Hidden Causes
Our lack of sleep stems mainly from
societal, not physical, problems,
says Michael Sateia, M.D., professor
emeritus of psychiatry at the Geisel
School of Medicine at Dartmouth.
“With the increasing demands of our
occupations and family life and the
incessant bombardment of media, we
aren’t giving ourselves the opportunity
for adequate sleep.”
If you toss and turn despite consis-tently allowing 7 or 8 hours in bed
or if you feel tired during the day, con-
sult a doctor. Common conditions
such as anxiety, depression, an
enlarged prostate, heartburn, and
pain can keep you up.
Or you may need to adjust the type,timing, or dosage of a medication you
take. Steroids, blood pressure drugs,
and allergy and cold medications, for
example, can act as stimulants and
interfere with sleep.
If you share a bedroom, your partnercan provide clues. Snoring and gasping
for breath can indicate sleep apnea;
excessive movement, restless legs
syndrome. To investigate, your doctor
may suggest an overnight test or refer
you to a sleep specialist.
A Little-Known
Talk Therapy
If those steps don’t help, the American
Academy of Sleep Medicine (AASM)
recommends cognitive behavioral
therapy for insomnia (CBT-I)—a form of
counseling that identifies and replaces
thoughts and behaviors that contribute
to poor sleep—as a first-line treatment.
“CBT-I is at least as effective asmedications, the benefits are long-lasting,
and it’s manifestly safer than any pill,”
Sateia says. But few people have heard of
it. “And even if they are aware of CBT-I,
it can be hard to find a trained therapist,”
he says. For advice, see “Finding a
Sleep Therapist,” on the facing page.The Problem With Pills
Nearly one-third of people who
complained of sleep problems at least
once a week said they had used an
over-the-counter or prescription sleep
drug in the past year.
But many of these people don’t get
the rest they seek: About one-third
reported very good or excellent sleep.
And they often don’t wake refreshed:
Nearly 60 percent of people taking
sleep drugs reported feeling drowsy,
confused, or forgetful the next day.
The evidence is strongest for
prescription drugs, says Buysse, who
along with Sateia and other researchers
reviewed 129 studies of sleep drugs for
the most recent treatment guidelines
from the AASM. But the benefits are
modest, increasing sleep time by about
20 to 30 minutes.
Most surprising: There’s little research
into the effectiveness of some of the
sleep aids Americans turn to most often,
including the antidepressant trazodone
(sold only as a generic) and over-the-
counter products, so it’s hard to know
whether they help. OTC drugs contain
older antihistamines, such as diphen-
hydramine in Advil PM and doxylamine
in Unisom Sleep Tabs, which can cause
drowsiness as a side effect.More Risk Than Reward
All sleep medications, including
OTC versions, have side effects. Most
commonly, that means making you feel
drowsy, dizzy, less mentally sharp, or
more physically unsteady the next day.
People have also reported experi-
encing hallucinations, having memorylapses, and performing activities such
as driving or eating while asleep.
With most sleep drugs, long-term
use can lead to dependence, and
abruptly stopping the drugs can lead to
a rebound effect, where insomnia gets
worse. Taking too much, combining
different types of sleep aids, or using
them with other drugs or alcohol
magnifies the risks.
Our survey also found that more
than 1 out of 10 Americans who used
prescription drugs for sleep took
an opioid for that purpose. That’s
particularly dangerous not just because
opioids are addictive but also because
they can slow your breathing and make
it more shallow. So when combined
with alcohol or other sedatives, which
have the same effect, “you could stop
breathing altogether,” Buysse says.
The survey also shows that people
often ignore warnings not to take any
sleep aids unless they can spend at
least 7 hours in bed. “After 4 or 5 hours,
you can still have the drug circulating
in your blood, so you will be less
alert at precisely the time you need
to be doing things that require your
concentration,” Buysse says.The Science of
Supplements
In CR’s survey, nearly 1 out of 5 people
said that they took supplements to help
them sleep. These included valerian,
chamomile, and, especially, melatonin,
a hormone that your brain secretes
at night to signal to your body that it’s
time to wind down.
While people in our survey reported
fewer problems with sleep supplements
than with drugs, these products still
caused side effects: About a quarter of
respondents said they were drowsy the
next day, and 12 percent said they felt80 %
SAY THEY HAVE TROUBLE SLEEPING
AT LEAST ONCE A WEEK.*30 %
SAY POOR SLEEP NEGATIVELY
AFFECTS THEIR QUALITY OF LIFE.**Source: Nationally representative 2018 Consumer Reports survey of 1,767 U.S. adults.AMONG ALL U.S. ADULTS:
Sleep Better
70 GUIDE TO WELLNESS CR.ORG