Insomnia, and its cure, can cause trouble


To sleep, perchance to dream? That is the quest of millions of people, but it's often unfulfilled.

Insomnia and sleep deprivation are common afflictions. Many people have a hard time falling asleep, while others wake too early. Others find that travel to other time zones results in jet lag.

We've had our own experiences with sleep deprivation. When we are finishing a book, the work always seems to take more time than we planned. The result is many late nights and early mornings.

Toward the end of a project, we sometimes get only a few hours of sleep at a time, perhaps at five o'clock in the afternoon when hit by an uncontrollable urge to nap.

While a brief nap may allow us to keep going, chronically depriving our bodies of sleep is not a good idea. Experts estimate that almost half the population is seriously sleep-deprived. Shift work, late-night television and other distractions or demands can disrupt sleeping schedules.

The resulting fatigue can be dangerous. Drowsiness due to missing several hours of sleep every night can make a person unreliable behind the wheel or in the cockpit of a plane or the control room of a nuclear reactor.

Physicians and medical residents are among the most affected. Residents are often on call for up to 48 hours at a time. How they are expected to make life-and-death decisions after less than two hours of sleep is a mystery to us.

The traditional way to solve the insomnia problem has been to take sleeping pills. Prescription drugs such as Dalmane (flurazepam), Halcion (triazolam) and Restoril (temazepam) have been popular for years. But controversy about their risks and benefits abounds.

Dalmane can linger in the body for days and may affect coordination and judgment, especially if combined with alcohol. Halcion, on the other hand, is very short-acting and does not usually produce a morning hangover as some over-the-counter sleeping pills may do.

But Halcion has been associated with early-morning awakening. Some people find that they wake up at 4 a.m. and cannot get back to sleep. Others report daytime anxiety or panic attacks and memory problems. People may forget things that they do the following day.

Now there are new ways of dealing with insomnia. Sleep experts emphasize the importance of establishing a regular schedule. Dr. Richard Wurtman at MIT has discovered that low doses of the natural brain hormone melatonin can help people fall asleep. And Ambien, a new prescription medicine, may be safer than traditional sleeping pills.

We discuss all these in our new guide, "Getting a Good Night's Sleep." If you would like a copy, please send $3 with a long (No. 10) stamped, self-addressed envelope to Graedons' People's Pharmacy, No. I-75, P.O. Box 52027, Durham, NC 27717-2027.

Q: What's in Excedrin PM? My father uses it every night so he can go to sleep.

A: Like a number of over-the-counter "PM" pain relievers, Excedrin PM contains acetaminophen and diphenhydramine. There is no logical reason to take an analgesic to get to sleep unless you are in pain.

Diphenhydramine is found in allergy medicine, such as Benadryl, and such sleeping pills as Sleep-Eze 3, Sominex 2 and Nytol. This antihistamine can cause drowsiness, but sleep experts caution against regular use of sleeping pills.

Q: My husband has heard that women who take testosterone have a stronger sex drive. He thinks I should ask my doctor for a prescription.

It is true that I am not as interested in sex as he is. But I am nervous about taking more hormones. I'm already taking Premarin and Provera for menopausal symptoms. Wouldn't the testosterone interfere with the benefits of my other medicine?

A: Hormones can have an important effect on sexuality. Progesterone can diminish desire, while testosterone can stimulate libido.

Some physicians do prescribe testosterone after hysterectomy to enhance a woman's sex drive. Occasionally men complain that their wives have become too demanding when taking male hormones.

The long-term safety of estrogen and testosterone in combination has not been carefully studied. It is unlikely that testosterone would counteract the benefits of estrogen. But in a recent issue of Epidemiology (July 1994) we read about a study suggesting that these two hormones may increase a woman's (( risk of breast cancer.

We suggest that you discuss these personal issues with your physician to see if there is a reason why your sex drive is low and whether there is an appropriate way to resolve the issue.

Joe Graedon is a pharmacologist. Dr. Teresa Graedon is a medical anthropologist and nutrition expert.

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