Are you one of the many Americans plagued with insomnia?

You’re not alone. According to an article published in the April 2007 issue of About.Com: Longevity, between 30 to 40 percent of adults report some difficulty falling asleep or staying asleep and 10 to 15 percent of report some form of long-term, chronic insomnia.

Researchers attribute insomnia to a variety of factors, and there are different treatments available. Which form of treatment will work best for each individual is determined, in part, by what’s causing the problem.

Some of the different causes of insomnia include:

* Obstructive Sleep Apnea — A common sleep disorder in which breathing is interrupted 5-100 times per hour. These interruptions may not cause a person to actually wake up, but can create a chronic feeling of fatigue and mental confusion.

Often times, the person suffering with sleep apnea may not even be aware of their disrupted sleep habits, such as snoring, gasping or choking during the night.

Some people may not realize the severity of these common night time occurrences and therefore, do not seek treatment.

The most common treatment for sleep apnea is the use of a Continuous Positive Airway Pressure machine. This device delivers pressurized oxygen to the patient via a facial mask while they sleep.

Other treatments include weight loss or surgical techniques to reduce tonsils and/or soft palate obstructions.

* Restless Leg Syndrome — Another common cause of insomnia. Between 5 and 15 percent of adults have some form of this syndrome. It is a disorder that causes a tingling or pricking sensation in the legs that is temporarily eased by movement of the legs.

Restless leg syndrome may be caused by a variety of conditions, including deficiencies in iron or vitamin B-12, hypothyroidism, diabetes and certain medications.

Your physician may want to order lab studies to evaluate your levels of ferritin, B-12, TSH, and blood sugar.

* Depression — Psychological distress can interfere with sleep onset. Conversely, sleep deprivation can lead to depression and can also exacerbate other conditions, such as bipolar disorder.

A psychological screening for depression may be advised to determine the need for short-term or long-term medications.

Many over the counter sleep aids are also available, including melatonin, valerian, chamomile, magnesium, calcium and 5-HTP.

Your physician and pharmacist should be made aware of any medications you are taking for insomnia or other medical conditions.

Sleep hygiene measures are changes in habits that could prove beneficial to all individuals with sleep problems regardless of the cause. The following is a list of a few of those suggestions:

* Maintain the same bedtime and waking time every day.

* Use the bedroom only for sleeping, not as a library, eating area or TV room.

* Sleep in a cool, quiet environment.

* If you do not fall asleep within 20 minutes of going to bed, you may find it helpful to switch to another bed, free from pets or other bed partners who may inadvertently be keeping you awake.

* If awakening during the night, avoid looking at the clock.

* Avoid daytime napping or limit nap time to no more than 15 minutes.

* Develop consistent and rest-promoting bedtime routines such as listening to soft music or doing a quiet activity using dim lighting.

* Prior to bedtime, avoid caffeine and nicotine in the afternoon or evening; alcohol intake of more than three glasses; large meals or rigorous exercise within three to four hours of going to bed; watching TV late at night, especially programs that are high volume and excessively violent. Both the volume and bright lights emitted from your television set can stimulate brain activity.

Insomniacs will learn ways to naturally fall and stay asleep according to Roger Cole, internationally known sleep researcher and yoga teacher.

“The essential message is that sleeping is a skill and an art you can learn,” said Cole, who is visiting from California. “Under certain circumstances, sleep comes easily. Under other circumstances, it doesn’t.”

Participants will learn about good sleep habits, effects of caffeine, use of light, critical napping skills culled from research on transcontinental pilots, the soporific effects of warm footbaths and iced beverages, yoga postures and more. Cohen’s doctoral dissertation at University of California, San Francisco, focused on the effects of reclining or inverted postures on sleep.

“An inverted posture is simply getting your legs above your heart and/or your head and neck below your heart,” he said. “Inverted is better for a quick nap because it stimulates certain blood pressure receptors that are linked into your arousal system and helps quiet down the brain. In the workshop we’re going to practice these things.”

Sleep is a huge issue for Americans, with as many as 70 million suffering from at least one of 84 known disorders, according to the Sleep Disorder Center of Morristown Memorial Hospital.

Insomnia is one of the most common disorders. The 2005 Sleep in America Poll of the National Sleep Foundation showed 54 percent of respondents had experienced at least one symptom of insomnia at least a few nights a week in the past year. While the vast majority of those polled said they never use sleep aids, 11 percent reported using alcohol, beer or wine; 9 percent, over-the-counter sleep aids; 7 percent, prescription medications; 3 percent, an eye mask or earplugs, and 2 percent, melatonin.

Sleep medications can be a good idea for some, especially people in chronic pain, according to Cole, but mostly he believes people should be weaned off their medications and able to sleep on their own. Insomniacs who learn natural techniques in a four- to eight-week cognitive behavioral therapy program continue to use the sleep skills they learn after the program ends. But those who take medications for four to eight weeks, and then stop, are no better off than when they began.

“Also, the sleep promoted by sleep medication is not quite natural,” Cole explained. “You get more of certain stages and less of other stages. We learn something during the day and during the night, in the various sleep stages, we consolidate the memories. Each stage has its function in that consolidation. If you start disturbing the stages, there’s always a potential for causing if not memory loss, at least modification of how the memory works.”

Dr. Carlos Schenck, author of the new book “Sleep: The Mysteries, the Problems, and the Solutions,” wrote that some 20 million Americans surpass insomnia and experience more extreme sleep disorders called parasomnias, which include sleep terrors, sexsomnia, sleepwalking, sleep paralysis and sleep related-binge eating. In a free talk at Somerville Medical Center Oct. 18, Schenck will discuss the symptoms of and solutions for these and other sleep disorders. (See below.)

What is at stake when sleep disorders go untreated? A lot, said Cole, including longevity, work performance and excess weight:

• Those who sleep seven hours a night live longer than those who sleep six or eight, according to epidemiological studies.

• Inadequate sleep may reduce production of liptin, a hormone that signals to the body that it is full, and so lead to unwanted weight gain.

• Even a sleep debt of 30 minutes a night can affect work quality when cumulated over a week or two.

For years, I rarely slept more than six hours a night during the week, propping myself up with any caffeinated beverage I could get my hands on. On weekends I’d collapse, skipping brunch, turning off my phone - anything for a little extra shut-eye.

I figured this pattern was normal. Not sleeping was a sign that I had a busy, exciting life. Then I started working at home. The two hours I used to spend getting ready and commuting every morning were two more hours I could spend under the covers. It didn’t take me long to realise that sleeping eight hours a night made me a different - nicer, saner, more together - person, despite the fact that my stress levels were sky-high because I didn’t have a steady salary.

I didn’t throw a fit when someone caused a delay in the supermarket queue. I could concentrate for longer periods of time. I did things other than sleep on weekends, and instead of falling facedown into bed every night, I had the energy to have sex with my partner - keeping us both in a better mood.

Turns out experts have a name for my old sleep habits. “Somnorexia is not getting enough sleep for days or weeks in a row, then crashing and sleeping for long periods of time,” explains neurologist Dr Anne Remmes. If you get fewer than seven hours of sleep a night during the week, and more than 10 hours a night on weekends, you fit the profile. Another clue? You can’t get through the day without loading up on caffeine.

You can’t get through the day without loading up on caffeine
Experts say this erratic sleeping cycle is all too common, especially among busy young women. But many somnorexics don’t know that their habits are unhealthy. “It’s easy to convince yourself that you can get by on five hours a night,” says Anne. “But the truth is, extremely few women can thrive on that little. Most women need a consistent eight hours to function properly. This type of sleep cycle is wreaking havoc in women’s lives.”

Why is getting eight hours a night important? “Throughout the night, your body goes through several cycles of light and deep sleep,” says sleep disorder expert Dr Susan Zafarlotfi. “You need eight hours in order to get enough of each cycle, particularly the deep stages.” During deep sleep, your cells and muscles rest and regenerate. Experts also believe that deep sleep is the time when your brain sorts memories and stores info that you’ve gathered during the day.

Regularly getting fewer than seven hours’ sleep a night can also derail your circadian rhythms - your body’s “internal clock”. Scientists are only now starting to understand these rhythms, but they do know that they help regulate energy, sleep and wake times, digestion and hormone levels. “This internal clock needs regularity to function optimally,” says Susan. “And when your sleep habits are erratic, all of the things governed by your circadian rhythms are upset. You can end up nauseous, moody and unable to concentrate.”

As important as sleep is, it’s the thing that many otherwise healthy women neglect. “We have too many things to do in 24 hours. Rather than cutting back on work or social activities, sleep is the first thing to go,” says sleep specialist James Wyatt.
When they finally do get horizontal, many somnorexics are too stressed or caffeinated to fall asleep quickly. “After days of not sleeping well, it’s difficult to get to bed at a normal time. I often use a sleeping pill to get my sleep schedule back on track,” confesses Nicole Francis, a 29-year-old retail manager.

“More and more women are turning to sleep medication to knock themselves out,” says Anne. Prescriptions for sleeping pills have increased dramatically, and women are more likely to use sleep aids than men. “While the drugs are safe and effective, they can cause psychological dependence,” warns James. Specialists agree that a better long-term choice is to get to the root of your sleep issues so you can sleep well without drugs.
Getting too little sleep can derail your internal clock

How bad is somnorexia, really?

Experts have long known that chronic sleep deprivation can lead to high blood pressure, a weakened immune system and an increased risk of depression and obesity. And while short-term sleep loss may be less devastating, it has very real effects: research shows that being sleep deprived for one day can lead to decreased reaction times and memory problems.

And perhaps the most obvious effect? An out-of-control appetite. “I end up grabbing chips or fast food and cheese when my sleep schedule is messed up,” says Jessica, 33, founder of an online art gallery. “It’s my way of coping with fatigue.”

In fact, a small study found that just two days of sleep deprivation leads to an increase in the hormone ghrelin (which triggers hunger) and a decrease in the hormone leptin (which signals when you’re full). In the study, participants reported a 23 percent to 34 percent increase in hunger. In other words, lack of sleep can make you eat up to 500 more calories a day - that’s enough to gain half a kilogram.

Can sleeping in on weekends help you rebound? No. “After one bad night, you can regain your ability to concentrate and improve your mood by catching up on sleep,” says Susan.

But somnorexics tend to skimp on sleep for days or weeks at a time. By the time they do crash, they’re already experiencing the complications of longer-term sleep deprivation. At that point, even sleeping for 12 hours straight won’t get you back to normal. “Only getting enough sleep on a regular basis can do that,” explains Susan.

How to break the somnorexic cycle

The most important thing you can do is follow a regular sleep schedule: for all seven nights a week, go to bed and wake up at the same time. Adapting to this new schedule could be a challenge, so Anne suggests creating a routine.

Get ready by… “Winding down two hours before bedtime,” advises Anne. “An hour before, get into your pyjamas, sit and read a book that takes you out of your life. This may activate your dreaming brain, helping you fall asleep when you put your head down.” If this sounds like a return to the routine you had as a toddler, remember that you won’t have to do it forever, just until you’ve learned to relax before bed.

More sleep-smart moves Limit alcohol and caffeine after lunch; both can erode sleep quality.

Another tip: Log off your computer earlier in the evening. “Women tend to check their email right before bed, but the light and the activity is stimulating, so they have a hard time getting to sleep,” says Prof Meir Kryger, author of A Woman’s Guide To Sleep Disorders (McGraw Hill, R219).

It’s not because you’re desperate to get replies from that mass email you sent out. “Circadian rhythms are greatly impacted by light - and computers are extremely powerful light sources, so your body doesn’t register that it’s time to wind down,” says Meir.

Of course, in the real world cutting back on sleep is unavoidable once in a while. When you must do so, says Susan, try not to drop below six hours - any fewer and your body won’t get through the most crucial deep-sleep stages. “Then try to catch up the next day,” she urges. If you can sleep in for an hour - or even two - do it. And, if you can fit it in, have a 30-minute nap in the afternoon.

That said, don’t spend the whole day in bed. Sleeping for more than 10 hours can throw your circadian rhythms out of whack, making it hard for you to fall (and stay) asleep at night and starting the somnorexic cycle all over again.

Getting eight hours of sleep every night - okay, almost every night - may sound like the end of your nightlife as you’ve known it, but take it from me, fitting in a little extra shut-eye doesn’t mean giving up your life; it means being able to actually enjoy it instead of going through the motions in a carboholic, zombified haze. “Just try it for a month,” says Anne. “You’ll never go back.”

With his new store, Zia Sleep Sanctuary, Jim Gabbert hopes to put you to sleep … and maybe sell a few beds and earplugs.

Jim Gabbert will tell you that the key to getting a good night’s sleep does not necessarily lie in your mattress, although that’s a good place to start.

Hypoallergenic sheets, scented candles and a $600 pair of earplugs that drown out snoring are just a few of the almost 1,100 products available at Gabbert’s new store, Zia Sleep Sanctuary, in Eden Prairie. While the store is dominated by high-tech beds and mattresses, these accompanying sleep aids were hand-picked by Gabbert, who is CEO of Edina-based Gabberts Furniture and Design Studio.

“It is a store that tries to bring together all of the possible solutions to help people sleep better,” said Gabbert.

At least one retail analyst thinks Gabbert may have a market.

“I’m not surprised that somebody’s doing it,” said Steve Denault, a retail analyst at Northland Securities in Minneapolis. “There’s sort of a movement in awareness regarding sleep … [and Gabbert] has definitely gotten in front of it with this store.”

According to the American Academy of Sleep Medicine, more than 70 million Americans suffer from sleep disorders. This week, the sleep industry’s biggest convention of the year drew some 5,400 medical experts and sales reps to Minneapolis. That’s about 10 times the number who came in 1990, when the city last hosted the event.

Denault said he thinks Zia is relatively unusual.

“I have not seen anything that specifically targets sleep that way,” he said.

Quiet holiday season

The 4,500-square-foot store opened at Eden Prairie Center in November and employs six “sleep advisers” who are trained to help customers evaluate their sleep needs.

“What we were looking for in our hiring was people with caregiving experience,” Gabbert said.

He would not disclose the store’s sales to date, but he said the holiday season drew in less business than expected, partly because the J.C. Penney store next door had not yet opened and traffic to his corner of the mall was low.

The new store comes after the recent downsizing and $5 million rejuvenation of Gabberts, a furniture retailer started by Jim’s father, Don Gabbert, in 1946. In 2006, after five years of declining sales, Gabberts pulled out of the Dallas-Fort Worth market and remodeled its flagship Edina store. Jim Gabbert has dabbled in another business in the past: he once started a store selling board games and puzzles, Games by James, which he later sold.

Gabbert said most of Zia’s sales are smaller items, such as CDs and alarm clocks, but he anticipates that mattresses and beds will make up half its business in the long run.

Eden Prairie resident Melanie Fransen, one of two customers Zia drew during lunch hours on Friday, said she appreciated that the store’s sales staff asked her questions about how she slept and what she likes in a bed as she shopped for a mattress. A first-time visitor to the store, Fransen said she is putting more thought into her bedding than ever before.

“As you age, you kind of get pickier,” said Fransen, who also expressed an interest in new pillows and snoring aids for her husband. “I can’t sleep on just any pillow. I think we’re all like that.”

Medical experts skeptical

But some experts are skeptical of nonmedical solutions to sleeping problems.

“There really is no data [that say] any of these things are helpful,” said Dr. Lawrence Epstein, past president of the American Academy of Sleep Medicine, who teaches at Harvard Medical School.

Epstein, who was in town this week for the sleep convention, said he is not familiar with Zia or its products. But, he said, there are a few basic things people can do to sleep better, including getting seven to eight hours of sleep a night, following a regular sleep routine, avoiding caffeine and alcohol before sleep, banishing televisions and computers from the bedroom and ensuring a dark, quiet environment.

If all that doesn’t work, he said, people should see a doctor to see if they have a medical condition.

The value of a place like Zia is that it encourages people to think more about proper sleeping habits, said Sandy Brandley, a clinician and supervisor of the Park Nicollet Sleep Store on the Methodist Hospital campus in St. Louis Park. The Sleep Store specializes in clinically recommended equipment to treat such disorders as obstructive sleep apnea and upper airway resistance syndrome.

“People consistently underestimate their need for sleep,” Brandley said. “[Comfort items] can help people to have a better night’s sleep … but they certainly aren’t going to help people with true sleep disorders.”

Gabbert launched an online version of his store about a month ago. He said he hopes to take Zia nationwide someday and that he will eventually look for investors.

Falls by the elderly, sometimes leading to fatal consequences, have increased at an alarming rate, particularly in nursing homes. A new study says elderly people with insomnia often go untreated, because of the perception that sleeping pills increase the risk of falls and injuries that are a bane of old age.
But a large new University of Michigan Health System study suggests that the real culprit may be the underlying insomnia, rather than the medications used to treat it. Residents with untreated, or partially treated, sleeplessness have a much higher risk of falls than those who take sleep medications and get relief from their insomnia.

Falls are a major problem for the elderly, especially those living in nursing homes. “One in three adults over 65 falls each year, and falls are the leading cause of injury-related deaths, nonfatal injuries and trauma-related hospital admissions in this group,” says U-M sleep specialist Alon Avidan, M.D., MPH, first author of the study published online by the Journal of the American Geriatrics Society.

Even though medications are only one way of treating insomnia, the new finding has implications for the way sleep problems are addressed — or not addressed — in nursing homes, and perhaps for the prevention of falls that often trigger major health crises in the elderly.

“Many physicians assume that when an older patient has insomnia, and is given a hypnotic drug to help induce sleep, the drug will make the patient likely to fall and develop a hip fracture,” says Avidan. “But our findings suggest that people whose insomnia is effectively treated are less likely to fall than untreated insomniacs.”

Hypnotic drugs are sleep-aiding medications that include many older, long-lasting drugs such as benzodiazepines and barbiturates, as well as newer, shorter lasting and commonly advertised drugs with fewer side effects.

The study included more than 34,000 Michigan nursing home residents over age 65. Data were collected over six months as part of ongoing mandatory assessments by nursing home staff.

Individuals who had untreated insomnia at the start of the study period were 90 percent more likely to fall in the next six months compared with those who did not have insomnia. In contrast, those who were taking hypnotic drugs to treat their insomnia at the start were only 29 percent more likely to fall.

The difference was even more striking when the researchers took into account a wide range of complicating factors — such things as age, sex, health problems, thinking problems and trouble with daily activities – all of which affect the risk of falls.

Nursing home residents who were on sleep medications and reported no problems sleeping at the start of the study had about the same risk of falling in the next six months as those who slept well without drugs.

But those with insomnia who weren’t on sleep medications had a 55 percent greater risk of falling, and those who took sleep drug but still reported insomnia had a 32 percent greater risk of falls.

“One study by itself isn’t enough to eliminate current concerns about hypnotics and falls, but many previous studies that raised these concerns did not look to see whether insomnia, rather than the drugs themselves, might be the problem,” says senior author Ronald Chervin, M.D., M.S. “Our results should encourage older people and their caregivers to pay attention to insomnia, and to seek help for it.”

Chervin, an associate professor of neurology who directs the U-M’s Sleep Disorders Center, notes that the new study is by far the largest and most comprehensive ever to focus on the relationship between sleep, falls and hypnotic drug use among nursing home residents. The data in the study came from the Minimum Data Set, a federally mandated effort to record information about nursing home residents. They were made available by the Michigan Department of Community Health.

“We are excited to continue to find valuable lessons in these data, primarily collected for care planning purposes but now usable for understanding ways to improve the care in our nation’s nursing homes,” says Brant Fries, Ph.D., a professor at the U-M School of Public Health and Institute of Gerontology, who was both a study author and helped develop the Minimum Data Set for the federal government.

The study is also the first to take a longitudinal look at fall risk over a period of time. And, it’s the first to take into account so thoroughly the many factors that can complicate the picture. Previous studies that suggested a higher risk of falls associated with hypnotic use were smaller and lacked this kind of complex analysis. They also were performed before newer sleep drugs were available.

In all, Chervin says, “Hypnotic drugs may be appropriate in some cases, and we in the medical community may not need to have the fear of them in older patients that we currently have.” He adds that the study did not look at patients who were prescribed powerful sedatives to help them sleep, such as morphine, nor did it include patients taking anxiety drugs that also aid sleeping ability.

Sleep-aiding medications, Chervin and Avidan note, are only one way to deal with persistent insomnia, and in fact are not the first tactic most patients should try. Behavioral therapy, whether one-on-one or in groups, has been shown to work as well as or better than medication. And almost everyone with insomnia would benefit from better “sleep hygiene” — including quiet, dark bedrooms and pre-bedtime habits such as low-key activity and abstaining from caffeine, alcohol or exercise for several hours before bed.

Insomnia, which includes trouble falling asleep, trouble staying asleep, frequent night-time waking and early waking, affects more than 40 percent of adults over age 50 and half of adults over age 70, compared to 30 percent of adults in their 40s, and less than 20 percent of teens and young adults. About one in every five adults over 65 has persistent insomnia, and many studies have linked common diseases of older adults with sleep problems, including heart and lung problems, arthritis and acid reflux. Incontinence, dementia and Parkinson’s disease also affect sleep.

“In many older adults, complaints of insomnia may be the tip of the iceberg, resulting from many other coexisting problems,” says Avidan, an assistant professor of Neurology at the U-M Medical School. “We also know that many older adults are being prescribed hypnotic drugs to help them sleep, because the elderly as a group account for 30 percent of all such prescriptions.”

About one percent of all falls in the elderly cause a hip fracture, which often restricts a person’s mobility, raises the cost of their medical care substantially, and increases the risk of death within a few months. Although the new study did not show a correlation between insomnia and hip fractures, it also didn’t show a relationship between hypnotic drug use and hip fracture.

Avidan and Chervin note that there are many possible ways in which insomnia, combined with other mental and physical factors, could lead to falls. People with insomnia may get out of bed in the middle of the night, running into or tripping over objects in the dark or just becoming confused about their surroundings. Insomnia is known to cause daytime sleepiness and clumsiness, as well as cognitive deficits. It slows down a person’s reaction time, which could reduce the likelihood of quick corrective maneuvers that might prevent a fall from happening.

Self-reported sleep complaints among the elderly serve as a risk factor for completed suicide, according to a research abstract that focused on data that were collected among 14,456 community elders over a 10-year period. It will be presented Thursday at SLEEP 2007, the 21st Annual Meeting of the Associated Professional Sleep Societies (APSS).

During the ten-year time frame of the data 21 individuals died by suicide, according to Rebecca Bernert of Florida State University, who did the study.

When each suicide was matched to 20 randomly-selected controls, it was discovered that disturbances in sleep, independent of depression, predicted an increased risk for eventual death by suicide.

“This suggests that, as a warning sign, poor sleep quality constitutes a significant and modifiable risk factor for completed suicide,” said Bernert.

“Evaluating sleep among at-risk patients may therefore guide and importantly inform both clinical decision-making and suicide risk assessment.”

It is recommended that older adults get seven to eight hours of sleep each night for good health and optimum performance.

Unfortunately, many older adults often get less sleep than they need. One reason is that they often have more trouble falling asleep.

Not sleeping well can lead to a number of problems.

Older adults who have poor nighttime sleep are more likely to have -
● a depressed mood,
● attention and memory problems,
● excessive daytime sleepiness,
● more nighttime falls, and
● use more over-the-counter or prescription sleep aids.

Poor sleep is also associated with a poorer quality of life. Insomnia, the most common sleep complaint, affects almost half of adults 60 and older.

Those who think they might have a sleep disorder are encouraged to consult with their primary care physician, who will refer them to a sleep specialist.

The annual SLEEP meeting brings together an international body of 5,000 leading researchers and clinicians in the field of sleep medicine to present and discuss new findings and medical developments related to sleep and sleep disorders.

More than 1,000 research abstracts will be presented at the SLEEP meeting, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The four-day scientific meeting will bring to light new findings that enhance the understanding of the processes of sleep and aid the diagnosis and treatment of sleep disorders such as insomnia, narcolepsy and sleep apnea.

Peter Bils has a bone to pick with Big Pharma. Drug companies generate some $2 billion a year from sales of prescription pills designed to help people get a good night’s sleep. As an executive at the biggest U.S. bed retailer, Bils reckons that what many folks need isn’t medication, but–you guessed it–a better bed. “Pharmaceutical (companies) are looking to regulate your sleep and wake cycles with pills,” says Bils, who’s chairman of the sleep advisory board of Select Comfort. “All it really takes is improving your sleep in the first place.”

Which is why Minneapolis’ Select Comfort adds controllers and air chambers that let users set personalized comfort levels for their side of the bed. And using recent research that shows people need seven cycles of sleep for the best rest, the maker of the Sleep Number bed is investigating new products that would help regulate those rhythms with natural sleep aids like lighting control and watches that calculate a body’s high and low points during the day.

A generic version is now (OFFICIALLY) available for Ambien® (zolpidem), a widely prescribed sleep aid. Since Ambien lost patent protection on April 21, the price for zolpidem has dropped from more than $4 to less than 25 cents per tablet, or $100 per month to less than $10. The price of Ambien® increased by over 30 percent in the last year. Of course, visitors to this site have been able to buy brand quality generic ambien for years!

“This represents a significant savings for health plans and consumers because prescription sleep aids are one of the most widely used and fastest growing drug classes,” said Richard Bruzek, HealthPartners vice president of pharmacy services. “This doesn’t however, change our main concern which is the appropriate use of drugs by patients, whether brand or generic.”

HealthPartners costs for sleep aids increased 60 percent from 2005 to 2006. About 7,000 HealthPartners members have prescriptions for Ambien®.

“The introduction of this generic will significantly decrease patient and plan expenses for this category of drugs,” Bruzek said. Sixty-seven percent of HealthPartners prescriptions are for generic drugs, an increase of over 15 percent in just three years. Every one percent increase in the use of generic drugs reduces HealthPartners plans and member costs by $7 million annually.

Remember those old American Express commercials in which Karl Malden warned travelers, “Don’t leave home without it” — as if you were going to wind up in a Turkish prison or on the streets of Calcutta if you forgot your credit card?

That advice seems antiquated nowadays, because there’s almost nothing you can’t get abroad.

That’s a good thing to remember when you’re tempted to over-pack. When I hit the road, I pare it down to the essentials:

# A carry-on bag: One piece of luggage in whatever shape and style suits you. It should be big enough for one week’s gear — only. When your clothes get dirty, go to a Laundromat. The bag should conform to airline carry-on regulations so it fits in the overhead bin, but it should also have some give so you can cram it full and check it on the way back. Tuck a sturdy fabric carry-all into a pocket of your main piece of luggage to accommodate acquisitions along the way.

# Medicines, glasses: Make sure you have your prescription drugs and vitamins; pack duplicate supplies in both checked and carry-on bags so if one gets lost you still have your meds. The same is true of eyeglasses and contact lenses.

# Plastic baggies: I am a firm believer in the unparalleled usefulness of zip-lock bags — for wet swimming suits, beautiful beach rocks, leaky toiletries, dirty underwear.

# Sink stopper: Globe-trotters often need to wash intimate apparel in the bathroom sink. Many hotels, mostly at the high end, have leaky
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sink drains. If you pack a flat, rubber drain-stopper, you’ll be happy even at the Ritz.

# Sleep aids: Unless you can sleep anywhere, long-haul flights, jet lag and noisy, unfamiliar hotel rooms can turn you into a zombie. To fight travel insomnia, take earplugs and eye shades. Check with your doctor if you think you need a prescription sleeping pill or want to try something homeopathic.

# First-aid kit: I have a well-used travel medical kit with all the usual suspects: bandages, aspirin, antiseptic. A few other items aren’t as obvious: a mini sewing kit, moleskin for blisters, insect repellent, Tiger Balm (good for achy muscles as well as a smelly loo, when applied underneath the nose) and Uncle Bill’s Silver-Gripper tweezers with pinpoint precision to remove splinters.

# Windbreaker: I rarely go anywhere without an old shell jacket that can keep me dry in a tropical downpour and warm in the Canadian Rockies, when worn with layers underneath. Many companies make these; get an unlined one so it can be wadded up and stuffed into a side pocket of your bag.

# Inexpensive sandals: Cheap rubber flip-flops always come in handy, whether you’re at the beach, showering in a shared bathroom or just kicking back in a none-too-pristine budget hotel room. You can also wear them on the street and pitch them before you leave.

# Little black jacket: This one’s for the girls. Leave home wearing a simple black jacket in a wrinkle-proof synthetic blend and a shawl as part of your travel attire. (Packing them takes up too much space.) The eminently accessorize-able black jacket will be worth its weight in gold, and the shawl can double as a blanket or pillow.

# A cuppa something: Many of us need a jolt of java in the morning, but when it’s unavailable, the caffeine in tea is a welcome substitute, and you can almost always cadge a cup of hot water at a hotel front desk. I keep an assortment of tea bags in a zip-lock bag: herbal to help me sleep, echinacea for when I’m under the weather and black for a boost.

Generic versions have been available from offshore pharmcies for may a year, but now Ambien, the worlds’s favorite prescription sleep aid, is finally out of patent even in the US. In fact, the first generic versions of the insomnia drug Ambien won federal approval Monday.
The Food and Drug Administration said it approved versions of the immediate-release tablets made by 13 drug companies for the short-term treatment of insomnia. A patent held by Paris-based Sanofi-Aventis on the drug, also called zolpidem tartrate, expired Saturday.
The approvals of generic versions of the drug come a month after the FDA asked makers of it and similar sleep aids to beef up warnings about their potential risks. The risks of the sedative-hypnotic drugs include severe allergic reactions and complex sleep-related behaviors, like sleep-driving.
The FDA said Ambien was the No. 13 brand-name drug by sales last year.