No more tossing and turning: drug-free ways to get your zzz's - includes sources and related articles

"AMERICA IS A NATION whose citizens do not get enough sleep," says William C. Dement, M.D., Ph.D., director of the Stanford University Sleep Disorders Clinic in Stanford, California. He ranks sleep deprivation along with sleep disorders as our number one health problem.

Dr. Dement is not alone in his concern. Recent research indicates the problem of sleeplessness has reached epidemic proportions in America and may be getting worse. A 1995 Gallup Poll conducted for the National Sleep Foundation, a non-profit organization in Washington, D.C., found 50 percent of Americans have trouble sleeping some of the time and 12 percent have frequent insomnia, compared to 1991 figures, when 33 percent reported trouble sleeping some of the time 10 percent complained of frequent insomnia (duration of three or more weeks.)

Where has this epidemic come from? No one knows the specific cause but many experts implicate our increasingly hectic way of life. Nancy K. Lonsdorf, M.D., Center in Washington, D.C. offers this explanation, "We have a society that has created insomnia through overwork and pressure at the expense of inner peace, harmony and balance."

Most of us have experience this lack of inner peace firsthand, watching infomercials through the wee hours of the morning. After nights like these when we've had trouble falling asleep or sleeping soundly, we feel the consequences the next day. Peter Haurim Ph.D., director of the Mayo Sleep Disorders Clinic, in Rochester, Minn. and co-author of No More Sleepless Nights (John Wiley and Sons, 1990), says the main effect is feeling sleepier than usual with a lower attention threshold for boring tasks. What to do when this kind of occasional insomnia strikes? Probably nothing. Hauri urges people not to be afraid of occasional insomnia because just worrying about it creates anxiety perpetuating the problem.

More frequent sleeplessness, however, may indeed merit concern as it can be costly to your well-being. Common symptoms of chronic insomnia include moodiness, irritability, depression, reduced physical and mental performance, lessened ability to bounce back from stress, impaired immune function and a tendency to be accident-prone. You should call your doctor if you routinely have difficulty sleeping or you feel anxious about falling asleep. Insomnia can be a symptom of medical, emotional or behavioral problems that need attention so don't be surprised if your doctor wants to do a physical exam and orders lab tests. You may even be referred to a sleep disorders clinic for a more sophisticated evaluation.

A CUSHION OF PILLS

Once serious medical disorders are ruled out, some doctors prescribe sleep medications. Sleeping pills are not, however, without risk. They disturb normal sleep patterns, cause "morning after" hangovers, amplify the effects of alcohol and impair coordination, increasing the risk of auto accidents. If that were not enough, you will probably need higher doses over time to experience the same effects, and withdrawal will cause a rebound in insomnia that can result in a vicious cycle of overdosing, addiction and even death. The safest, and therefore the most often prescribed sleeping pills are the benzodiazepines--Valium, Restoril, Prosom, Doral, Dalmane, Halcion--and Ambien, drugs that have been linked with temporary amnesia, a rare side effect.

Many people take over-the-counter sleeping medications, which usually have antihistamines as the main ingredient. While not as strong as prescribed sleeping pills, antihistamines (which are usually found in allergy medications) can cause side effects such as dry mouth, constipation, visual difficulties and agitation. Like sleeping pills sold by prescription, over-the-counter remedies don't work for very long because your body adapts to them.

Are sleeping pills ever warranted? Hauri says they may be appropriate when insomnia is acute or when it's very important you get a good night's rest, such as before a big presentation or exam. He urges people to use pills at their lowest effective dose and only for a few nights at a time.

MENTAL MASTERY: BEYOND COUNTING SHEEP

Almost all Chronic insomniacs need the help of some behavioral therapy, according to Sonia Ancoli-Israel, Ph.D., director of the Sleep Disorders Clinic at the Veterans Administration Medical Center in San Diego, Calif., and author of a new book, All I Want is a Good Night's Sleep (Mosby, 1996). The first step is to identify poor sleep habits and replace them with good ones. Beyond that, relaxation training seems to help many people, a observation supported by a growing body of clinical research.

One technique, progressive relaxation, involves tensing and relaxing groups of muscles sequentially, starting at the toes and working up to the head. Other mindbody techniques such as meditation, biofeedback, self-hypnosis and yoga also have been reported by scientists to be effective in evoking a restful state conducive to sleep. Ancoli-Israel is convinced that "In the long run, behavioral therapies work better than pills."

At the Maharishi Ayur-Veda Medical Center, Dr. Lonsdorf, sees many patients with insomnia. She recommends her patients learn transcendental meditation (TM). This technique, practiced twice daily for 15 to 20 minutes, involves closing the eyes and repeating a mantra, a prayer-like phrase, to quiet and focus the mind. TM produces deep physiologic rest and a reduced level of stress.

According to a report from the October 1995 National Institutes of Health Technology Assessment Conference, "Well-controlled, randomized studies have fauna that TM reduces time needed to fall asleep, causes deeper and more continuous sleep and results in a more restful quality of sleep."

NATURAL SLEEP AIDS

Elaine Calenda, Nationally certified massage therapist and faculty chair at the Boulder School of Massage Therapy, says a slow, rhythmic massage with particular attention to the spine and surrounding muscles induces deep relaxation. The ideal time is near bedtime. If you don't happen to have a live-m masseuse, Calenda says, a massage therapist can teach you to reduce tension with a self-massage that focuses on the temples, ears, jaw, throat and chest.

Herbs offer another way to soothe away restlessness. Although no substance should be used AS a crutch to mask the symptoms of insomnia, herbal medicines are far safer and gentler than sleeping pills. Herbs can be taken internally or absorbed through the skin from an infusion added to your bath. According to Rob McCaleb, president of the Herb Research Foundation in Boulder, Colo., a number of herbs can ease insomnia. Those supported by both a long history of use and scientific studies include valerian root, California poppy, hops and lemon balm. Note: To make herbal teas, combine one teaspoon of dried herb or two tablespoons of minced, fresh herb in one cup of hot water. If you are pregnant or nursing, do not take any medicinal herb without first consulting a skilled practitioner.

Valerian root (no relation to Valium) is McCaleb's first choice. In scientific studies, the extract has been shown to reduce the time to fall asleep and to improve sleep quality. It leaves no "morning after" hangover, has no synergistic action with alcohol and doesn't lead to addiction. The herb should be taken 30 to 45 minutes before bedtime at one of these doses: 1 to 2 grams (g.) of the root in tea, 1 to 1.5 teaspoons of tincture or 150 to 300 ma. of an extract standardized for valeric acid, the active ingredient. McCaleb prefers an extract of the fresh root (as opposed to an extract of dried root) because it tastes better. He says in one out of ten people this herb has a stimulating instead of a sedating effect.

California poppy, according to McCaleb, is a promising new herb for insomnia Usage is fairly recent and there's not as much research available in its support as there is for valerian root. The California poppy, as opposed to the opium poppy, is gentle and contains no narcotics. The whole plant is used, one teaspoon for each cup of tea. If you re using am extract, follow the manufacturer's dosage recommendations.

Hops are also sedating. McCaleb cites a clinical study in which a combination of valerian and hops was found to reduce stress and improve sleep. (In fact, one well-known European folk remedy for insomnia is to sleep on a pillow filled with hops.) For internal use, blend equal parts of valerian and hops extracts and take 3 0 drops before bedtime. Caution: Hops should be avoided during pregnancy.

Lemon balm is mildly calming and better tasting than valerian root. McCaleb recommends brewing it in hot but not boiled water, adding 1.5 to 4.5 grams of the dried herb per cup of tea. (A teaspoon is about two grams; a heaping teaspoon is 3 to 4 grams.) Although considered a gentle herb, pregnant women shouldn't take it.

Other gentle herbs for sleep include passionflower (said to be good for quieting those late night worry sessions), oats, skullcap and chamomile McCaleb also recommends St. John's wort for people who have trouble sleeping because of mild depression and kava kava root when anxiety contributes to insomnia.

Botanicals also can help you coax sleep -with soothing scents. Marcel Lavabre, president of Aroma Vera, an essential oils company in Culver City, Calif., favors fragrant oils of neroli (orange blossom), marjoram, spikenard, Roman chamomile, lavender and ylang ylang for a good night's rest.

Lavabre says you can put a couple drops of undiluted neroli, marjoram or lavender on your pillow. As a general rule, you shouldn't apply undiluted essential oils on your skin because they might elicit an allergic reaction. Instead, try adding 10 to 15 drops to the bath. The heat of the water provides a double-benefit: It gently diffuses the scent while it relaxes muscular tension. Lavabre suggests a mixture of 5 drops lavender, 5 drops marjoram, 3 drops ylang ylang and 2 drops spikenard. You can also make a massage oil by adding 12 to 15 drops of this blend to one ounce of a high quality oil such as almond oil. Either solicit a massage from a loved one or apply the oil to your forehead, temples and back of the neck.

Here's to sweet dreams and restorative sleep. If you have a sleepless night, don't worry. Even good sleepers can have bad nights. If you stick with good sleep habits, your insomnia should soon vanish.

RELATED ARTICLE: Twelve Ways To seduce Sleep

Get regular exercise. People who are sedentary often have problems falling asleep because their bodies simply aren't tired. Aerobic exercise helps you fall asleep more readily and also deepens sleep. The best time to exercise is in the late afternoon. Caution: Strenuous work-outs right before bedtime can interfere with sleep.

EAT A BALANCED DIET. Poor nutrition can lead to a number of physical and emotional ailments, including insomnia. A diet of fresh, whole foods improves health, and if you're healthy, you'll sleep better. Hauri recommends consuming a variety of fresh vegetables and whole grains and making the evening meal a light one because a large, rich meal late in the evening can keep you awake. Avoid bedtime sweets to avoid a low blood sugar rebound that can trigger reactions that may keep you awake.

ELIMINATE STIMULANTS. Avoid consuming coffee, tea, caffeinated sodas and chocolate or avoid consuming them within six hours of bedtime. Two stimulant herbs to watch out for are guarana and ephedra (ma huang).

AVOID ALCOHOL AND TOBACCO. Either eliminate them completely or abstain from using them within a couple of hours of bedtime. Alcohol makes people sleepy initially but is very disruptive of sleep during the night. Also, because nicotine is a stimulant, cigarette smokers often have difficulty falling asleep and sleep more fitfully. Recreational drugs such as marijuana, cocaine. amphetamines and heroin also disrupt sleep.

GET ENOUGH VITAMINS AND MINERALS. Several B vitamins have been shown to reduce insomnia, so you might want to consider taking a B-complex supplement. Also, the minerals calcium and magnesium have long been known to calm the nervous system. Hauri notes that calcium absorption decreases with age, a factor which can contribute to insomnia. If you suspect you may not be absorbing enough of these minerals, consult your practitioner.

Go over your medications. Check with your doctor to determine whether your medications may be contributing to your insomnia. Common culprits include prescription diet pills containing amphetamine, some antidepressants, many asthma medications, Gold preparations with pseudoephedrine, nasal decongestants, pain-relievers containing caffeine, thyroid hormone, some drugs for high blood pressure, steroids and sleeping pills.

Nap with caution. Although an occasional afternoon nap may be OK if you need an alertness boost and nighttime sleep has been limited, napping can interfere with a good night's sleep. If you feel drowsy. try exercising instead of napping. If you choose to snooze, do it before 3 p.m. and for no longer than 30 minutes.

Wait until you're truly sleepy before you lie down. Light sleepers who stay in the sack long hours are sometimes cured by spending less time in bed with a resultant deeper, more efficient sleep. If you awaken in the night, get out of bed and do something relaxing.

ESTABLISH REGULAR BEDTIMES. The experts say the most important thing is to wake up every day at the same hour." Avoid sleeping late on weekends, which can lead to Sunday-night insomnia.

SET ASIDE A WORRY TIME. Rather than fretting in bed, designate a time earlier in the day to worry and plan and make lists.

WIND DOWN YOUR DAY WITH PLEASANT BEDTIME RITUALS. YOU can try relaxing activities such as yoga, a hot bath (with herbs or essential oils), sex, listening to soft music, light reading, a massage from your mate or thinking about pleasant things.

CREATE A BEDROOM ATMOSPHERE CONDUCIVE TO SLEEP. Make your boudoir a dark, quiet, well-ventilated sanctuary for sleeping and sex, a haven removed from work, arguments and worries. Cover your bedside clock so you can't check it if you awaken in the night.

RELATED ARTICLE: Melatonin : Miracle Cure or Snake Oil?

Melatonin is a hormone secreted at night by the pineal gland, a tiny gland deep inside the brain. It regulates several physiologic processes, including sleep. As a general rule, after the age of 40, production sometimes begins to drop. Andrew Monjan, Ph.D., Chief of the Neurobiology of Aging Program at the National Institute on Aging, notes, "You find a range of melatonin levels in older people, going from very low levels in individuals with insomnia to near-normal levels."

Although books and magazines trumpet melatonin as everything from an antiaging potion to nature's sleeping pill, the results of studies on its use for insomnia are inconsistent. Clifford Singer, M.D., a principal investigator of a National Institute on Aging research project on melatonin and sleep in the elderly, says there's really no consensus on how effective melatonin is or whether it is safe. On the other hand, some people have great responses to melatonin with increases in total sleep time of over an hour a night, without side effects. Singer's experience is melatonin helps one half to two-thirds of the people who try it. Taken as a drug, the hormone increases the dream stage but decreases deep sleep.

Some reports indicate disturbing side effects, including melatonin aggravating depression, stimulating vivid and disturbing dreams and causing next day grogginess. Many researchers are concerned long-term usage of high doses of melatonin might suppress steroid hormone production, particularly in women, resulting in suppressed ovulation and increased risk of chronic disease.

Who should take melatonin? According to Singer, if your insomnia is so severe that it affects your daytime functioning, you've had a good diagnostic workup and don't like taking sleeping pills, then it is probably a reasonable thing to try. The optimal dosage of melatonin for insomnia is yet to be clearly defined. Singer suggests taking between 0.5 to 6 milligrams (mg.) 30 minutes to one hour before bed. You should not take however, if you are trying to get pregnant, are already pregnant or have an autoimmune disease. Melatonin use is still experimental, and many sleep experts feel its use is premature. Authorities also worry about product purity, recommending synthetic melatonin as safer and more effective than the natural hormone (from animal sources).

RELATED ARTICLE: National Sleep Foundation

1367 Connecticut Ave., NW, Dept. VT Washington. DC 20036 E-mail address: [email protected]

For a list of accredited sleep centers, send a self-addressed, stamped business envelope (SASE) to the above address. With 55 cents postage, you also will get a brochure on insomnia.

America Sleep Disorders Assoc. 1610 14th St., NW, Suite 300 Rochester, MN 55901

Also distributes a list of accredited sleep disorders centers. Just send a SASE to the above address.

To find someone in your area who can teach you transcendental meditation, call (800)-LEARN TM.

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