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DANIEL BUYSSE, MD: The amount of sleep that we need is the amount that keeps us awake, feeling refreshed and able to concentrate and function well during the day.
ANNONCER: But every night, an estimated 70 million Americans don't achieve that goal.
GARY ZAMMIT, PhD: The bad news about insomnia is that it can be debilitating. The good news is that there are treatments available, and these treatments include nonpharmacologic as well as pharmacologic treatments.
The nonpharmacologic treatments for insomnia include things like sleep hygiene, stimulus control therapy, sleep restriction therapy, relaxation therapies and other therapies, such as light therapy, that might be helpful to sleepers.
ANNOUNCER: Everyday stress can be a factor in poor sleep, so doctors often recommend a program that promotes relaxation.
DANIEL BUYSSE, MD: There are many different relaxation techniques ranging from progressive muscle relaxation to guided imagery, even to meditation techniques and yoga.
All of them, though, have in common the fact that they reduce a person's arousal level and really help to refocus attention from the sleep problem to some other more neutral stimulus.
ANNOUNCER: Other techniques include learning new bedtime behaviors.
GARY ZAMMIT, PhD: The person with insomnia who tosses and turns in bed for a couple of nights begins to associate the bed and the bedroom with wakefulness rather than sleep. So stimulus control tries to break those associations by making sure that the sleeper gets out of bed whenever he or she is awake.
DANIEL BUYSSE, MD: People will talk on the telephone, watch TV, balance their checkbook. And all of those things keep us awake in bed when what we're really trying to do is train ourselves to be asleep in bed. So eliminating bedtime activities that have nothing to do with sleep is one important aspect of sleep hygiene.
ANNOUNCER: But changing habits can take time.
DANIEL BUYSSE, MD: Behavioral treatments for insomnia can be very effective for people who are highly motivated and people who are able to practice the techniques that are given to them. The downside of behavioral treatments is that they require some time with a practitioner and it's important for patients to realize that these techniques don't work overnight, so to speak.
ANNOUNCER: For some, prescription medications may offer relief.
DANIEL BUYSSE, MD: The only drugs currently approved for treatment of insomnia are hypnotic drugs that tend to fall into one of two classes. One class is benzodiazepine drugs that are similar to some of the older drugs like Valium, Librium or Ativan.
Interestingly, the most common side effect is also the desired effect. That is, if a drug makes us sleepy at night, it's a therapeutic effect. If it makes us sleepy into the next morning, we consider that to be a side effect.
In addition to next day sedation, hypnotic medications can cause some difficulties with memory and concentration, particularly the longer acting drugs. The other class of drugs are the non-benzodiazepine hypnotics and those include Ambien and Sonata.
GARY ZAMMIT, PhD: Both of these medications are believed to be as effective as the older class of drugs, but in many respects safer in that people don't seem to have problems with abuse or dependence or many of the adverse effects that were associated with the older class of drugs. If people do experience side effects, the most commonly reported are probably headache, nausea and dizziness. But for the most part the rate of side effects with these newer medications is pretty low.
ANNOUNCER: Different prescriptions can achieve different results.
DANIEL BUYSSE, MD: There are some hypnotic drugs that have a very short duration of action, may be appropriate for sleep onset problems. Other hypnotic drugs have a slightly longer duration of action and may be useful for people who have some middle of night awakenings. There are also longer acting hypnotic drugs that may be useful for people with late night awakenings but the problem with those drugs is that they may be so long acting that they lead to next day sedation.
ANNOUNCER: Over the counter medications can also help people with difficulties sleeping.
DANIEL BUYSSE, MD: There are actually several different types of over the counter drugs that have been used to treat insomnia. The most common are the antihistamines, diphenhydramine and doxylamine.
GARY ZAMMIT, PhD: Some people respond reasonably well to these medications. Other people, though, report that these medicines fail to produce the desired effect, or that they experience significant adverse effects when using these medicines. These can be things like dryness, morning grogginess, fogginess. So the thing that the over-the-counter medication is supposed to help-waking up feeling rested and refreshed-is exactly what doesn't happen.
ANNOUNCER: Whichever method is used, it's important to address whatever is preventing you from getting a restful sleep.
DANIEL BUYSSE, MD: The factors that can disrupt a particular person's sleep may differ substantially from those that disrupt another person's sleep. So the important thing is to really do an inventory of your waking and your sleeping life. Look for factors that can disrupt your sleep and really do your best to minimize those factors.
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