Cooling Cap Could Provide Insomnia Relief

There is no easy cure for insomnia. Sleeping pills appear to be a quick fix, but the potential for psychological attachment and rebound insomnia make medication for insomnia a solution for short-term problems only. Alternatively, you can seek cognitive behavioral therapy to help eliminate the harmful thoughts and bad habits that promote extended periods of insomnia. This solution is very effective but also time-consuming and requires effort and dedication.

New research presented at SLEEP 2011, the 25th Anniversary Meeting of the Associated Professional Sleep Societies LLC (APSS), suggests another treatment choice for insomnia may be on the horizon. The potential treatment would use a cooling cap that would lower your brain temperature to help you fall asleep.

Normally, a reduction in brain metabolism occurs as you fall asleep. However, during insomnia, the brain metabolism increases, keeping you awake. The cap helps reduce metabolic activity by cooling the front half of the brain.

The study involved 24 people. Half of the participants had insomnia. Each was subjected to several overnight sleep studies while wearing the cooling cap. The settings for the cooling cap differed each night, ranging from maximum amounts of water cooling to not wearing the cap at all.

Results show patients who wore the cooling cap set to its maximum level slept nearly as well as the subjects who didn’t have insomnia. These findings suggest the device could be a new promising therapy for insomnia sometime in the future. The treatment is still a long ways off; more studies will need to be conducted before the device can hit the marketplace.

Study Links Sleeping Pills to Mortality

Sleeping pills lengthen your slumber and may shorten your life, a Canadian report claims. The 12-year study linked hypnotic class sleep drugs and anti-anxiety medications with long-term mortality.

Consumption of sleeping pills or anxiety relieving medications was associated with a 36 percent higher death risk, the study concluded. Respondents to a large Canadian National Survey who said they used the medications at least once a month had a mortality rate of 15.7 percent. Those who said did not use the medications had a rate of 10.5 percent. The results were controlled to person risk factors like tobacco use, depression and physical health.

The study offers no clear explanation of the findings. The results bare resemblance to a study published in the September issue of the journal SLEEP that investigated a possible link between insomnia and long-term death risk. It reported five times as many middle-aged male insomnia patients died over the 14-year study length compared with healthy subjects.

Could the elevated mortality rates associated with sleeping pills be due to long-term insomnia? It is not a stretch to conclude a many of the people who regularly use sleeping pills over an extended period of time also have long-term insomnia.

Dr. Geneviève Belleville, the lead author of the sleeping pill study, offers an alternate explanation. Dr. Belleville speculates the sleeping pills and anti-anxiety medications may cause accidents and promote suicides.

Sleeping pills and anxiolytics impact reaction time, alertness and coordination. Under these conditions, the risk of injury from a fall or an automotive accident increases.

A review shows sleeping drugs may increase the risk of suicide as many as seven times over. Central nervous system inhibitors found in the medications may alter a person’s judgment, making some people more likely to carry out suicidal ideations.

The AASM reports hypnotic class drugs are safe and effect short-term solutions to insomnia when used as directed. Go to bed immediately after taking sleep medications and avoid physical activity, driving, or operating heavy machinery. Never take more than the recommended dose, for risk of serious complications.

Dr. Belleville recommends insomnia patients consider the alternative of cognitive behavioral therapy, the most effective solution to long-term insomnia. The approach helps you change actions or thoughts that hurt your ability to sleep and promote a healthy pattern of sleep.

Image by Zach Armstrong

Sleep Drug during Depression Treatment can Solve Insomnia Symptoms

Insomnia and depression are often closely related. The relationship can go both ways: depression can cause insomnia, and insomnia can lead to depression.

Depression drugs are the front-line treatment for most patients, but as the bleakness of depression goes away the sleeplessness often stays.

A team of researchers say the insomnia can be easily solved by altering patients’ prescriptions. They found that pairing the hypnotic sleeping pill Lunesta with serotonin reuptake inhibitors (SSRI) may be the ideal approach for depression with insomnia.

The study involved 60 patients diagnosed with depression and insomnia. After one week of taking Prozac, the subjects began combining the drug with Lunesta or a placebo.

Patients who took the sleeping drugs reported a higher health-related quality of life. Depression improved and the patients had less difficulty sleeping.


The AASM reports that insomnia can occur in 85 percent of people with a major depressive episode. Frequent awakenings during the night are typical; waking up early in the morning and being unable to go back to sleep also is common.

Often the insomnia complaint is among the earliest symptoms to appear in a person with a mental health disorder. People often attribute their mental symptoms to poor sleep.

Photo by Max Talbot-Minkin

Learning from Lindsay Lohan, Follow Doctors' Orders for Sleeping Pills

Former teen starlet turned jailbird Lindsay Lohan reportedly was asking for trouble by combining Ambien and several other drugs. A report by the tabloid TMZ claims the troubled actress’s medicine cabinet contained Zolpidem, Adderall and Dilaudid, a potentially dangerous combination. Although CBS News was unable to verify it, the Lohan’s story is an opportunity to talk about responsible use of sleeping pills.

For Lohan, the consequences could have been a lot worse than a 90-day prison sentence. CBS News Chief Medical Correspondent Dr. John Lapook reports combining Dilaudid and Ambien can depress your breathing and cause oxygen in your blood to become dangerously low.

Other potential drug combinations may be a recipe for trouble. Although probation has prevented Lohan from drinking or using illegal recreational drugs, it’s anyone’s guess what she may have been doing before had to wear a monitoring bracelet and take drug tests regularly.

Sleeping pills should never be taken with alcohol. That combination may result in a visit to the emergency room. Other drugs, especially those with depressant effects may lead to similar serious health problems.

The AASM reports Ambien is a safe short-term solution to insomnia… if you closely follow doctors’ orders. Strange episodes of sleep walking, sleep driving or even sleep sex can occur when the drug isn’t used as directed.

Cognitive behavioral therapy may be a better choice for long-term or chronic cases of insomnia.

FDA Approves Silenor for Insomnia

The makers of sleeping pills such as Ambien, Lunesta and Rozerem will soon have new competition. On March 17 the FDA granted approval to Somaxon Pharmaceuticals for its drug Silenor. Somaxon reports that the insomnia medication should be available in the second half of 2010.

But Silenor isn’t for people who have trouble falling asleep. It takes about 3.5 hours for the drug to reach its peak concentration in the blood.

So the FDA approved Silenor to help people who struggle with “sleep maintenance.” It may benefit people who tend to wake up during the night or early in the morning and struggle to return to sleep.

The drug that Silenor contains is called “doxepin.” For years this histamine-blocking drug has been used at high doses as an antidepressant.

It has been known that doxepin also improves sleep. But at high doses it may cause severe side effects. This prevented the drug from being used as a common sleep aid.

Now studies have shown that doxepin can reduce the symptoms of insomnia at doses as low as 3mg or 6 mg. Side effects are minimal at these low doses. The FDA recommends that older adults start with the 3 mg dose.

One of these studies was published in the journal Sleep in 2007. It involved 66 adults with chronic primary insomnia. They had a mean age of 42 years, and 70 percent were women. Both 3 mg and 6 mg doses of doxepin were compared with a placebo.

Results show that doxepin reduced the time spent awake after falling asleep by about 22 to 23 minutes. It increased total sleep time by about 26 to 29 minutes. But it did not reduce the number of awakenings during the night.

Last year the Sleep Education Blog reported an increase in prescriptions for sleeping pills. The use of sleeping pills by young adults also rose dramatically.

The AASM offers these Guidelines for Taking Sleep Medications. Contact your doctor or pharmacist if you have any other questions about taking sleeping pills.

You also should ask your doctor about cognitive behavioral therapy for insomnia. It is a safe and effective treatment option.

Get help for insomnia at an AASM-accredited sleep center near you.

Understanding Unusual Ambien Side Effects

A new study may help explain why some people have unusual side effects when taking the sleep aid zolpidem – also known as Ambien.

Reuters reports that the drug can shut down brain circuits that normally inhibit some activity. This may release the brakes on other brain circuits while you sleep.

“In a way, Ambien is awakening other circuits because the brakes are not in place," study co-author Molly Huntsman told Reuters. “It's a population of neurons that is normally in place to stop activity. We find what Ambien does is inhibit their function to inhibit.”

Ambien is a sedative-hypnotic that is FDA-approved for the short-term treatment of insomnia in adults. The most common side effects include drowsiness and dizziness.

But other unusual side effects can occur. In 2007 the FDA requested changes to the product labeling of all sedative-hypnotics.

One of the proposed changes was to include a warning about the risk of “complex sleep-related behaviors.” Examples include sleepwalking and sleep eating. Rare cases of sleep driving also have been reported.

The FDA-approved Medication Guide for Ambien now states that, “You may get up out of bed while not being fully awake and do an activity that you do not know you are doing. The next morning, you may not remember that you did anything during the night.”

But why do these unusual side effects only occur in some people? Huntsman suggests that something may have happened to their brain circuitry.

It is possible that a previous experience changed their brain receptors. This could affect how they respond to a drug like Ambien.

“A lot of things can change your brain chemistry - stress, alcohol use," Huntsman told Reuters.

The AASM offers these Guidelines for Taking Sleep Medications. Contact your doctor or pharmacist if you have any other questions about taking sleeping pills.

You also should ask your doctor about cognitive behavioral therapy for insomnia. It is a safe and effective treatment option.

Get help for insomnia at an AASM-accredited sleep center near you.

Michael Jackson’s Death & Prescription Drug Abuse

Soon after Michael Jackson’s death questions arose about his possible abuse of prescription drugs. Five days later those questions remain. Investigators recently took more medications from the rented house where Jackson collapsed.

The controversy has focused attention on the nationwide problem of prescription drug abuse. The risk of addiction extends far beyond the rich and famous.

The National Institute on Drug Abuse reports that millions of people in the U.S. abuse prescription drugs each year. The NIDA estimates that 48 million people have abused or misused prescription drugs in their lifetime.

Which drugs are most likely to be abused? The NIDA warns that three classes of drugs carry the greatest risk.

Opioids are commonly abused. These drugs are used to treat pain. Examples include morphine, codeine, OxyContin, Vicodin and Demerol.

Stimulants also may be abused. These drugs are used for problems such as narcolepsy. Examples include dextroamphetamine and methylphenidate.

Central nervous system depressants also are commonly abused. This class of drugs includes barbiturates such as Nembutal. It also includes benzodiazepines such as Valium and Xanax.

Some benzodiazepines are used to treat insomnia. Examples include Dalmane, Doral, Halcion, Prosom and Restoril.

But newer “nonbenzodiazepines” have a lower risk of addiction. Examples include Ambien, Lunesta and Sonata.

Another low-risk sleep aid is ramelteon. It is marketed as Rozerem. This drug is a melatonin receptor agonist. It targets the part of the brain that regulates the sleep-wake cycle.

The AASM offers these Guidelines for Taking Sleep Medications. Contact your doctor or pharmacist if you have any other questions about taking sleeping pills. You also should ask your doctor about cognitive behavioral therapy for insomnia. It is a safe and effective treatment option.

The NIDA reports that drug addiction is a brain disease that can be treated effectively. Treatments include detoxification, counseling and drug therapy.

To get help call 1-800-662-HELP or go online to http://findtreatment.samhsa.gov/.

Learn more about prescription drug abuse on SleepEducation.com.

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Combining Cognitive Behavioral Therapy with a Medication to Treat Insomnia

For people with insomnia, taking a medication can help break the cycle of sleepless nights. And cognitive behavioral therapy can lead to long-lasting improvements with little risk of side effects. But what happens when you combine these two treatments?

A new study helps to answer this question. The results were published today in The Journal of the American Medical Association.

The study involved 160 adults with chronic insomnia. For six weeks they were treated with either CBT or CBT combined with 10 mg of zolpidem at bedtime. Zolpidem is the generic name for Ambien.

Then the study continued for six months. Some of the people treated with only CBT attended monthly treatment sessions; others had no further treatment. Some participants in the combined treatment group continued with CBT and zolpidem; others continued only with CBT.

Results show that for the first six weeks, both CBT and CBT combined with zolpidem reduced insomnia symptoms. About 60 percent of participants in each treatment group slept better. Treatment eliminated insomnia symptoms in 39 percent of the CBT group and 44 percent of the CBT with zolpidem group. The combined treatment also produced a larger increase in total sleep time.

What was the best long-term treatment? CBT with zolpidem for the first six weeks, followed by ongoing CBT without medication. This method eliminated insomnia symptoms in 68 percent of participants.

The study suggests that a combined approach may maximize the strengths of both common insomnia treatments.

You should never take a sleeping pill without first getting approval from your doctor. A sleep specialist at an AASM-accredited sleep center can develop a treatment plan for insomnia that is best for you.

An Economic Upturn for Makers of Sleeping Pills

Another sign that the economy is affecting our sleep: We’re taking more sleeping pills.

Advertising Age reports that sleeping-pill prescriptions increased seven percent last year. Sales rose even though ad spending dropped by hundreds of millions of dollars.

Sepracor had revenues of $161.9 million for the fourth quarter of 2008 from sales of Lunesta. This was up from $149.8 million for the same quarter in 2007. Full-year revenues were a little more than $600 million in both 2007 and 2008.

But sales aren’t up across the board.

Fourth-quarter net sales of Ambien CR (controlled release) in the U.S. were $170 million for sanofi-aventis. This was down from $190 million in the same quarter of 2007. Full-year sales dropped from $751 million in 2007 to $681 million in 2008.

Full-year net sales for Ambien IR (immediate release) fell to $125 million in 2008. The sanofi-aventis patent for this drug expired in April 2007. Many other companies then received FDA approval to sell less expensive, generic versions of Ambien.

The Boston Globe points out two other reasons why prescriptions may be up.

One reason has to do with safety. Older types of sleeping pills were limited to short-term use for one or two weeks. There was a risk that long-term use could cause addiction. There also was a risk that your body would develop a tolerance to the drug.

But sleeping pills introduced in the last two decades are considered to be safer. Ambien CR, Lunesta and Rozerem all have been approved for long-term use.

A study in the journal Sleep in 2008 found that regular use of Ambien CR for six months is safe and effective. The study was funded by sanofi-aventis.

In 2007 a study in the journal Sleep confirmed the long-term effectiveness of Lunesta. A nightly dose of 3 mg remained effective after six months. The study was funded by Sepracor.

A study in the Journal of Clinical Sleep Medicine in 2007 showed that nightly use of Rozerem was safe and effective over five weeks. The study was funded by Takeda.

The Globe also reports that more doctors are taking insomnia seriously. They recognize that treatment can promote both physical and mental health.

In 2008 a study in the journal Sleep affirmed that primary insomnia is a legitimate disorder. It linked primary insomnia to low levels of the brain chemical GABA. Many of the most effective sleeping pills increase brain activity at the GABA neurons. The study was funded in part by Sepracor.

Read the Guidelines for Taking Sleep Medications from the AASM.

Take Sleep Medications Carefully

Sleep medications are a safe and effective treatment option for insomnia. They can help break the cycle of sleepless nights.

But like any other drug, sleeping pills can cause side effects. These include nausea, headaches and dizziness. A recent incident involving a school-bus driver in Winston-Salem, N.C., is a reminder that daytime sleepiness is another possible side effect.

Some people also may sleepwalk, sleep eat or have other complex sleep behaviors as a side effect. In 2006 the FDA told drug makers to add these risks to their product labeling for sleeping pills.

So how can you reduce your risk of these and other side effects?

First, carefully follow your doctor’s prescribing instructions. Never take more than the dosage that your doctor prescribes. Always talk to your doctor before taking another medication along with a sleeping pill.

Also, allow time for a full night of sleep after taking a sleeping pill to reduce morning or daytime drowsiness. It is also important to avoid drinking any alcohol before or after taking a sleep medication.

Tell your doctor right away if you have any side effects from taking a sleeping pill. Your doctor may adjust your dose. Or you may be able to try a different medication.

There are a variety of effective sleeping pills available. So your doctor should be able to find one that is right for you.

If you prefer a drug-free alternative, ask you doctor about CBT for insomnia. It’s an effective treatment option that can have long-lasting effects.

Get more Tips for Taking Sleep Medications. Get advice from a sleep specialist in this Expert Q&A that focuses on insomnia.

The Curious Case of the Sleep E-mailer

Add e-mailing to the long list of behaviors that can occur during an episode of sleepwalking.

The journal Sleep Medicine has an article “in press” that will appear in an upcoming issue. It describes the case of a woman who sent some strange e-mails while she was asleep.

Sleepwalking can involve routine or unusual behaviors. Examples include making phone calls, walking outside or eating. But this is the first reported case of sleep e-mailing.

The New York Times reports that the woman was taking Ambien for her insomnia. The sleep e-mailing occurred after she decided on her own to increase her dose.

Like any other drug, sleep medications may cause some side effects. These side effects can include sleepwalking, sleep eating and other complex sleep behaviors. Some people also may experience memory problems.

The AASM Tips for Taking Sleep Medications note that you should follow your doctor’s instructions when taking a sleeping pill. Never increase the dose on your own. You also should only take the sleeping pill for as many days or weeks as your doctor tells you.

The Times article also reports that a new feature from Google could help protect sleepwalkers from sending embarrassing e-mails. It’s called Mail Goggles.

When enabled, it stops you from sending late-night e-mails on weekends. Before a message is sent, you have to solve a few math problems. The intent is to force you to stop and consider if you really want to send the message.

The math problems are fairly simple. But for a sleepwalker, it might be enough to prevent you from sending a strange e-mail to a co-worker or friend.

Update 03/02/09: The article appears in the February 2009 issue (volume 10, issue 2) of Sleep Medicine.

More Young Adults Using Sleeping Pills

The New York Times reports that the use of sleeping pills by young adults has risen dramatically. The biggest increase from 1998 to 2006 came among adults between the ages of 18 and 24.

The report is based on an analysis by Thomson Reuters. It examined drug claims by adults under the age of 45. Overall sleeping pill use was highest among adults between the ages of 35 and 44.

The most popular sleeping pills were Ambien CR and Lunesta. The drugs were prescribed for an average of 93 days.

AASM president Dr. Mary Susan Esther told the Times that chronic insomnia often is linked to other problems. These include depression and anxiety. In these cases a sleeping pill won’t address the related problem.

Insomnia also can be caused by disruptions to the sleeping environment. This is called environmental sleep disorder. Dr. Esther pointed out that a noisy dorm is a common sleep disrupter for college students.

The report did not examine the use of other treatments for insomnia. One of the most effective treatments is cognitive behavioral therapy. Following the tips of good sleep hygiene also helps some people with insomnia.

Like any other drug, sleeping pills may cause some side effects. These side effects can include sleepwalking, sleep eating and other complex sleep behaviors. Some people also may experience memory problems.

The AASM offers these Guidelines for Taking Sleep Medications. Contact your doctor or pharmacist if you have any other questions about taking sleeping pills.