Q: I am an avid reader of your column. You have given safe, sound advice on a number of different maladies. I’m a 61-year-old female, white, 5’7” and weigh 125 pounds. I am now and will always be a recovering alcoholic. I drank for 40 years and it wasn’t until I drank so heavily between 2000 and 2005 that I lost everything and almost died twice that I stopped.
I am now moderately depressed and have had a problem sleeping for years. I’ve been put on amitriptyline, Ativan, Ambien, Remular, Seroquel, Lunesta and trazodone and I still can’t get a full night’s sleep. It’s like I have a time clock in my head that goes off every two hours. I will get up, have a glass of milk and go back to bed to drift of only awaken again. The PA I see told me she is at the end of her rope.
I have also been diagnosed with severe PAD, have had an abdominal bypass to my legs and a small obstruction removed in the last year. I smoked up until one month ago. I know there has got to be something out there that can help me. I told my PA I didn’t give a hoot if it became an addiction, as long as something will work for me and I can get a good night’s sleep. I don’t drink caffeine up to two hours before I go to bed, so can you give me some advice on what could be good to make me sleep that I can take to the clinic and see what is thought there?
A: I must go on record as opposing your views on becoming addicted to a sleep aid medication. There’s really not much sense in trading one bad habit for another, so let’s begin by reviewing your medications; however, I am unclear about whether you are currently taking all these drugs you listed, or if you have merely tried them in the passed and discontinued them. Amitriptylene is prescribed to treat depression and can cause insomnia. Ativan, an anti-anxiety medication can cause insomnia and depression. Ambien treats insomnia. Trazadone, an anti-depressant can cause sleepiness. In my view, you are being over-treated with anti-depressant medication, with three of your prescriptions having potential side-effects of keeping you awake at night. Not everyone is affected in the same manner but you appear to be. Risk factors that come in to play include being female over the age of 60, having a mental health disorder, working a swing-shift, and being under stress.
There are numerous causes for being unable to get a good night’s sleep, to include depression, anxiety, stress, specific medications, caffeine, some medical conditions, and what is referred to as “learned insomnia”. Let’s review them briefly. Depression may prevent you from relaxing enough to be able to fall asleep and stay asleep. Anxiety can disrupt a person’s sleep pattern. Stress at home or in the workplace can lead to insomnia. Medications such as antidepressants, decongestants, those to treat hypertension, cardiac or allergy issues can be to blame. Caffeine, as we all know, can prevent a person from falling asleep. While we may consider that cup of coffee, we must also take into consideration a cup of tea that isn’t decaffeinated, cocoa, or a piece of chocolate. It’s also important to stop caffeine intake six to eight hours before going to sleep. And there’s learned insomnia that results from worrying too much – primarily about not being able to remain asleep throughout the night. This is what I refer to as problem solving in the middle of the night but, in actuality, problems are rarely solved by hashing them over at 2 AM. Some individuals may nod off while watching television or reading, or when finding themselves sufficiently relaxed in an upright position. Have you been tested for sleep apnea, a thyroid abnormality, or restless legs syndrome that could have an enormous bearing on your sleep pattern? Speak to your physician about the possibility of undergoing a sleep study.
Were I you, I would begin by speaking with my physician about the many medications you are taking (if you are indeed taking them). He or she knows your medical history and will be the best source to determine what – if any – drug can be eliminated. I would begin with a modification of my anti-depressants and switch to one only that does not have insomnia as a potential side effect. I would ask about discontinuing the sleep aids, perhaps one at a time until you are off them and switch to melatonin, an over-the-counter supplement that might reset your internal sleep clock, or try munching on a handful of raw walnuts before retiring.
Then the work begins and you are in control. If you currently doze even for short periods during the day, attempt to discontinue the habit. Make your bedroom conducive to sleep. If you find a bath relaxing prior to bed, take one. Add equal portions of lavender or orange oil and a carrier oil to your bath water. Inhaling the vapors will be most relaxing. Perhaps you will sleep better in a slightly cooler room. Consider turning the thermostat down a few degrees. Discontinue caffeine after 2 or 3 PM. If you become thirsty, drink water or fat-free milk instead. Avoid large meals later in the evening. Get exercise during daytime hours. If you begin to crave a nap, put on your coat and walk around the block instead. Plan to go to bed and get up at the same time each day. If you find you cannot sleep, don’t toss and turn. Get out of bed and situate yourself in a comfortable easy chair in a quiet room until you feel you can return to the bedroom to sleep. Don’t constantly look at the clock to see how much time has passed since you awakened. Remove the clocks to prevent this.
The answer is not more drugs. Try taking as few as possible. Reprogram yourself and take steps to get the sleep your body needs.
Readers who are interested in learning more can order Dr. Gott’s Health Reports “Sleep/Wake Disorders” and “More Compelling Home Remedies” by sending a self-addressed, stamped number 10 envelope and a $2 (for each report) US check or money order to Peter H. Gott, MD Health Reports, PO Box 433, Lakeville, CT 06039. Be sure to mention the title(s) or print an order form from www.AskDrGottMD.com.
