The way sleep aids are used by Americans is changing. As we all know, it gets harder to enjoy a good nights sleep as you get older, so unsurprisingly the tendency to use sleep aids increases with age. But recently, there has been a significant increase in the use of sleeping pills by the young. However, the reasons for this might not be what you’d expect.

In fact, the use of sleeping pills among American children and very young adults rose 85 percent from 2000 to 2004, a study shows, in yet another sign that parents and doctors are increasingly turning to prescription medications to solve childhood health and behavioral problems.

About 15 percent of people under age 20 using sleeping pills were also being given drugs to treat attention deficit and hyperactivity disorder, according to a study by Medco Health Solutions, a managed-care company that estimates about medication use in the population based on extrapolations from its own data. Drugs used to treat attention disorders can cause insomnia.

No sleep medication has been approved by the Food and Drug Administration for children under 18. Doctors commonly use medications for patients and disorders for which the drugs have never received formal approval, particularly when those patients are children.

Dr. Robert Epstein, Medco’s chief medical officer, said, “It leads you to wonder whether these children are being treated for insomnia caused by hyperactivity, or whether the medication itself causes the insomnia.”

Medco took the data from 2.4 million of its customers. In 2000, of 340,124 patients age 10 to 19, 554 took sleep aids. In 2004, of 342,568 patients age 10 to 19, 1,032 took sleeping pills. After adjusting for the difference in sample sizes, the rise in use was 85 percent, Medco said.

The use of sleep aids among adults doubled from 2000 to 2004, but older people are most likely to use sleeping pills, Medco found.

At every age, girls and women were more likely than boys and men to take sleeping pills.

Gregg Jacobs, a Harvard Medical School assistant professor of psychiatry, said “too many prescriptions are being written for people who don’t need a prescription or who would do just as well or better with cognitive behavioral therapy, which doesn’t have the side effects of medication.”

Ambien CR is the new 2-layer formulation of Ambien with a time-released core. The outer layer helps you fall asleep and then it has a core that releases slowly so you sleep uninterrupted. Sounds to me like this is Ambien’s response to the success of Lunesta. One of the strengths of Lunesta is that it helps you sleep with fewer interruptions.

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Ambien CR is non-narcotic and a non- benzodiazepine, formulated to offer a similar safety profile to Ambien with a new indication for sleep maintenance, in addition to sleep induction. In contrast to Ambien, Ambien CR is not limited to the short-term treatment of insomnia.

According to a recent National Sleep Foundation poll, more than one half (54%) of Americans said they experience at least one symptom of insomnia at least a few nights a week. In fact, one in five adults experienced difficulty falling asleep and one in three reported waking often during the night at least a few nights a week.

Ambien CR is a bi-layered tablet delivered in two stages. The first layer dissolves quickly to induce sleep. The second layer is released more gradually into the body to help provide more continuous sleep.

College students get a lot of stress and that can lead to bad sleep habits and insomnia. Although sleep aids can help this problem, unfortunately, some students end up ignoring best advice concerning their usage. This is an extract of an article in the Princeton review illustating just such problems that on campus there.

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A few bad nights of sleep in the beginning of freshman year quickly snowballed into chronic insomnia for Ryan Harris ‘07. He was soon popping sleeping pills and downing alcohol before bed. Often fatigued and dysfunctional, Harris was consumed with worries about not being able to sleep.

Though Harris’ case is extreme, a large number of Princeton students have trouble sleeping at some point during their time here, and many suffer from longterm sleeping disorders, reflecting a nationwide trend among college students.

John Kolligian, director of Counseling and Psychological Services at McCosh Health Center, said his impression is that sleeeping disorders are not unusual.

“It’s hard to give a percentage but it’s one of those fairly common complaints that students come in with,” Kolligian said.

Along with Counseling and Psychological Services, students with sleep difficulties can also seek help through Medical Services at McCosh, which deals primarily with short-term problems. But Director of Medical Services Peter Johnsen said he suspects that most students with a problem are not coming in.

According to Kolligian, while treating most sleep-related problems is “routine,” regular therapy or medication is sometimes required. When this is the case, Counseling and Psychological Services often refers students to nearby psychiatrists or sleep centers for more fine-grained analysis.

Princeton is not the only campus at which sleeping disorders are prevalent. The McKinley Health Center at the University of Illinois recently found that at least two thirds of college students report occasional sleep disturbances, and one third of those suffer from severe sleep difficulties. Greg Eels, the director of Cornell’s health services, agrees that poor sleeping habits are common across campuses nationwide.

“There’s a clear trend in the direction of more sleeping problems,” Eels said. “I think it’s getting worse because of increased stress — people are trying to squeeze too much into a day. I do see those pressures increasing, as well as the expectation that you have to do it all.”

Stress and anxiety are some of the more common causes of insomnia on campus, according to Kolligian, especially because of the demanding Princeton environment.

“Everyone who is here is a high achiever and is to some degree ambitious,” Kolligian said. “There’s an intense academic and social realm, and a degree of competitiveness.”

He said that when a person with past psychological issues experiences these stresses, the combination often results in a sleep disorder.

Harris believes that sleep disorders are usually mental, since his own sleep problems arose because of self-induced pressure and anxiety.

“When I lay my head on the pillow at night, my brain just started thinking and thinking — it was everywhere,” he said.

Harris’ sleep was also disrupted by adjusting to college life. Having been originally placed in a double his freshman year, he found he could not fall asleep while his roommate was awake due to his sensitivity to sound.

He requested a single and was granted one, since sleep disorders are a valid justification for special needs housing. This year, there were nine requests on the basis of sleep disorders.

The stress of moving to a new environment is a typical cause of college students’ sleep problems. Kolligian said that cases of sleeping disorders are most common among freshmen in the beginning of the year, since this can be an overwhelming time.

“If one happens to be a lighter sleeper, then living in a place where the walls might be thinner and where there’s a lot of things going on can mix with a little bit of stress levels being up and can create a problem where there wasn’t one before,” he said.

He added that these problems usually become resolved as the year goes on, though.

Students also suffer in the transition to college because their normal sleep schedule is thrown off.

“For a lot of students, the whole biological time clock gets changed when you get to college,” Johnsen explained. “For some people, that works fine, but for others who are going to have to get up early for class, it becomes disruptive and becomes a downward spiral.”

Harris said he was caught up in the vicious cycle of sleep deprivation.

“It’s like I needed I good night’s rest to have the confidence to fall asleep the next nigh,” he said.

Counselors at McCosh try to develop strategies to break this cycle with the student.

“Sometimes it’s a matter of doing some relaxation training, meditation or mindfulness, sometimes it’s paying attention to caffeine, getting more exercise or establishing a nighttime routine,” Kolligian said. “And sometimes, there’s a place for medication … at least to break the cycle.”

According to both Kolligian and Johnsen, a concern is that many students with sleeping problems are self-medicating with over-the-counter sleeping aids, which can leave them drowsy the next morning and hinder their daily functioning.

“[Students] take a sleep aid even when simple things would facilitate sleep,” he said. “There are a lot of good behavioral techniques to train yourself to get to sleep.”

Harris managed to break his cycle of insomnia near the middle of his sophomore year. Similar to what happens with many students, his problems just seemed to go away on their own. Now, he only occasionally has trouble sleeping.

To encourage healthy sleeping habits among students, Kolligan said it would be worth considering a special outreach effort.

“I think we try to focus on wellness and ways to keep a balance, such as eating well, getting exercise and drinking responsibly, so why not emphasize the primacy of sleep?”

It may be obvious, but it certainly bears repeating. As you get older, your body’s processes don’t work so well. In particular, that means that it’s harder to eliminate substances and so medications may have a longer lasting effect, or they may tend to create more side-effects. Reviewing the usage notes on most sleeping pills and the data from the manufacturers, it’s clear that smaller doses are often recommended by doctors for older patients.

Here’s an extract of an article we found on the BBC about a survey of elderly people taking sedatives in the UK. It doesn’t give much information in terms of what sedatives, what doses, and who exactly the the elderly were in the review, but it has some interesting information. Older people using sleep aids certainly need to be sure to use their common sense in these matters and, as always - doctor knows best - so always follow correct usage instructions.

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Taking sedatives to aid sleep may do the elderly more harm than good, researchers have concluded.
Up to a third of elderly people in the UK are prescribed sleeping pills because they are affected by insomnia.

Canadian researchers detail an analysis of 24 studies in a report in the British Medical Journal.

They conclude that the risk of side effects such as dizziness, loss of balance, falls, and disorientation outweighed the benefits of such drugs.

The research reinforces the need for regular reviews of medicines for older people to ensure that the benefits outweigh the risk rather than vice versa

Dr Lorna Layward, Help the Aged

The studies, carried out between 1966 and 2003, covered 2,417 participants over 60.

People who had taken sedatives for five consecutive nights were compared with others taking dummy pills.

The studies covered a range of medications, including over-the-counter medications such as antihistamines, and prescription only drugs like benzodiazepine.

Effects such as dizziness or loss of balance were reported in 13 studies (1,016 participants).

Seven cases led to serious events - six falls and one car crash.

Medication reviews

Benefits from taking sedatives, such as more sound uninterrupted sleep, ease of getting to sleep and greater total sleep time, were reported.

But, writing in the BMJ, the team from the Centre for Addiction and Mental Health in Toronto suggested older patients are more than twice as likely to experience an adverse event after taking sedatives as they are to gain a better quality of sleep.

The team, led by Dr Usoa Busto, said: “Although the improvements in sleep variables obtained from prescription sedative hypnotics are statistically significant, the effect size is small, and the clinical benefits may be modest at best.”

They added: “The added risk of an adverse event may not justify these benefits, particularly in a high risk elderly population.”

The researchers suggested older people with sleep problems should try non-drug therapies, such as cognitive behaviour therapy.

“Because fewer risks are associated with behavioural therapies, they may be a viable treatment alternative in a healthy elderly population,” they said.

Worth trying

Dr Peter Passmore, a geriatrician at Queen’s University, Belfast, said the findings of the study did not apply to people with anxiety, other psychiatric conditions, or illnesses which caused them severe pain, who would benefit from taking sedatives.

And he said others should ensure they really do need the drugs: “People are on sedatives for a variety of reasons; It’s an issue of reviewing the need for medication.

“Non-medication methods of helping sleep are worth trying.

“Older people tend to have a nap in the afternoon, which can disrupt night-time sleep, and they may be drinking tea or chocolate at bedtime, which both contain caffeine and can act as a diuretic, which can both disrupt sleep.”

Dr Lorna Layward, research manager at Help the Aged, said: “This research will prove vital, not just because as many as half of all older people suffer from irregular patterns of sleep, accounting for 40% of sleeping pill prescriptions, but - importantly - because there isn’t enough evidence-based research carried out on older people in this area.

She added: “The research reinforces the need for regular reviews of medicines for older people to ensure that the benefits outweigh the risk rather than vice versa.”

Just couldn’t resist… from Biblical sleep metaphors to life as a dream… my news-hungry script dug this one out of the net for us…

…the Holy See on kicking the ‘habit’ habit at Advent.

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Father Cantalamessa on Advent’s Wake-up Call

Papal Household Preacher Comments on Liturgical Readings

ROME, NOV. 27, 2005 (Zenit.org).- In his commentary on today’s liturgical readings, Capuchin Father Raniero Cantalamessa, the preacher of the Pontifical Household, talks about how Advent helps us to kick bad habits.

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Mark 13:33-37

Life Is a Dream!

Jesus’ way of speaking implies a very precise view of the world: the present time is like a long night; the life we lead is like a dream; the frenetic activity we engage in is, in fact, a dream. A Spanish writer of the 17th century, Calderón de la Barca, wrote a famous play on the subject: “Life Is a Dream.”

In sleep, our life reflects above all brevity. Sleep occurs outside of time. In sleep things do not last as in reality. Situations that would take days and weeks, in sleep happen in a few minutes. It is an image of our life: Reaching old age, one looks back and has the impression that life has been no more than an instant.

Another characteristic of sleep is irreality or vanity. One can dream one is at a banquet and eats and drinks to the point of satiety; one awakes and is again hungry. A poor man, one night, dreams he has become rich: He exults in his sleep, he shows off, he even disdains his own father, pretending he does not recognize him, but he awakens and realizes he is just as poor as he was before! This also happens when one comes out of the dream of this life. One has been rich down here, but then dies and finds himself exactly in the situation of the poor man who awoke after dreaming he was rich. What remains of all his riches if he has not used them well? Empty hands.

There is a characteristic of sleep that does not apply in life, the absence of responsibility. One might have killed or robbed in dreams; one awakes and there is no guilt; one’s certificate of criminal antecedents is without a stain. Not so in life; we know it well. What one does in life leaves its trace, and what a trace! It is written in fact that God “will render to every man according to his works” (Romans 2:6).

On the physical plane there are substances that “induce” and aid to sleep; they are called sleeping pills and are well known by a generation such as our own, sick with insomnia. Also on the moral plane there is a terrible sleeping pill. It is called habit.

A habit is like a vampire. The vampire — at least according to what is believed — attacks people who are asleep and, while it sucks their blood, at the same time it injects a soporific substance which makes sleep even lovelier, so that the unfortunate individual sinks into ever more profound sleep and the vampire can suck all the blood it needs. The habit of vice also lulls the conscience, so that one no longer feels remorse; one believes one is very well and does not realize that one is dying spiritually.

The only salvation, when this “vampire” has attached itself to an individual, is that something unexpected happen to awaken one from one’s dream. This is what the Word of God that we hear so often during Advent is determined to do, cry out so that we wake up!

We conclude with a word of Jesus that opens our hearts to confidence and hope: “Blessed are those servants whom the master finds awake when he comes; truly, I say to you, he will gird himself and have them sit at table , and he will come and serve them” (Luke 12:37).

Here’s an extract from a very interesting comparision report on sleep aids. Since insomnia has different causes and symptoms, as we might expect - there are no winners, just differences. But if you have an insomnia problem, this information might help you find the best insomnia cure.

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FRIDAY, Dec. 9 (HealthDay News) — No single sleeping pill stands out as the best, according to a U.S. review of the newer sleep aids on the market.

The researchers reviewed 141 studies of the sleeping pills Sonata, Ambien, Lunesta and a Canadian brand called Imovane. These are all considered newer sleeping aids and are commonly prescribed for insomnia in place of older benzodiazepine sleeping aids such as Halcion, ProSom and Restoril.

The OHSU review concluded that these newer sleeping pills were more effective than placebo pills at treating insomnia symptoms and that “although there are some differences between the drugs on some outcomes, no one drug appeared to be consistently superior.”

For example, Sonata seemed better than Ambien at putting people to sleep quickly, while people taking Ambien slept longer and reported having a better quality of sleep than people who took Sonata.

“Although there are some differences among the drugs on the different outcomes, it does not follow that one drug would necessarily be more or less effective for patients with one type of insomnia over another,” the authors said. “We found no studies comparing the different drugs in patients with different insomnia complaints, so we do not know for sure that one drug would work better in one patient over another.”

They also found that the newer sleeping pills had similar rates of short-term side effects such as headaches and daytime sleepiness.

Abuse of Rohypnol to commit date rape has been widely reported, but according to some experts there is no known case of Ambien being used in this way. Despite this, experts caution against the misuse of Ambien. Here’s an extract of an article we found with some interesting information.

Sexual assault nurse examiner Janie Cantu-Cabrera vividly remembers when police came to her four to five years ago with two teenaged sisters who had been drugged at a Pharr hotel party and then raped, possibly repeatedly.

The younger sister, who was 13 at the time, told the nurse that all she could recall was being trapped inside a bathtub while several faces hovered above her. Standing in the door frame was her older sister, 18, just watching.

The older sister, Cantu-Cabrera said, told the nurse that all she could remember from the previous night was seeing her sibling in the shower. Both of the girls reported feeling “funny” in the genital area.

“Both had physical findings of sexual assault,” Cantu-Cabrera said.

These girls were both likely drugged with Rohypnol, she said — a substance local teens still commonly abuse for recreation because of the euphoric state it can induce, and that predators use to facilitate rapes because of how it lowers victims’ inhibitions.

According to Juan J. Gonzales, Edinburg Consolidated Independent School District police chief, the prescription sleep aid Ambien is also “very popular” among local youth.

“It’s becoming more and more widely known,” he said.

These kind of reports make it especially important for revelers as they head out to parties this holiday season.

Even though statistics from the U.S. Drug Enforcement Administration point to a decrease in the availability of the drug on a national scale, Texas has experienced a spike in poison control calls and treatment admissions for Rohypnol, especially among Hispanic youth living along the border.

“It’s gotten worse,” Cantu-Cabrera said, referring to the recreational use of prescription drugs.

Kids as young as 12 years old are now taking Rohypnol, or roche pills as they are commonly called. Pills cost as little as $1. And although the pills are illegal in the United States, they can be bought with ease in Mexico and smuggled across the border.

And earlier this month at a meeting in which sexual assault victims’ advocates, law enforcement officials and nursing community members came together to discuss the establishment of a Sexual Assault Response Team, a specialist with the Texas Attorney General’s office also mentioned Ambien as a “date-rape drug” growing in popularity.

Experts working with sexual assault victims say they have never seen a confirmed case of Ambien used to commit a rape in Hidalgo County; however, some do see the potential for this type of abuse and are concerned about the trend the sexual assault community development specialist, Lisa Zapata-Maling, has recognized elsewhere in the state.

“It’s going to put someone to sleep,” said Vanessa Recio, a pharmacist with Saenz Pharmacy in Mission.

Recio said Ambien is widely prescribed, but it is mostly approved for adults. It is classified as a controlled medication, along with Vicodin and other strong medications with potential for abuse.

“You don’t see too many adolescents prescribed a sleep aid,” she said. “I don’t know I’ve ever dispensed an Ambien to a patient under 30.”

Ambien causes central nervous system depression and can impair cognitive thinking.

It’s one of the best drugs on the market to treat insomnia, said Andrea Lerma, a psychiatric clinical specialist at Tropical Texas MHMR, which is the state’s local mental health facility. Lerma prescribes Ambien with frequency for patients suffering from major depression, bipolar disorder and other mental health illnesses.

Some people, however, do experience Ambien amnesia when taking the drug, she said.

People have been known to get up and cook in the middle of the night or eat a lot. They wake in the morning to find candy wrappers or dirty pots and pans, she said, and they don’t remember any of it.

Lerma said she can see how Ambien could be used as a “date rape drug.”

It also has a short half-life, which means it is eliminated from the body very quickly.

One reason why Ambien has not yet gained as much popularity in Hidalgo County as roche pills is because of its price.

“Ambien is very expensive — $90 to $100 for a one month supply,” Lerma said. “It’s expensive over in Mexico, too.”

Ambien is more difficult to obtain, too, said ECISD Police Chief Gonzales.

“If kids are using it (Ambien), they are getting it somewhere else,” Cantu-Cabrera said.

Kids could be stealing their parents’ or grandparents’ pills, said Diana Cuellar, prevention educator with Women Together/Mujeres Unidas, a safe house for victims of sexual assault.

“Sleep aids in general are being abused,” Cuellar said. “… Prescription sleep aids are very powerful.”

Here’s some additional information about comparison benefits of different sleep aids.

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The most popular prescription sleep drug now available is Ambien. It too has a short half-life, but not as short as Sonata’s, which means you can take Sonata later in the night than Ambien, without increasing your risk of morning hangover.

Over-the-counter (OTC) sleep medications and products such as Tylenol PM and Benadryl are popular as well. Some of these sleep aids contain antihistamines. They do induce sleep in some people, but, according to Dr. White, they may have more potential side effects than some prescription sleep aids, such as dry nose, dry eyes, and urinary retention. And they, too, can cause “hangovers.”

Many experts, including Dr. White, suggest trying other methods of preventing insomnia before trying medications. These include relaxation and stress reduction techniques and certain dietary changes. Also, check with your doctor to see if any medications you’re taking may be causing a sleep problem. Some drugs for high blood pressure and asthma are linked with sleep disturbance. Avoiding alcohol, caffeine, and nicotine within several hours of bedtime may also help.

Did you ever think about the flip side of Insomnia? Narcolepsy is where people just can’t stay awake. This is a very rare condition. Most guys falling asleep at their desk don’t have this - they are probably just not getting enough sleep and are most likely untreated insomniacs (and maybe a terribly boring job!). True narcolepsy is actually pretty serious - imagine being wide-awake driving your car and - boom - you take a nap!

Here’s some background on a new drug for the poor souls with this rare disorder…

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The flip side of promoting sleep is enhancing wakefulness. A new drug, Provigil, is available for this purpose. Provigil is intended for the treatment of narcolepsy—a condition characterized by excessive sleepiness during the day, even after a full night’s sleep. It’s important to note that narcolepsy is a very different sleep disorder than insomnia. Far fewer people have it—about 125,000-250,000. But it can be a dangerous condition, because it can lead to sudden or unexpected sleep during the day. Most people with narcolepsy are treated with stimulant drugs, such as Ritalin, or amphetamines like Dexedrine, both of which can be habit forming.

Provigil stimulates the body via a different mechanism than these drugs and is therefore less likely to be habit forming. “It has very little abuse potential,” according to Dr. White. The FDA apparently agrees and has classified it differently than Ritalin and Dexedrine, which require special licensing and prescription regulations.

One of the advantages of Sonata is that you can take it after you’ve tried to sleep and failed when you only have about 4 hours or so left to sleep. Most sleep aids, like Ambien and Lunesta, require a full 8 hours.

Here’s an extract from a report we found with some additional data.

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Sonata, recently approved by the FDA, may put an end to groggy mornings for people with insomnia. It is specifically designed to have a short “half-life,” meaning that it stays active in the body for only a short time. Therefore, it helps promote sleepiness when you take it at night, but doesn’t leave you feeling sedated many hours later when you’re trying to get on with your day.

Sonata is a short-acting product, so it will help you go to sleep but won’t help keep you asleep for more than 4 hours or so. If you wake up at 4 a.m. and have to get up at 6 a.m., you’ll still be tossing and turning until the alarm goes off. “Some people go to sleep fine, but wake up and can’t go back to sleep. For these people, I’m concerned that Sonata won’t be as helpful, ” says David White, MD, Director of the Sleep Disorders Program at Boston’s Brigham and Women’s Hospital.

The scientific research on Sonata shows that it stays active only until sleep is initiated. Then the body clears it from the system naturally. On tests of nearly 3,000 people (including nearly 1,000 elderly people) with transient or chronic insomnia, Sonata helped induce sleep within 30 minutes and was more effective than a placebo. After 4 or more hours after taking the drug, people had no problems with memory or physical motor skills—common side effects associated with that hungover feeling. About 28% of study participants who took Sonata complained of headache and 5-7% reported dizziness or undesirable drowsiness. Sonata is intended only to treat short-term (5-7 days) bouts of insomnia.