quick fix for those who can’t catch enough Zs at night to stay awake in class for As in the morning often involves popping a sleeping pill. But a recent report suggests the popular pills may not be as effective as one would hope, and many experts are promoting other, drug-free means of falling asleep.
According to a National Institutes of Health analysis this year, newer drugs such as Ambien, Lunesta, and Sonata do tend to work better than older medications like Dalmane and Restoril, but their results are still less than dynamic. Sleeping pills are reported to reduce the time it takes to fall asleep by 12.8 minutes, newer drugs extend sleep for only 32 minutes — compared to the older drugs, which extend sleep time for 52 minutes.
According to Beth Israel Deaconess Medical Center statistics, insomnia haunts more than 70 million Americans, who spend spend about $4.5 billion a year on sleep medications. But is it worth $3.50 for one pill that may only give you 11 to 19 minutes of extra sleep?
Some say no, some say yes, others give the green light only if some basic lifestyle changes don’t work first.
ERRATIC HOURS
“Sleeping pills extend sleep only a little. By no means do they make a dramatic difference,” said Dr. Carolyn D’Ambrosio, Director of the Center for Sleep Medicine at Tufts-New England Medical Center.
She said that sleeping pills are for most people best relegated to short periods of use, usually for jet lag resulting from travel between different time zones — but not to remedy a problem that is as much to blame on personal habits as it is on external factors.
“College students self-medicate with alcohol or other substances. They drink energy drinks all day, drink alcohol, go to bed late and then repeat the cycle. They are the number one example of bad sleep habits,” D’Ambrosio said. “I don’t like sleeping pills. They feed into the erratic hours and the caffeine intake.”
D’Ambrosio said many who can’t sleep take a pill because they are frustrated, exhausted and just want to feel better. When most people go to a doctor with sleeping problems, the first thing they ask for is a sleeping pill – which they think will be a quick fix that will deliver those precious eight hours of sleep.
New sleeping pills boast that they cause no chemical dependence, but many patients still become psychologically attached. Dr. D’Ambrosio said she has patients who never refill their prescriptions. They just keep the prescription on hand – just in case. “Just knowing they have the pill allows them to calm down and sleep,” D’Ambrosio said.
Despite a dramatic increase in popularity — sleeping pill prescriptions have grown fivefold within the last decade — D’Ambrosio cautions those looking for some shuteye. “Most people should try to avoid sleeping pills. Recognize they have limited benefit, are not a guarantee of benefit, and are by no means a cure for insomnia.”
A CYCLE OF ANXIETY
Sleeping pills target the same brain receptors as anti-anxiety drugs, reducing a person’s worry that they aren’t getting enough sleep — often part of a cruel cycle of insomnia — allowing them to fall asleep faster. The anxiety doesn’t always stem from lack of sleep itself, though, but from everyday stresses of school and work.
Before prescribing sleeping pills, Dr. Margaret Ross, the Director of Behavioral Medicine at Boston University Student Health Services, checks for factors that may lead to poor sleep patterns, including anxiety and stress factors.
“When we see a student who is having trouble sleeping, we will first try to determine if there is anything that might be causing this. Depression can interfere with sleep, some medical conditions can, stress of course can interfere,” Ross said in an email. She prescribes sleeping pills only after all other methods to get sleep have been exhausted.
Emily Yoerger, a College of Arts and Sciences freshman, was diagnosed with insomnia a year-and-a-half ago and has been prescribed three different sleeping pills. “I haven’t had a whole lot of success with sleeping pills. Some didn’t even help me fall asleep at all. With the sleeping med[ications] that have worked, it’s hard because I wake up feeling groggy.”
Yoerger believes her insomnia started with stress. She struggled to adapt to the hectic schedule of a college student living in a dorm room with two other girls. “It got much worse when I came [to college]. I’m on a totally different schedule than in high school. . . . My mind gets tired, my body gets tired and I just can’t sleep.”
While it is recommended by the National Sleep Foundation that adults receive seven to nine hours of sleep a night, a 2004 University of California-Davis Student Affairs Research and Information Department study estimated that 52 percent of college students get fewer than eight hours of sleep a night.
Yoerger, then, is not alone in estimating she sleeps about six hours a night. “If I have work to do I can just stay up all night,” she said. “I just forget to go to sleep.”
When taking sleeping pills, many companies recommend that setting aside at least eight hours to sleep; however, that doesn’t mean those taking sleeping pills will actually ensure a full eight hours of sleep.
“They never keep me asleep for eight hours. When I do fall asleep, I wake up soon afterwards and I don’t feel rested at all,” Yoerger said.
Meghan Wieckowski, a CAS sophomore, hasn’t been diagnosed with a sleeping disorder, but uses at times uses aids such as Tylenol PM when she has trouble getting to sleep.
“I’m the type of person who needs about 10 hours of sleep,” said Wieckowski. “If I really need to get a good night’s sleep for the next day and I can’t fall asleep, I’ll take something.”
While Wieckowski says she only uses sleeping agents about once a month, she claims that her restless nights may be caused by stress. “It usually goes in spells which I think [are] stress-induced. It’s never lasted more than four days.”
SHEEP-BY-SHEEP BASIS
Dr. Sanford Auerbach, Director of the Boston Medical Center Sleep Disorders Center, said new drugs like Lunesta and Ambien CR make it easier for sleep physicians to treat individual needs — on a case-by-case basis.
“Sleeping medications are wonderful things to have. They are wonderful agents to use to tailor to the right patient with the right problem,” Auerbach said.
Both Lunesta and Ambien CR can be tailored to individual regimens, and are relatively safe under appropriate and supervision, he said.
Sleep problems are not the same across the board. Stress, environmental factors, medical conditions like insomnia — all can adversely affect sleep patterns.
“The first issue is ‘what is going on with this particular individual?'” Auerbach said. “What’s the sleep problem? Is sleeping medication appropriate for this individual?”
Sepracor Pharmaceutical Company, manufacturer of Lunesta, did not answer requests for comment.
SLEEP ON IT
So what’s the answer? According to the National Institutes of Health analysis as well as a 2004 study done by Beth Israel Deaconess Hospital, it may not be found in a pill — some experts prefer to help patients change their habits instead.
“Cognitive-behavioral therapy teaches people to change sleep behavior that causes insomnia,” said Dr. Gregg Jacobs, an Insomnia Specialist at the Sleep Disorders Center at the University of Massachusetts Medical School and founder of CBTforINSOMNIA.com, a website that provides an interactive drug-free program for insomniacs.
CBT permanently improves sleep in 80 percent of patients with insomnia, according to Jacobs.
“The longer you use sleeping pills, the less effective they become and the more dependent on them you become. They cause greater mortality if you use them long-term,” Jacobs said. “There are several situations in which you wouldn’t recommend sleeping pills: if you are pregnant, use alcohol or very young. There are few situations in which you wouldn’t recommend CBT.”
Jacobs teaches CBT to patients over a four- to six-week period, after which patients no longer need to practice consciously because it becomes part of their daily routine. As part of CBT, patients establish a consistent sleep schedule based on a sleep diary, learn relaxation techniques through MP3 files and use cognitive techniques aimed at helping them worry less.
“The college lifestyle has a lot of variables: sleeping in late, staying up later; the environment is not conducive to sleep,” Jacobs said.
But a a regular sleep schedule is crucial in college, Jacobs said. That schedule can include naps to make up for sleep lost in staying up later, but only if the naps are done right, he said. “Use naps to help oneself. Learn to nap carefully. Napping technique can be helpful, but it can also be harmful,” Jacobs said.
According to Student Health Services’ Ross, simple changes can improve chances of getting some quality shuteye, especially limiting caffeine intake and being aware of “sleep hygiene.”
“I help the student figure out a ‘bedtime ritual,’ just like young children have, when they need a bedtime story to help them to sleep. I suggest things like putting aside your work or whatever a good half an hour before you want to actually go to sleep. Take a hot bath or shower, then get in bed and turn off the lights. Do some deep breathing; visualize some peaceful places. Some people like to read something boring, like a course guide or phone book,” Ross said.
She also suggests establishing a constant time to go to bed and wake up. “Try to use your bed only for sleep and sex, not studying or reading, so you associate [your bed] with sleep,” she said.