It's the middle of the night, and?boiiing!!?you're awake. Should you pop a pill? Read a book? Or decide to get a 4 a.m. jump on your day? Depends. Karen Stabiner has the latest on treating insomnia. It is 4 o'clock in the morning, and Los Angeles is asleep?except for Robin, who is painting, and Diane, who is listening to National Public Radio, and Joan, who is reading a trashy novel. They're not alone?more than half of women agges 30 to 60 have trouble sleeping through the night, according to a National Sleep Foundation survey.
We think of insomnia as the inability to fall asleep, but two other forms of the ailment tend to plague women: With maintenance insomnia, sufferers wake up in the middle of the night and have trouble getting back to sleep; with terminal insomnia, they wake up at 4 or 5 o'clock and are too alert to doze off again. Once up, she starts to worry about how long she'll be awake, or all the things she failed to do during the daylight hours. The more distressed she gets, the less likely she is to fall asleep again.
Certain people are predisposed to developing insomnia, according to Oneil Bains, MD, director of the insomnia program at Seattle's Virginia Mason Medical Center, and some of the reasons are beyond our control?a womman's genetically determined "sleep drive", for example, and her personality. Life changes can also trigger insomnia, and we can't do much about those, either. But the third element in the slumber trifecta is the way we think about sleep, and that's where free will comes into play.
Most insomniacs worsen their condition by worrying about it. Then again, it's hard not to. The 11th commandment in this culture might as well be "Thou must have eight hours of sleep"?we fear anything less means not being as fresh, alert, or prooductive as our well-rested colleagues. Letting go of that 11th commandment is the first step toward relief. "Most people with insomnia don't need eight hours," Bains says. When they stop fighting with themselves and settle for less, they feel better.
For the many insomniacs who need more than NPR or a good bodice ripper, the classic approach is behavioral modification. Experts prescribe an arsenal of lifestyle adjustments that help patients practice what's known as good sleep hygiene, for example avoiding stimulating conversation, books, or television shows before bedtime. Bains also tells patients not to turn on the light or to look at the clock when insomnia strikes.
If gentle modifications don't work, some sleep experts practice various forms of tough love, such as depriving a patient of sleep until she's so tired that her sleep drive overcomes her tendency to wake up. Sometimes the best solution is medication?one doctor sometimes prescribes hormone replacement theraapy for newly menopausal patients who are suffering from significant sleep problems.
In many cases, insomnia experts prefer the strategic use of new, short-acting prescription sleep drugs in conjunction with behavioral changes. Sonata, which lasts about three hours, and Ambien, which lasts about six hours, can be especially helpful for women who have trouble falling or staying asleep, because they won't feel groggy in the morning. But Bains points out that both drugs are for short-term use only, generally no more than a couple of weeks. For ongoing sleep troubles, he suggests addressing behavioral factors rather than continuing to take medication.
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