Have you ever experienced trouble falling or staying asleep, or even wake up feeling unrefreshed and unable to get a good night‘s rest? If you answered yes to any of these, then you may be suffering from insomnia. Insomnia is a symptom. It may be caused by stress, anxiety, depression, disease, pain, medications, sleep disorders or poor sleep habits. Your health habits and sleeping environment may also play a role in your sleep problems. In April 2006, the prestigious National Academy of Science’s Institute of Medicine released a report saying that sleep loss and sleep disorders were an "immense" public health burden in the United States.

NATIONAL SLEEP FOUNDATION INSOMNIA POLL DATA:

• Forty-eight percent of Americans report insomnia occasionally, while 22 percent experience insomnia every or almost every night.
• Women are 1.3 times more likely to report insomnia than men.
• People over age 65 are 1.5 times more likely to complain of insomnia than younger people.
• Divorced, widowed and separated people report more insomnia.
  
  

Some medications can lead to insomnia as well, including those taken for:

• colds and allergies (some antihistamines & decongestants)
• high blood pressure (antihypertensive)
• heart disease (betablockers)
• thyroid disease
• birth control (hormones)
• asthma
• pain medications (containing caffeine)
• depression (especially SSRI antidepressants)

According to the National Heart Lung and Blood Institute, a number of other conditions can also cause insomnia, such as:

• Conditions that cause chronic pain, such as arthritis and headache disorders
• Conditions that make it hard to breathe, such as asthma and heart failure
• Overactive thyroid
• Gastrointestinal disorders, such as heartburn
• Stroke
• Sleep disorders, such as restless legs syndrome and sleep-related breathing problems
• Menopause and hot flashes

Sleep is as essential to a person’s health and wellbeing as diet and exercise. Inadequate sleep can result in fatigue, depression, concentration problems, and can contribute to health problems such as weight gain, high blood pressure, and a decrease in the immune system’s power which may lead to illness and injury. Treating insomnia with medication is the most common treatment for these sleep problems. Twenty-five percent of Americans take some type of medication every year to help them sleep.

INSOMNIA CONVERSATION WITH COACH McGUIRK


Related Links:

http://www.hci.utah.edu/patientdocs/hci/drug_side_effects/insomnia.html
http://www.emedicinehealth.com/insomnia/article_em.htm
http://www.merck.com/mmhe/sec06/ch081/ch081b.html
http://www.askdocweb.com/insomnia.html


References:

Gillin J.C., Roehrs T.,Roth T. (2009) Sleep Aids and Insomnia. National Sleep Foundation waking America to the importance of sleep. Retrieved on 1st October, 2009 from http://www.sleepfoundation.org/article/sleep-related-problems/sleep-aids-and-insomnia

U.S. Department of Health and Human Services. National Institutes of Health. National Heat lung and blood institute Disease and conditions index. What causes Insomnia? Retrieved on 1st October, 2009 from http://www.nhlbi.nih.gov/health/dci/About/index.html

Insomnia Overview Medications. (2008). New York Times. Retrieved from http://health.nytimes.com/health/guides/disease/primary-insomnia/medications.html?print=1

Michael,W., Smith. (2008, September, 14). What is Insomnia? Good Sleeping habits for beating insomnia Retrieved on 11th October, 2009 from http://www.webmd.com/sleep-disorders/insomnia?page=2

Side Effects and Strange Behaviors Associated with Prescription Sleep Medication

All sleeping medicines have side effects, may have the potential to cause dependency, and even worsen insomnia problems when abused, misused, or are taken too often. The side effects include daytime sleepiness, cognitive impairment, dizziness, unsteadiness, rebound insomnia, memory lapses, and hallucinations. Complex behaviors are a potential side effect of sedative-hypnotic products—a class of drugs used to help a person fall asleep and stay asleep.


Reported complex sleep behaviors include:
~ sleep walking
~ sleep-driving (individual drives when not fully awake)
~ making phone calls
~ eating or cooking while asleep
~ having sex
*Those effected have no memory of these odd events.

The Food and Drug Administration has said that the most widely prescribed sleeping pills can cause strange and bizarre behavior like driving and eating while asleep. Announcing that strong new warnings will be placed on the labels of 13 drugs. A review was prompted, in part, by queries to the agency from The New York Times, after some users of the most widely prescribed drug, Ambien, started complaining online and to their doctors about unusual reactions ranging from fairly benign sleepwalking episodes to hallucinations, violent outbursts, nocturnal binge eating and — most troubling of all — driving while asleep.



Night eaters said they woke up to find Tostitos and wrappers of Snickers in their beds, missing food, kitchen counters overflowing with flour from baking sprees, and even lighted stoves.
Sleep-drivers reported frightening episodes in which they recalled going to bed, but woke up to find they had been arrested roadside in their underwear or nightclothes.


At the University of Minnesota, Dr. Carlos Scheneck and Dr. Mark Mahowald, Professor of Neurology and Director of the Minnesota Regional Sleep Disorders Center at Hennepin County Medical Center; said that they had been studying the cases of nearly 30 Ambien users who developed unusual nighttime eating disorders. In some cases, the patients had gained more than 100 pounds.

For some patients, the strange side effect of sleep walking and sleep eating is unacceptable. They may gain a significant amount of weight, or worry about operating kitchen appliances while asleep. For others, like Rebecca Wiseman, 26, of Sumter, S.C., sleep eating happens only occasionally—and according to her it is a small price to pay for the relief that medication can bring. Mrs. Wiseman is hoping that by only taking it twice a week she'll keep her nighttime side effects to a minimum and be able to get back on a more regular schedule without medication. "But for now—even with the night eating and walking—a full night's sleep is still worth it all when you hit those lows," she says. "People don't realize what no sleep can do to you."

Related Links and References:

“Ambien Sleep Walking Turned Me Into a Midnight Binge Eater”. Health.
9 May 20008. Time Inc. 1 Sep. 2009.
http://www.health.com/health/condition-article/print/0,,20189024,00.html

Saul, Stephanie. “Warning: Side effects may include sleep-driving”. SignOnSanDiego.com by the Union-Tribune. 15 March 2007. Union-Tribune Publishing Co. 18 Sep. 2009
http://www.signonsandiego.com/uniontrib/20070315/news_1n15sleep.html

Ambien CR. (2009, September). Ambien CR side effects. Retrieved on 11th October, 2009from
http://www.ambiencr.com/using-ambien/ambien-cr-side-effects.aspx

VIDEO - SLEEPING PILL ALERT:

Is the popular drug Ambien causing people to binge eat in their sleep?

http://abcnews.go.com/video/playerIndex?id=1727387

Bizarre Sleep Medication Experiences

The New York Times wrote an article called "Some Sleeping Pill Users Range Far Beyond Bed," telling the surprising story of a registered nurse who took Ambien before going to sleep one night in January 2003. Sometime after falling asleep, she went out into the Denver winter night wearing only a thin nightshirt, even though the temperature was only 20 degrees. She got into her car, caused an accident, urinated in the middle of the intersection and then got into a violent altercation with the police officers who came to arrest her. In the matter of one night and one sleeping pill, her traffic record went from exemplary to tarnished with a reduced charge of careless driving. Interestingly enough, she says she remembers nothing of what happened during that Ambien-influenced night.

DRIVERS THAT SHOULDN'T BEDRIVING WHILE ASLEEP - VIDEO
http://abcnews.go.com/video/playerIndex?id=1707379


Watch CBS News Videos Online

Another Ambien user (initials MH) posted the following on AskDocWeb.com :
“Just one 10 mg dose of Ambien resulted in prolonged, horrible hallucinations for me, and I still have no memory of the month prior to my taking it. In fact, I ended up in a mental hosptial, where they continued giving me Ambien for I don't know how long, until they figured out that this drug was the problem! If I had found the website AskDocWeb.com before when I was checking out the drug info, I would never have taken it. I believe this drug should be removed from the market- any "medication" that makes people hallucinate or crazy is not beneficial. In fact, my doctor tells me that he no longer prescribes Ambien at all now, based upon my experience. Good for him!"

Everyday, an increasing number of people are experiencing the strange, sometimes terrifying effects that common sleeping pills can create. On AskDocWeb.com, a number of everyday people have posted their Ambien experiences.


Read further ambien stories:

http://www.askdocweb.com/ambien.html

WHAT’S BEING DONE?

FDA Orders Stronger Label Warnings On Products

To make known the risks of these products, the FDA ordered the makers of 13 sedative-hypnotic drug products to strengthen warnings on their labels about two rare but serious side effects: allergic reactions and complex sleep-related behaviors.

The revised labeling and other actions to make risks known affect these sedative-hypnotic products:

• Ambien, Ambien CR (zolpidem tartrate)
• Butisol sodium
• Carbrital (pentobarbital and carbromal)
• Dalmane (flurazepam hydrochloride)
• Doral (quazepam)
• Halcion (triazolam)
• Lunesta (eszopiclone)
• Placidyl (ethchlorvynol)
• Prosom (estazolam)
• Restoril (temazepam)
• Rozerem (ramelteon)
• Seconal (secobarbital sodium)
• Sonata (zaleplon)
  

In addition to the labeling changes, FDA has requested that manufacturers of sedative-hypnotic products:

• send letters to health care providers to notify them about the new warnings. (Manufacturers sent these letters beginning in March 2007.)

• develop Patient Medication Guides for the products to inform consumers about risks and advise them of precautions that can be taken. (Patient Medication Guides are handouts given to patients, families, and caregivers when a medicine is dispensed. The guides will contain FDA-approved information, such as proper use and the recommendation to avoid ingesting alcohol or other central nervous system depressants.)
  
  
• conduct clinical studies to investigate the frequency with which sleep-driving and other complex behaviors occur in association with individual drug products.
  

Related Links:

http://usgovinfo.about.com/b/2007/03/15/fda-calls-for-stronger-warnings-on-sleep-drugs.htm
http://fmsglobalnews.wordpress.com/2007/03/14/fda-requests-label-change-for-all-sleep-disorder-drug-products


Resources:

U.S. Department of Health and Human Services. U.S. Food and Drug Administration. (2009, July 22). Side effects of Sleep Drugs Retrieved on 1st October, 2009 from
http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm107757.htm

U.S. Department of Health and Human Services. U.S. Food and Drug Administration. (2009, October 27) Sleep Disorder (Sedative-Hypnotic) Drug information Retrieved on 29th October, 2009 from
http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm101557.htm

VIDEO - SLEEPING PILLS WARNINGS NOT ENOUGH?

http://abcnews.go.com/video/playerIndex?id=2952195

Precautions for Sleep Aid Medications: Prescription and OTC’s

Precautions should be taken for people who use prescription and OTC sleep aid drugs. Those who are more vulnerable to harm, are children, elderly, pregnant women, and extremely ill people. Since sleep medications do not cure insomnia, they may cause worse situations if taken for a long period of time.

Recommended guidelines and precautions to follow if you are using sleeping pills:

• Talk to your health care provider before you start these medications and if you have any questions or concerns.
• Read the Medication Guide, when available, before taking the product.
• Follow directions closely and as instructed by your physician. Do not change frequency or increase the dose prescribed by your health care provider. Complex sleep-related behaviors are more likely to occur with higher than appropriate doses.
• Inform your doctor of all medications you are consuming. Drug interactions can occur between both prescription, nonprescription, and herbal supplements; and cause dangerous effects.
• Be sure to discuss other medical conditions and symptoms with your physician. Certain drugs might cause side effects.
• Do not discontinue the use of these medications without first talking to your health care provider; stopping abruptly can cause rebound insomnia, severe withdrawals, and other symptoms.
• Only take sleep medication when you are ready to go to bed. You need at least 7-8 hours of sleep to have a full night’s rest.
• Avoid drinking alcohol, it will disrupt your sleep and interact with your sleeping medication.
  

Related Links:

http://www.sleepeducation.com/Article.aspx?id=316
http://helpguide.org/life/sleep_aids_medication_insomnia_treatment.htm#guidelines
http://www.articlesnatch.com/Article/Restrictions-And-Precautions-One-Needs-To-Follow-When-Using-Insomnia-Medications/283194


References:

“Guidelines for Taking Sleep Medications”. Buy Sleeping Pills UK. 2009.
sleeping-pills.org.uk. 1 Oct. 2009.
http://www.sleeping-pills.org.uk/sleep-medications-Guidelines.html

“Prescription Sleep Aids”. Deprivation of Sleep. 2009. Deprivationofsleep.com.
8 Sep. 2009.
http://www.deprivationofsleep.com/prescription-sleep-aids.html

Hussar PhD., Daniel A. “ Precautions With Over-the-Counter Drugs”.
The Merck Manuals-Online Medical Library. April 2007. Merck & Co., Inc.
5 Sep. 2009.
http://www.merck.com/mmhe/sec02/ch018/ch018b.html

Schroeder, MS, RD., Karen. “Sleep Medications” Third Age. 1 July 2008.
ThirdAge Inc. 19 Sep. 2009
http://www.thirdage.com/sleep/sleep-medications-0

HOSPITAL-INDUCED INSOMNIA

Hospital patients with general medical disorders frequently complain of disturbed sleep. Ensuring that patients have adequate sleep and rest while hospitalized, are important nursing goals to promote patient recovery. Complaints of insomnia require close investigation and are subjective; for example, a patient may blame being fatigued on insomnia, but might be anemic.


Common causes and interventions to help patients sleep:

ACROPARESTHESIA - Improper positioning may compress superficial nerves, disrupting circulation to the compressed nerve. This causes numbness, tingling, and stiffness in an arm or leg. Teach the patient to assume a comfortable position in bed, with his limbs unrestricted. If he tends to awaken with a numb leg or arm, tell him to move it until sensation returns and to assume an unrestricted position.


ANXIETY - Physical and emotional stress produces anxiety, which causes autonomic nervous system stimulation. Encourage the patient to discuss his fears and concerns, and teach him relaxation techniques, such as guided imagery or deep breathing. If ordered, administer a mild sedative such as temazepam or another sedative hypnotic, before bedtime. Emphasize that he should use these medications only for a short time.


DYSPNEA - With many cardiac and pulmonary disorders, a recumbent position causes restricted chest expansion, secretion pooling, and pulmonary vascular congestion, leading to coughing and shortness of breath. Elevate the head of the bed, or provide at least two pillows or a reclining chair to help the patient sleep. Suction him as needed, and encourage deep breathing and inventive spirometry. Also provide supplementary oxygen as ordered.


PAIN - Chronic or acute pain from any cause can prevent or disrupt sleep. Administer pain medication as ordered, 20 minutes before bedtime, and teach deep, even, slow breathing to promote relaxation.


PRURITUS - A localized skin infection or a systemic disorder, such as liver failure, may produce intensely annoying itching, even during the night. Wash the patient’s skin with a mild soap and water, and dry it thoroughly. Apply moisturizing lotion such as calamine lotion on area. Administer diphenhydramine or hydroxyzine as ordered to help minimize itching.

Related Links:

http://www.wrongdiagnosis.com/symptoms/sleep_symptoms/book-causes-16a.htm
http://rightdiagnosis.co.uk/symptoms/insomnia.htm


Reference:

Lippincott W., Wilkins (2008) Nursing: Interpreting Signs and Symptoms. American Nursing Student, 10(1).

Good Sleep Habits for Beating Insomnia

~ Try to go to sleep at the same time every night and get up at the same time each morning. Avoid naps during the day.

~ Avoid caffeine, nicotine and alcohol: Caffeine, a stimulant, is found in coffee, chocolate, some soft drinks, nonherbal teas, diet drugs and some pain relievers. Smoking disrupts deep sleep cycles and can prompt nicotine withdrawal when you first wake up. Drinking alcohol keeps you from getting deep and REM sleep.

~ Get regular exercise earlier during the day. Not three hours before bedtime.

~ Do not eat a heavy meal late at night or before bedtime.

~Make your bedroom comfortable. Be sure it is dark, quiet and not too cold or too warm.

~ Follow a routine to help you relax before sleep.

~ Avoid using your bed for anything other than sleep or sex.

~ If unable to go to sleep because worrying about things, (which most people do) make a to-do list before going to bed. This helps not to focus on those worries overnight.

Related Links:

http://www.webmd.com/sleep-disorders/guide/10-tips-to-get-better-sleep
http://www.mayoclinic.com/health/sleep/HQ01387
http://www.sleepdisordersguide.com/articles/better-sleep.html


Reference:

Carr, E. (2001, May 14). Nurse Week. Eyes Wide Open : Nurses can Battle insomnia and workplace fatigue with a few routines to help them catchsome shut-eye. Retrieved on 1st October, 2009 from http://www.nurseweek.com/news/features/01-05/insomnia.html

Prescription Medications and OTC's used to Treat Insomnia

Over-the-Counter(OTC)Drugs as Short Term Sleep Aids


About 20% or more adults depend on sleep aids such as prescriptions, over the counter (OTC) drugs, or even alcohol for their insomnia problems. Insomnia medications can be helpful in resolving the problem, but they could also be addicting after certain period of time. When starting with medication for insomnia problems people should start with over the counter treatment. According to the American Academy of Sleep Medicine, antihistamine is the most common ingredient in OTC sleep aids. Over-the-counter sleep medications rely on the sedating effects of the antihistamine which induces drowsiness to facilitate sleep. Most OTC drugs include antihistamines which induces drowsiness and thus helps in resolving the problem. Diphenhydramine is the most common antihistamine used in OTC sleep aids. Some contain diphenhydramine alone such as in Nytol, Sleep-Eez, Sominex. Others contain combinations of diphenhydramine with pain relievers like Excedrin P.M. and Tylenol P.M.

Side effects of these drugs include: Feeling sleepy and tired during the day, dizziness, blurry vision, dry mouth, cognitive impairment. People who should not take these drugs: patients with angina, glaucoma, dysrythmias, urinary issues, chronic lung disease should consult their physicians before taking any OTC medications for insomnia.

PRESCRIPTION SLEEP MEDS

Non-benzodiazipines:
These are the new drugs, the effect of which lasts for a short time. Some of the commonly prescribed drugs that are included in this category are:


Zolpidem (ambien) – This is one of the most commonly prescribed medication for insomnia. This medication is also available in an extended release form – Ambien CR, which is one of the first insomnia medication available in an extended release form. This drug should not be taken until and unless the patient is sure to sleep for atleast 7 to 8 hours.
Zaleplon (sonata) – This is a short acting drug and its effect is diminished after 4 hours. This drug is beneficial to patients who have difficulty staying asleep.
Other drugs include Eszopiclone (Lunesta), Ramelteon (Rozerem),etc.


Side Effects:
When patients are on non-benzodiazipines they have low risk of developing a dependency for that type of drug, however have high risk of the side effects caused by that drug. They could have severe allergic reaction, anaphylaxis, facial swelling (angioedema). Also these drugs may also cause patients to perform strange behaviors like driving, making phone calls, or even eating while they are asleep.


General side effects includes, drowsiness, fatigue, headache, dizziness, diarrhea, unpleasant taste.


Interactions: These drugs have interactions with alcohol and other CNS depressants.

Benzodiazipine Hypnotics:
These drugs target the effects of the neurotransmitter gamma amniobutyric acid. However these drugs have a very high risk of tolerance and dependence. Drugs included in this type are,flurazepam (Dalmane), clonazepam (Klonopin) and quazepam (Doral) which are long acting benzodiazipines, while triazolam (Halcion), lorazepam (Ativan), alprazolam (Xanax), temazepam (Restoril), oxazepam (Serax), prazepam (Centrax), estazolam (ProSom), and flunitrazepam (Rohypnol) are short acting in this category.



Side effects: Older people are more susceptible to side effects than younger individuals. The side effects of these class of drugs include severe allergic reaction, anaphylaxis, facial swelling (angioedema), respiratory problems, might increase the problem of depression among certain individuals, high daytime drowsiness, urinary problems, strange behaviors like sleepwalking, sleep driving, eating while asleep. These drugs could also cause memory loss. Since these drugs cross the placenta pregnant women or nursing mothers cannot take this drug.

Related Links:

http://www.aurorahealthcare.org/yourhealth/healthgate/getcontent.asp?URLhealthgate="21258.html"
http://insomnia-relief.com/information/?p=9
http://www.healthcentral.com/sleep-disorders/insomnia-introduction-000027_8-145.html


References:

Saisan, J., Kemp,G.,Barston, S. (2008,July). Sleeping Pills, Sleeping aids, And Medications Prescription, OTC, And Natural Slep Aids; What you need to know. Helpguide.org Understand, Prevent, and resolve life's challanges. Retrieved on 10th October, 2009 from http://helpguide.org/life/sleep_aids_medication_insomnia_treatment.htm#authors

Palo Alto Medical Foundation. (2009). FDA Warning: Sleep Medications may cause dangerous side effects. Retrieved on 1st October, 2009 from
http://www.pamf.org/news/drugalerts/0307sleep.html

Herbals and Supplements

More than 1.5 million Americans use complementary and herbal therapies to treat insomnia. There is no specific evidence that these dietary supplements or herbals do help in the condition of insomnia. However people have reported that it has helped them to overcome their insomnia problems. It is strongly advised that if patients choose to take herbals with other prescribed drugs for the same, they must inform their physicians about it.

Herbs and other supplements used to treat insomnia are:

Melatonin: This is the most researched natural remedy for insomnia. According to research findings it reduces the time required to fall asleep and also improves the time spent asleep. However, higher dose might keep people awake. Side effects: Disrupts the circadian cycle (the sleep and wake cycle of the brain), mental impairment, severe headache, nightmares.

Valerian root: An herb that has sedative qualities. Some studies support the fact that it improves insomnia but there has not been any specific well conducted study to prove the same.

Chamomile: A tea preparation people drink for its sedative properties. In most cases it is safe but people who have plant or pollen allergies could develop an allergic reaction to this tea.

Kava: Kava is a herb that is used by people due to its sedative properties. It has been reported unsafe as it causes damage to the liver. There have been cases of liver failure and even deaths reported due to the use of this herb. It is strongly not recommended to patients who have liver problems. This herb has dangerous interactions with alprazolam, which is an anti anxiety drug. It further enhances the effects of other drugs like other sleep medications, antidepressants, and alcohol.

Chinese herbal remedies: Research suggests that almost 30% of herbal plant remedies from China contain potent pharmaceuticals like phenacetin, steroids and toxic metals. Some of these herbs also contain benzodiazepines, one of the major components in prescription sleeping medication.

Related Links:

http://www.herbal-remedies-supplements.org/herbs-for-insomnia/
http://sleep-disorders.suite101.com/article.cfm/natural_sleep_aid_remedies_for_insomnia
http://www.medicinenet.com/sleep_aids_and_stimulants/page3.htm


Reference:

Saisan, J., Kemp,G.,Barston, S. (2008,July). Sleeping Pills, Sleeping aids, And Medications Prescription, OTC, And Natural Sleep Aids; What you need to know. Helpguide.org Understand, Prevent, and resolve life's challanges. Retrieved on 10th October, 2009 from
http://helpguide.org/life/sleep_aids_medication_insomnia_treatment.htm

Conclusion and Share Your Thoughts:

Insomnia involves difficulty falling asleep, staying asleep, and low amount of sleep. We are all at risk for experiencing and suffering from insomnia induced by our busy lives, stress and other health factors. Prescription sleep medications can be very useful and beneficial to many individuals who suffer with insomnia. If taking prescription sleep meds, the extremely important points to remember is to follow your doctors prescribing directions and not to endanger yourself by consuming alcohol and other drugs that can interact, intensify, or alter the drugs effects. We hope all who read our blog are educated about the dangerous and possibly life threatening side effects of taking prescription sleep medications.

Please share your thoughts and opinions with us. Do you have a story about sleeping pills and strange behavior? We would love to hear about your experiences with insomnia and/or your results with treatments and solutions. We hope this blog was helpful and informative. Thank you for taking the time to read it and please leave us feedback!

Below are further links to check out:

http://www.ambienoutrage.com/
http://www.sleepassociation.org/index.php?p=insomniaawarenessweek
http://www.umm.edu/altmed/articles/insomnia-000096.htm