A wide-awake look at beating worry-based insomnia

It's 1 a.m. You have to get up at 6. You're exhausted, but you can't sleep. What do you do?

You may find yourself slurping a spoonful of NyQuil or taking a Tylenol PM. Is that the best approach?

It all depends on how often you are in this situation, experts say.

Lynelle Schneeberg, a psychologist and director of the behavioral sleep medicine program at Gaylord Hospital in Wallingford, Conn., says that "if you're talking short-term insomnia during a short-term stressful situation," then taking a pill can be OK. But "chronic insomnia, when you are talking six months or longer, is a different animal."

For many, worries about jobs and the economy have been interfering with sleep. Almost one-third of Americans say their sleep has been disturbed at least a few nights a week in the past month because of personal financial concerns, the U.S. economy or employment worries, according to a survey by the National Sleep Foundation.

Taken once in a while, those over-the-counter medications might be just the push you need to shove off into dreamland, but there are downsides. For starters, the sedating effects caused by the antihistamine in such products as NyQuil and Tylenol PM may not end when you wake up. And if you take them frequently, they might even be associated with occasional memory problems.

Edward O'Malley, a sleep expert and owner of Optimal Sleep LLC in Easton, Conn., says that antihistamines can continue to affect people six to eight hours after ingestion.

Dr. Amarish Dave, a neurologist in Crystal Lake, Ill., says that many of these sedating medications can "slow cognitive performance." Whenever he sees patients complaining of not feeling "sharp mentally," he looks at what medications they have been using.

Taking sedatives also can cause problems for people with breathing disorders and occasionally can have cardiac effects in elderly people, O'Malley says.

Experts have varying opinions on herbal remedies. O'Malley says they may be preferable to over-the-counter sleeping medications, but he suggests that people use only synthetically made melatonin rather than any made from animal brain tissue.

Melatonin is the hormone secreted when the body is naturally preparing itself for sleep. O'Malley says it is most appropriate when used to address jet lag.

Schneeberg tells patients about the "every third night" rule when they ask about taking medications that may enhance sleep, whether the over-the-counter variety or prescription medications such as Lunesta or Ambien.

The theory is that if you sleep poorly on Monday night, you probably will have a sound sleep on Tuesday night. But sometimes that doesn't happen partly because people lie awake consumed with worry. ... But if you know that on the third night, Wednesday night, you'll allow yourself to take a sleep medication, Schneeberg says, sometimes that's all you need to ease yourself to sleep on Tuesday night.

"If you know that every third night is a rescue night, it lowers your anxiety," she says. "You really will never get into too much trouble if you take it every third night."

If you take sleep-enhancing medications every night, you "can become psychologically and physically dependent on them," Schneeberg says, and even lose your ability to get to sleep without taking something.

In general, however, sleep experts agree that the best way to address sleep problems is through behavior changes. Schneeberg teaches people how to behave when they can't sleep.

"They do all the wrong things with the right intentions," she says. "They lie in bed trying really hard to sleep. They will tell me, 'At least I'm resting,' but what they are doing instead: They are conditioning their bed to be a place associated with worry and frustration. ... We don't want bed to be associated with anything but drowsiness and sleep."

After 20 minutes of wakefulness, it's best to leave bed and do something quiet and relaxing, like reading, she says. It's best if this is done as near to the bedroom as possible without disturbing a partner. "Sometime the act of climbing the stairs wakes you up," she says.

Good sleep habits also involve going to bed and getting up at about the same time every day.

"The body loves routine," she says.

Other tips: A light snack before bedtime is OK, but not a heavy meal; exercise during the day to make you physically tired at night; avoid naps; and take whatever action you can to address your worries.

Distributed by the Los Angeles Times-Washington Post News Service

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