From the office of
Robert S. Grimshaw Jr MD FACP
Internal Medicine
3535 Hill Blvd Yorktown Hts NY
914 962-3180
NEWS
Recognized Provider  “With Distinction” by the American Diabetes Association/National Committee for Quality Assurance 2/99-2/02
89                          October 2000

To Sleep, Perchance to Dream:

Insomnia is one of the most frequent complaints we hear. In fact, most Americans sleep too little: the average adult sleeps just under 7 hours during the work week, according to a 2000 survey by the National Sleep Foundation.  The recommended amount of sleep is 8 hours.  One in 3 sleeps 6.5 hours or less.  
Drowsy driving is estimated to cause 100,000 crashes annually.  Not surprisingly, 62% have trouble sleeping a few nights a week.  43% say that daytime sleepiness interferes with their activities a few days a month.  Some of these problems will come from diseases: heartburn  (gastroesophageal reflux disease) wakes up many.  People with lung disease, heart failure, arthritis and certain neurological conditions including strokes commonly have trouble sleeping.  By far the most common is use of some medications, caffeine and rebound from alcohol.


So what can be done?  From Dr. Joseph Kwentus writing in the Clinical Geriatrics, some thoughts on sleep hygiene:

Dr. Kwentus’ Sleep Hygiene Guide:    

•   Don’t go to bed until sleepy
•   Do your bedtime rituals of washing up, brushing your teeth etc at the same time every night
•   Get up at same time every day
•   DON”T NAP!!
•   Exercise daily, early in the day
•   Don’t use your bedroom except for sleep and romance
•   Don’t ruminate about problems at bedtime - do it in the morning
•   Avoid heavy meals at bedtime
•   STOP SMOKING! (At first your sleep will be worse, then better)
•   Drink coffee, tea, chocolate, colas or other caffeinated beverages only in the morning and in limited amounts
•   No alcohol 4 hours before bed
•   Take diuretics earlier in the day
•   Waking up with pain? Tell us!
•   Empty your bladder before bed
•   Limit night light, noise and temp
•   Get a comfortable mattress
•   Wear comfortable bedclothes
•   DON”T WATCH THE CLOCK!
•   Try reading or music at bedtime
•   Get some sun (or bright light) during the day.
•   Don’t exercise 2 hrs or less before bedtime
•   Ask us about any medicines (or supplements such as ephedra) that might be keeping you up, including decongestants, and asthma inhalers.
                
When All Else Fails:
we have medications which can help:


•   Antihistamines such as diphenhydramine (Benadryl, etc) - but tolerance develops after 1-2 weeks, some men have trouble urinating and some feel a daytime “hangover”.


•   Valerian is an herb which is sometimes helpful, 200-1000 mg ½-1 hr before bed; it’s unregulated.


•   Melatonin 0.3-1 mg 2 hrs before bed may help, particularly seniors; it’s also unregulated by FDA.


•   Antidepressants such as Elavil, Sinequan, Desyrel, Remeron or Serzone can be helpful, even for long periods. Side effects include dry mouth, constipation, etc.


•   Benzodiazepines such as Sonata, Ambien, or Restoril can help for 4 weeks or less.  Side effects include early morning awakening, short-term amnesia and rebound insomnia if withdrawn abruptly.