People who suffer from the most common sleep disorder, insomnia, have difficulty falling or staying asleep. Sleepiness caused by insomnia reduces concentration and slows reaction time during waking hours, leading to reduced productivity and accidents. One in three adults experiences some degree of insomnia at one time or another, especially during periods of stress. Longer-lasting cases of insomnia, called chronic insomnia, are less common and may be caused by a number of factors in addition to stress, including imbalances in body chemistry or other medical conditions.
Taken under the guidance of a qualified physician, sleeping pills are an effective treatment for temporary insomnia and may help some chronic insomnia patients. In some cases of insomnia, psychological treatments and physical exercise programs help patients identify or manage stress, enabling them to sleep better. Recent work has suggested that melatonin, a hormone naturally released into the bloodstream during the hours of darkness, may play a role in synchronizing sleep to a 24-hour cycle. Results from studies of the effects of melatonin on human sleep have been inconsistent. However, some evidence suggests that supplements of this hormone combat insomnia in older people who are melatonin deficient.
Narcolepsy is a sleep disorder that affects both NREM sleep and REM sleep mechanisms. Narcoleptics are persistently sleepy and experience periodic losses of muscle tone called cataplexy. During cataplectic attacks, the narcoleptic's muscles weaken, and if the attack is severe, the narcoleptic falls to the ground. Cataplectic attacks are triggered by sudden strong emotional reactions, such as laughter. A related symptom, called sleep paralysis, can occur when the narcoleptic is lying down, prior to falling asleep or just after awakening. At these times the person may lose muscle tone, resulting in an apparent paralysis, while remaining fully awake. Sleep paralysis can be terrifying if the narcoleptic does not realize that it is not life threatening. Animal studies have shown that the loss of muscle tone experienced by narcoleptics in waking results from an activation of the REM sleep-active and an inactivation of the REM sleep-inactive systems that normally function to reduce muscle tone in REM sleep. Narcoleptics are treated with stimulants to block sleepiness and with REM sleep suppressants to block cataplexy.
Children often experience one of several sleep disorders. Nocturnal enuresis, commonly known as bedwetting, typically occurs during NREM sleep. Sleep talking and sleepwalking also usually occur during NREM sleep (see Somnambulism). Night terrors, typically marked by a scream and a terrified, confused awakening, affect many children. These disorders do not indicate any serious neurological or behavioral problem. Children suffering from them usually outgrow them by puberty, although sleep talking and sleepwalking may persist into adulthood.
In another common disorder, sleep apnea, relaxation of the muscles of the tongue and the soft palate at the base of the throat, allows the breathing passage to collapse in individuals with a narrow airway. Although chest movements may continue, no air flows into the lungs and oxygen levels in the blood decrease. When blood oxygen levels fall too low, the person briefly wakes to take a breath. This gasping breath can produce a loud, characteristic snort. The cycle of sleeping, airway collapsing, waking, and sleeping repeats, often hundreds of times in a night. Individuals with sleep apnea do not remember these brief awakenings and believe they slept through the night. However, the interrupted sleep leaves the individual exhausted in the morning and sleepy throughout the day. If left untreated, sleep apnea may also cause cardiovascular problems and greatly shorten life span. Effective treatments are available at medical centers specializing in sleep disorders. One treatment, called continuous-positive-airway-pressure (CPAP), uses a mask to deliver a stream of air through the nose, preventing airway collapse, restoring normal sleep. Sometimes surgical treatments that enlarge the airway can be effective.
Herbal sleeping pills
Thursday, June 28, 2007
List of all sleeping pills
David Neubauer, M.D., Associate Director of the Johns Hopkins Sleep Disorders Center, talks about insomnia.
A good night’s rest can become a rare commodity as you age. This is because sleep patterns change as you get older: You spend more time in the lighter stages of sleep and less time in the deep, restorative stages. If you have trouble falling asleep or staying asleep more than three nights a week, or if lack of sleep leaves you exhausted, you probably have insomnia. David Neubauer, M.D., Associate Director of the Johns Hopkins Sleep Disorders Center and the author of Understanding Sleeplessness (Johns Hopkins University Press), explains his approach to insomnia and evaluates the new sleeping pills.
Q. A new Gallup survey finds that most people with sleep problems or insomnia never ask their doctors for help. What would you tell them?
A. People should have a low threshold for talking to their doctors about insomnia. Insomnia is not just one problem but is simply the end product of a lot of potential problems. Insomnia can occur in response to stressful events, but it may also be related to an underlying and/or undiagnosed medical condition such as depression or other psychiatric problems, chronic pain, Alzheimer’s disease, or digestive problems. People may think they have insomnia when what they have is sleep apnea (heavy snoring and interrupted breathing during sleep). The physician should work with the patient to discover the cause or causes of the insomnia. Underlying disorders can be treated. Evaluation at a sleep disorders center or clinic may also be appropriate.
Q. How effective are sleeping pills for treating insomnia?
A. They can help break the cycle of insomnia. For many years, the benzodiazepines—so-called tranquilizers, such as Valium (diazepam), Halcion (triazolam), Xanax (alprazolam), Restoril (temazepam), and others—have been prescribed for insomnia. Since they are available as generics, they are inexpensive. Because of their long-lasting effects, they may leave you groggy and/or disoriented the next day. Some research has suggested that such side effects as falls may actually outweigh the benefits for older people. These drugs tend to be habituating—that is, you may require larger doses over time. For that reason, they are only approved for short-term use of insomnia.
Q. Are newer drugs, such as Ambien (zolpidem), Sonata (zaleplon), Lunesta (eszopiclone), and Rozerem (ramelteon), better choices for insomnia treatment?
A. Ambien, Sonata, and Lunesta—the nonbenzodiazepines— more precisely target chemical receptors in the brain and have fewer side effects than the older drugs. These sleeping pills have been extensively studied for older people and found to be safe and effective. Rozerem, very recently approved, is different in its chemical action; it triggers the release of melatonin, a natural brain chemical that controls sleep.
Q. Which, if any, of these sleeping pills would you prescribe for insomnia?
A. Much depends on a patient’s specific problems. Having trouble falling asleep is one problem, having trouble staying asleep is another. Working out the proper dosage may take time. Some people can reestablish their sleep cycles fairly quickly on small doses. But if sleeping pills are needed for long-term use for insomnia, there’s no reason not to prescribe one of the newer sleeping pills. Lunesta, Roserem, and a new time-release formulation of Ambien CR (zolpidem) have been approved by the FDA for long-term use for insomnia. But they are very expensive. None comes as a generic. People taking sedatives for insomnia should keep in touch with their doctor for regular reevaluation of progress as well as side effects if they occur.
The New Sleeping Pills
Ambien (Zolpidem) induces sleep quickly but causes grogginess if you sleep less than eight hours. It is not approved for long-term use. 30 tablets (5 mg) cost about $80. Ambien CR, a new time-release pill, is approved for long-term use. 30 tablets (6.25 mg) cost about $100.
Sonata (Zaleplon) wears off in about four hours. It can be taken during the night if you have problems staying asleep. 30 tablets (5 mg) cost about $75.
Lunesta (Eszopiclone) will help you fall asleep quickly but should only be used when you expect to get eight hours of sleep. Otherwise, temporary memory loss may result. Lunesta should not be taken right after a heavy meal. 30 tablets (1 mg) cost about $100. It is approved for long-term use.
Rozerem (Ramelteon) is not a controlled substance, although manufacturers warn that its use increases the possibility of addiction or abuse. Rozerem helps with sleep-onset problems but is not recommended for restarting sleep if you wake up during the night. 30 tablets (8 mg) cost about $130.
Prescription sleeping pills
A good night’s rest can become a rare commodity as you age. This is because sleep patterns change as you get older: You spend more time in the lighter stages of sleep and less time in the deep, restorative stages. If you have trouble falling asleep or staying asleep more than three nights a week, or if lack of sleep leaves you exhausted, you probably have insomnia. David Neubauer, M.D., Associate Director of the Johns Hopkins Sleep Disorders Center and the author of Understanding Sleeplessness (Johns Hopkins University Press), explains his approach to insomnia and evaluates the new sleeping pills.
Q. A new Gallup survey finds that most people with sleep problems or insomnia never ask their doctors for help. What would you tell them?
A. People should have a low threshold for talking to their doctors about insomnia. Insomnia is not just one problem but is simply the end product of a lot of potential problems. Insomnia can occur in response to stressful events, but it may also be related to an underlying and/or undiagnosed medical condition such as depression or other psychiatric problems, chronic pain, Alzheimer’s disease, or digestive problems. People may think they have insomnia when what they have is sleep apnea (heavy snoring and interrupted breathing during sleep). The physician should work with the patient to discover the cause or causes of the insomnia. Underlying disorders can be treated. Evaluation at a sleep disorders center or clinic may also be appropriate.
Q. How effective are sleeping pills for treating insomnia?
A. They can help break the cycle of insomnia. For many years, the benzodiazepines—so-called tranquilizers, such as Valium (diazepam), Halcion (triazolam), Xanax (alprazolam), Restoril (temazepam), and others—have been prescribed for insomnia. Since they are available as generics, they are inexpensive. Because of their long-lasting effects, they may leave you groggy and/or disoriented the next day. Some research has suggested that such side effects as falls may actually outweigh the benefits for older people. These drugs tend to be habituating—that is, you may require larger doses over time. For that reason, they are only approved for short-term use of insomnia.
Q. Are newer drugs, such as Ambien (zolpidem), Sonata (zaleplon), Lunesta (eszopiclone), and Rozerem (ramelteon), better choices for insomnia treatment?
A. Ambien, Sonata, and Lunesta—the nonbenzodiazepines— more precisely target chemical receptors in the brain and have fewer side effects than the older drugs. These sleeping pills have been extensively studied for older people and found to be safe and effective. Rozerem, very recently approved, is different in its chemical action; it triggers the release of melatonin, a natural brain chemical that controls sleep.
Q. Which, if any, of these sleeping pills would you prescribe for insomnia?
A. Much depends on a patient’s specific problems. Having trouble falling asleep is one problem, having trouble staying asleep is another. Working out the proper dosage may take time. Some people can reestablish their sleep cycles fairly quickly on small doses. But if sleeping pills are needed for long-term use for insomnia, there’s no reason not to prescribe one of the newer sleeping pills. Lunesta, Roserem, and a new time-release formulation of Ambien CR (zolpidem) have been approved by the FDA for long-term use for insomnia. But they are very expensive. None comes as a generic. People taking sedatives for insomnia should keep in touch with their doctor for regular reevaluation of progress as well as side effects if they occur.
The New Sleeping Pills
Ambien (Zolpidem) induces sleep quickly but causes grogginess if you sleep less than eight hours. It is not approved for long-term use. 30 tablets (5 mg) cost about $80. Ambien CR, a new time-release pill, is approved for long-term use. 30 tablets (6.25 mg) cost about $100.
Sonata (Zaleplon) wears off in about four hours. It can be taken during the night if you have problems staying asleep. 30 tablets (5 mg) cost about $75.
Lunesta (Eszopiclone) will help you fall asleep quickly but should only be used when you expect to get eight hours of sleep. Otherwise, temporary memory loss may result. Lunesta should not be taken right after a heavy meal. 30 tablets (1 mg) cost about $100. It is approved for long-term use.
Rozerem (Ramelteon) is not a controlled substance, although manufacturers warn that its use increases the possibility of addiction or abuse. Rozerem helps with sleep-onset problems but is not recommended for restarting sleep if you wake up during the night. 30 tablets (8 mg) cost about $130.
Prescription sleeping pills
Names of sleeping pills
Every minute of shut-eye counts when you're a new mom. But sometimes you just can't fall asleep when you need to. When — if ever — is it okay to pop a pill?
• "Sleep is important no matter how you can get it in the beginning," says Joyce Walsleben, Ph.D., former director of the Sleep Disorders Center at New York University School of Medicine. "I'm fully in favor of quick fixes in certain situations."
• A sleeping pill is appropriate on an occasional basis, she says, but you should have backup babycare (Dad counts!) and you shouldn't nurse until the morning after you take one, as the drug may get into your breast milk. Two brands Walsleban likes for new moms? Sonata and Rozerem. "Sonata is short-acting," she says. "It will get you to sleep but allows you to be alert in the morning." Similarly, Rozerem, a nonsedating sleeping pill, won't leave you with a sleep hangover.
• Avoid certain sleeping agents, including Ambien, Lunesta, Sominex, Benadryl, and Tylenol PM. They're longer-acting and may be more tranquilizing than you need, says Walsleban.
Online sleeping pills
• "Sleep is important no matter how you can get it in the beginning," says Joyce Walsleben, Ph.D., former director of the Sleep Disorders Center at New York University School of Medicine. "I'm fully in favor of quick fixes in certain situations."
• A sleeping pill is appropriate on an occasional basis, she says, but you should have backup babycare (Dad counts!) and you shouldn't nurse until the morning after you take one, as the drug may get into your breast milk. Two brands Walsleban likes for new moms? Sonata and Rozerem. "Sonata is short-acting," she says. "It will get you to sleep but allows you to be alert in the morning." Similarly, Rozerem, a nonsedating sleeping pill, won't leave you with a sleep hangover.
• Avoid certain sleeping agents, including Ambien, Lunesta, Sominex, Benadryl, and Tylenol PM. They're longer-acting and may be more tranquilizing than you need, says Walsleban.
Online sleeping pills
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