Author: Julie Ryan

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Wellbeing

Ambien: Dream Come True or Nightmare Waiting to Happen?

A little more than five years ago I talked to my doctor about how I was having trouble sleeping, which lead to daily fatigue. I think it was my neurologist that initially started me on various sleep aides. I tried each of the major sleeping pills one-by-one and none seemed to help me sleep, until I tried Ambien. I’ve continued to use it off and on ever since.

I don’t use Ambien every night or even close to it, in fact it takes me six months or more to go through a 30-day supply, but if I have to be awake early in the morning, or I just can’t seem to get to sleep, I’ll take it.

I seem to go in cycles, going months without taking a single pill then taking it daily for a few weeks. I’ve been on a 10mg dose from the beginning. So, when I heard a 200lb ex-army guy talking about the trouble he had waking up from it and how he had to cut his pill in half if he wanted to get up in the morning I was really surprised. The guy is almost twice my size and I’m taking twice the amount he is. Typically, when I do take it I’m up and wide awake in eight hours (or less). I’ve rarely ever had a sleep hangover after taking Ambien.

Then a few weeks ago I overheard two women having a conversation about sleeping pills and one of them said something about Ambien interfering with REM sleep. What? That can’t be. I sleep so well when I take it and wake so refreshed I have to be getting quality sleep, including full cycles of REM.

Don’t I?

I decided to do a little research into my little bedtime buddy – Ambien. I hadn’t really done this previously because it seemed that it wasn’t causing me any negative side effects.

Interestingly, the first thing I came across was a 2013 announcement from the FDA [decreasing the recommended dosages by about half. The current recommended dosage for females is just 5mg! Half of what I’m taking. Why did they do this? Because they found that a large percentage of users were waking up with the drug still in their system leading to morning drowsiness and fatigue.

But does Ambien Interfere with REM sleep?

According to three different (albeit small) studies (Besset et al, Dujardin et al, Uchimura et al) that I found, the rumor that Ambien affects REM sleep isn’t true. In fact, it doesn’t seem to negatively alter any stage of sleep.

So, why do people think that Ambien interferes with REM sleep?

My guess is that it’s because the older and more common benzodiazepine sleep aids (eg. Valium) actually do negatively affect sleep cycles. According to the same studies mentioned previously, benzodiazepine drugs decreased both stage 3 and 4 sleep. Benzodiazepines are intended only for short-term use and have a high risk of addiction and abuse. Ambien is considered a non-benzodiazepine sleep aide, meaning that it works in a way that is similar to benzodiazepines but not quite the same.

Non-benzodiazepines (also known as Z-drugs) are not as habit-forming as benzodiazepines, although I guess I can see where anything that helps you get a good night’s sleep can eventually become habit-forming.

That’s not to say that Ambien doesn’t have other side effects. I already mentioned the potential for a sleep-hangover and morning drowsiness if you don’t get at least eight hours of sleep. But, there is also an increased risk for depression or gastric reflux. Then, there are the even worse side effects, like decreased motor control, impaired judgement, hallucinations, and even anterograde amnesia (the inability to form new memories).

There are also those who end up sleepwalking, talking, and eating while on Ambien. I had one friend that called me three times in one night to tell me the same thing. I found out the next morning that she’d decided to try to get some work done after taking Ambien and she didn’t even remember calling me.

If that’s not bad enough, a 2012 study by Kripke, Langer & Kline indicated that you are five times more likely to die of a heart attack or cancer than those not taking these drugs. Scary stuff!

Maybe it’s time to find some alternative ways of getting better sleep.

References:

Besset A, Tafti M, Villemin E, Borderies P, Billiard M. Effects of zolpidem on the architecture and cyclical structure of sleep in poor sleepers. Drugs Exp Clin Res. 1995; 21(4):161-9.

Dujardin K, Guieu JD, Leconte-Lambert C, Leconte P, Borderies P, de La Giclais B. Comparison of the effects of zolpidem and flunitrazepam on sleep structure and daytime cognitive functions. A study of untreated unsomniacs. Pharmacopsychiatry. 1998 Jan; 31(1):14-8.

Kripke, D. F., Langer, R. D., & Kline, L. E. (2012). Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ open, 2(1), e000850.

Uchimura N, Nakajima T, Hayash K, Nose I, Hashizume Y, Ohyama T, Habukawa M, Kotorii N, Kuwahara H, Maeda H. Effect of zolpidem on sleep architecture and its next-morning residual effect in insomniac patients: a randomized crossover comparative study with brotizolam. Prog Neuropsychopharmacol Biol Psychiatry. 2006 Jan; 30(1):22-9.

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Wellbeing

Ambien Alternatives To Put Your Mind and Body to Rest

There are plenty of risks associated with not getting enough sleep. At the same time, there are plenty of studies that Ambien, the most popular sleep aid in the country, has some pretty serious risks of its own. So, it feels a bit like a Catch-22. Perhaps the answer is not in a drug but in finding other ways to fall asleep and stay asleep.
Personally, I’ve found that diet and lifestyle choices affect my sleep more than anything else. Eating certain foods too late in the evening, or even eating a large meal can keep me from sleeping well. Alcohol certainly doesn’t help me sleep either. One glass of wine doesn’t hurt, but more than that and I’ll be tossing and turning instead of sleeping soundly.
Before resorting to medications that could cause more harm than good, try a few more natural approaches. Sure, everyone is different, but chances are, one or more of these simple tips will help ease you into the good nights sleep you deserve.

  • Be Good to Your Gut: Avoid eating large meals late in the day. This decreases the likelihood of heartburn or indigestion keeping you awake. [LL1] Keep dinner small and eat no later than two hours before bed.
  • Herbal Help: Drink an herbal tea before bed that includes a combination of tulsi, ashwagandha, chamomile, skullcap, and valerian root.  Valerian root alone is known to be a good sleep aid. The others help fight stress, making it easier to relax.
  • Take a Bath: The magnesium in Epsom salt helps relax muscles, and going from the warm bath to a cool room helps your body temperature drop. A lower body temperature actually helps you sleep better.
  • Cool the Room: You will fall asleep and sleep better in a colder room. Consider setting your thermostat timer to decrease the temperature by five degrees at bedtime. Alternatively, sleep with only a sheet and forgo the heavy blankets.
  • Lights Out: Cover any lights on your electronics with tape so that the light is not visible in the dark. Even the smallest light can keep you from sleeping well.
  • Screens Off: An hour before bed, turn off all electronics. The flickering and brightness of the screens will often prevent your brain from shutting down.
  • Dim Your Reader: If you read on an e-book device turn the brightness down as low as possible, and flip the colors so that you are reading white text on a black background.
  • Stock Up on Protein: If you often wake up hungry in the middle of the night, eat a small protein-rich snack just before going to bed. Avoid heavy carbs that will keep your stomach working. A handful of almonds, or macadamia nuts, is your best choice.
  • Exercise: Those who get regular exercise during the day (but not right before bed) typically report better sleep. Consider going for a brisk walk after dinner.
  • Stick to a schedule: When you have trouble sleeping it’s often easy to just try to stay up until you can’t stand it anymore, but that will actually make your sleep problems worse. Go to bed and get up at the same time every day.

I’d love to say that I stick to all of these religiously, but I don’t, which is probably why I end up taking Ambien occasionally. There are a few of these that even Ambien won’t overcome (like alcohol and eating too much).
I have found that sticking to a regular bedtime schedule and routine definitely helps me sleep better. About an hour before I want to be asleep I turn off the television and take a nice warm bath with Epsom salts, while drinking my herbal tea. After the bath I climb in bed with my tablet and read an ebook (white text on black background with the brightness set as low as possible) until I fall asleep. With any luck I stay asleep (more or less) until morning.
Do you have any other tips for improving sleep naturally? If so, share them in the comments below.

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Lifestyle

Is Sleep Hangover a Real Thing

I recently read an article about Sleep Hangover that said that the reason we feel so totally wiped after sleeping in is because of our circadian rhythms and biological clock getting thrown off when we oversleep.  But, I don’t have to just have an extra-long night’s sleep to end up with sleep hangover, a long nap will do it just as well as what seems like a regular night’s sleep.

I remember as a kid I’d call this “Sunday Afternoon Nap Syndrome” because I’d often take a nap on Sunday afternoon and when my mom would wake me up I’d just feel totally wiped and like I could never fully wake up. Unfortunately, as I’ve gotten older I’ve found that I can end up feeling a “sleep hangover” without sleeping in, or taking a long nap. It seems that I can wake up feeling tired, achy, and like I can’t move regardless of the amount of sleep I actually get.

The last few weeks I’ve been using a Fitbit to track my sleep. Last night, despite being in bed for over 10 hours I slept less than seven, and when I woke up I didn’t feel like I could move, let alone get out of bed. I was groggy and out of it and I felt like I was fighting through a fog just to be conscious.

So, if sleep hangover is a real thing, and if it’s caused by getting too much sleep, as the Wired article seems to indicate, then why am I waking up with a sleep hangover regardless of whether I get seven hours or twelve?

According to Dr. Michael Breus it might be a result of waking up at the wrong time–in the middle of a REM cycle. We sleep in 90 minute cycles, taking about 30 minutes before we hit full REM sleep. So, napping just 10-20 minutes will keep us from hitting REM and allow us to wake feeling more refreshed. Otherwise, we need to make sure that we sleep for at least 90 minutes, or multiples of 90 minutes.

This explains a lot for me. I’ve always felt that I needed to sleep in three hour intervals (90 minutes times two). And, chances are that my mom woke me from those Sunday afternoon naps after an hour, not letting me complete the cycle.

Taking a look at my Fitbit I can see just how long I slept and in what intervals and last night my sleep was all over the place. I had one span of sleep that actually lasted a little more than 90 minutes, but all of the other sleep times were less than that.

What’s worse is that the last couple of hours I was in bed I was mostly awake, sleeping fitfully for about 30 minutes at a time. Just as my system was going into REM sleep I was waking up again.

What’s most interesting to me, though, is that there were seven spans, according to the Fitbit, when I was awake (or at least moving around) for up to thirty minutes at a time. I don’t remember being awake which means that I was either in one really fitful dream or I was just moving around in my sleep a lot. That would certainly explain not feeling rested.

I honestly don’t know how people who wake up to alarm clocks on a regular basis do it. How do you keep your alarm from interrupting your sleep right in the middle of a REM cycle? There are some new wearable devices out there that claim they will wake you during the end of a sleep cycle, ensuring that you wake up without that dreaded sleep hangover. I have no idea if they work, but now that I’ve learned that it could keep me from a sleep hangover, I’m certainly curious to find out.

The next time you wake up wondering about that whole “sleep hangover” thing, rest assured (pun intended) that sleep hangover is a very real thing, and that you are not alone. But, there are things you can do to avoid it like sleeping in 90 minute intervals, and taking shorter naps.

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Wellbeing

Using Meditation to Conquer Your Insomnia

I’ve lived with insomnia for almost a decade. It started with hitting my head on a chair. “Nothing more than a mild concussion,” they said. If only that had meant it wouldn’t affect me for the rest of my life. It’s a rare night when I can fall asleep easily and stay asleep through the night; and about once a month I just won’t be able to sleep at all.
Insomnia can be caused by a number of things. Aging alone decreases the neurotransmitters and affects sleep patterns. I am getting older! Stress and anxiety don’t help, and neither does chronic illness. Check. Check. And Check. Add indigestion and medications (or better yet indigestion caused by medications) and you can end up with serious issues with insomnia.
Lucky me, I have all of that!
But, insomnia is about more than just lost sleep; insomnia impairs your cognitive functioning, your behaviors, and your emotions. Insomnia affects every facet of your life, and it can often feel like nothing helps.
You follow all the instructions for great sleep hygiene, making sure the room is completely dark, the TV is off an hour before bed, you avoid electronics, take a warm bath, etc. Yet sleep still doesn’t come. Or you fall asleep only to wake up again two hours later. It seems like no matter how many sheep you count, you just can’t get back to sleep. But, I have found one thing you’ve probably not tried that really can help me get to sleep, or get back to sleep, and stay asleep—meditation.
Meditation is a practice, based on Eastern theology, of clearing the mind and focusing on a specific thought, to change the way you think. Meditation has been shown to be a powerful tool to help not only aid with insomnia, but improve self-confidence, develop positive emotions, reduce anxiety, and improve immune response (Sun, Kang, Wang, & Zeng, 2013).
Meditation is quite easy to learn thanks to the large number of apps available that offer meditation training. Typically, the apps allow you to choose a focus and most offer meditation to help calm you and help you fall asleep.
To find these apps visit the app store for your device and search for “meditation.” You’ll find several free apps, so just try a few until you find one you like.
I’ve tried a few of these apps and I’ve found that they can be really helpful. The meditations typically begin by telling you to clear your mind, they then provide you with guided imagery to help you focus your mind on an image that calms you and lulls you into sleep.
If you have a busy mind, like I do, it can be difficult to clear it and really focus on the imagery. I struggled, often finding my thoughts wavering back to real life, but the more that I practiced the easier it got to return to the focus provided by the meditation.
Often when I wake up in the middle of the night I will plug my headphones in and turn on one of these meditation apps and before I know it I’m back in a restful state and asleep; sometimes I won’t wake again until morning.
I find that when I’m using meditation regularly, I sleep better and stay calmer during the day.
These apps will typically allow you to choose to play a meditation once or have it repeat. Often, when I’ve chosen the latter I will wake up in the morning to find that it is still playing and I’ve slept right through it. I also find that when I use these meditations to help me sleep I wake up in a more restful state with less anxiety.
I will also use meditation during the day to help calm my nerves when I’m feeling anxious or stressed. A simple 15-minute meditation really helps clear the mind and leaves me refreshed, focused, and ready to face the day again. This decreased stress during the day may also contribute to the reduced insomnia later.
Proper sleep is associated with increased production, higher quality of life, improved cognitive functioning, improved life satisfaction and happiness, and decreased inflammation (Irwin, et al., 2013).
Insomnia often prevents our ability to get this proper sleep, but meditation can help. By learning to use meditation to conquer your insomnia you will find that you not only sleep better at night, but you wake up more refreshed, less stressed, and with higher mental functioning. Using meditation during the day can also help reduce your stress and aid in conquering insomnia.