When You Can't Sleep: Remedies From A To Zzz

It's the rare one among us who hasn't suffered the torments of the middle of the night. We fidget and toss, too hot, then too cold. Our worries swarm and ambush us like relentless mosquitoes. The digital glow of the clock taunts us from the bed stand. It was 2:30 at last glance. Must be near dawn now. Aagh. Just 2:53.

Roughly 100 million Americans have sleeping problems, with one-third of them suffering from chronic insomnia. A telling indicator: The U.S. television audience for programming between midnight and 3 a.m. is believed to be about 20 million people. Of course, not everyone watching TV at those hours has a problem. Sleep patterns vary: Some people can get away with only three hours a night, others need 10. If you're not getting enough sleep, you're probably desperate for relief, but correcting the problem may be more complex than you realize, depending on whether it is caused by psychological or physical factors. Perhaps your biological clock needs to be reset.

PILLS 'N' BOOZE. Most of us gulp coffee to counteract the effects of a single night of insomnia. But feelings of tiredness and irritability persist until we catch up on what researchers call our "sleep debt." Military researchers have documented that a person loses 25% of the ability to think, plan, and execute a task for every 24 consecutive hours awake.

To combat sleep problems many people toss back a nightcap. Big mistake. "Alcohol has only deleterious effects on sleep," ranging from breathing problems to troubled, restless sleep quality, says Thomas Roth, chief of the division of sleep disorders and medicine at Henry Ford Hospital in Detroit. When the first drink doesn't help, some people have another, and that can lead to alcoholism.

Next, people typicaly ask their doctors for sleeping pills. Some doctors recommend that patients first try an antihistamine, such as Benadryl, which tends to cause drowsiness, can be purchases over the counter, and is nonaddictive. More serious sleeping medications must be used carefully. They are unquestionably addictive and can lead to an effect called "rebound insomnia." That's when insomnia returns and even worsens after you stop taking the pills.

Increasingly, sleep docs only recommend sleeping pills for patients with indentifiable, temporary causes of insomnia, such as jet lag, tension over an upcoming event, or a marital or financial crisis. A drug such a Halcion, make by Upjohn, is "a darned good drug for business travelers." who need to rest on an airplane or shortly after arrival in a new time zone, believes Craig Heller, chairman of Stanford University's human biology program. That's because Halcion tends to act quickly and then be gone form one's system within about six hours. That's not the case with agents, such as Dalmane, that metabolize more slowly. Halcion is not without side effects, however, and at highter doses, it has been linked to short-term amnesia.

CAUSES AND CURES. When it comes to chronic insomnia, Heller notes, "there just is no good drug." Indeed, sleep researchers say chronic insomnia is a symptom of other problems, not a disease by itself. That's one reason why nearly every major hospital in the country now has a sleep disorders clinic or program, where clinicians check for underlying causes of insomnia, such as depression, which is a leading cause of early morning waking. Sleeping pills do nothing to battle depression, but often counseling and antidepressants can help a patient return to more normal sleep patterns.

Similarly, sleeping pills only complicate sleep apnea, a medical condition that blocks your air passages. Apnea victims may stop breathing for from 10 to 90 seconds, jolting awake repeatedly during the night and suffering chronic daytime sleepiness. Apnea treatment often calls for losing weight and learning to avoid sleeping on your back. In some cases, it may require surgery.

If your insomnia is intolerable or affecting your job or relationships, call a local medical center and ask for their sleep clinic -- or get a lis of sleep specialists by writing to the National Sleep Foundation, 122 S. Robertson Blvd., Suite 201-BW, Los Angeles, Calif. 90048. But alsorealize that a typical visit and evaluation at such a center averages $1,500, which may not be reimbursed by your insurer. That's why those suffering from chronic insomnia might do well to first try some of the techniques sleep center doctors (or somnologists) use.

A good starting point is a book, No More Sleepless Nights, co-authored by Peter Hauri, director of the Mayo Clinic Insomnia Research & Treatment Program (John Wiley & Sons, $12.95). The book provides valuable advice on identifying what kind of insomnia you hve and then addressing it specifically. Half or more of all insomniacs have identifable psychological stress, anxiety, or depression. For these patients, experts typically recomment seeking psychotherapy so patients learn to deal more effectively with their worries during the day. Stress reducers such as meditation or exercise may also be in order. Sleep experts recommend that you exercise in late afternoon or early evening, however, so you're not worked up right before bedtime.

Learning to relax is easier for some than for others. Gentle stretching before bedtime can be useful, as are such mental games as imagining that you're a sponge, soaking up quiet and tranquility. Concentrating on breathing deelply from your abdomen as you lie on your back can also promote relaxation.

Insomnia can have physiological roots, too, including chronic pain or respiratory difficulties. Caffeine, smoking, and medications can slo disrupt sleep. Or there may be environmental factors such as noise, bightness, or even an uncomfortable bed or a snoring spouse.

LIGHTS AND LOGS. Another possible cause of sleepless nights is a disruption in an individual's circadian rhythms. The body's "inner clock" can be thrown off so that your wake at dusk and sleep at dawn. Walter Greenleaf, founder of Greenleaf Medical Systems in Palo Alto, Calif., is a self-described "night owl." During his graduate student days, Greenleaf would often do research or write until the wee hours, then sleep until late morning -- a pattern that failed him when he went into business.

Greenleaf has gradually gotten more in sync, but he still has a tendency to lapse back into night work and day sleep. So, when he travels or absolutely must work all night, he forces himself to stay up the next day and not go to bed until early the next evening. That's a trick called "chronotherapy." It's one of a number of behavioral-modification techniques that sleep experts use to help people recalibrate their circadian rhythms.

Another interesting treatment is called is called "bright light therapy," and makes use of the influence of daylight on regulating human sleep-wake patterns. At the Brigham & Women's Hospital in Boston, research Charles Czeisler has successfully reset sleep-wake cycles in shift workers by exposing them to bright light for several hours over just a few days. Someday, frequent fliers may wear light goggles as they fly to help them adjust to a new time zone.

If the cause of your sleeplessness is still not clear, try keeping a sleep log. Some patients find that after a week or two they see patterns emerging. Poor sleep may consistently follwo unresolved incidents at work or a big meal eaten late.

A hard part of lingering insomnia is that patients often develop a fear of not sleeping. Just worrying about it can keep you up. Hauri advises that patients never "try" to sleep or lie awake fretting in the dark. Get up, read, do something low-key. You may get too drowsy to stay awake.

WHERE TO GET HELP -- Sleep Disorders Center, Baylor College of Medicine, 
      Houston, 713 798-4886 -- Sleep Disorders Center, Columbia-Presbyterian Medical 
      Center, New York, 212 305-1860 -- Sleep Disorders Center, Mayo Clinic, 
      Rochester, Minn., 507 286-8900 -- Sleep Disorders Center, Rush-Presbyterian-St. 
      Luke's Hospital, Chicago, 312 942-5440 -- Sleep Disorders Clinic, Stanford 
      University Medical Center, Stanford, 415 723-6601 -- Sleep Disorders Unit, Beth 
      Israel Hospital, Boston, 617 735-3237 DATA: NO MORE SLEEPLESS NIGHTS; BW
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