Medical Edge Newspaper Column

Taking Extra Care, Not Pills, May Help With A Good Night's Sleep

March 20, 2008
Dear Mayo Clinic:
I'm a 57-year-old man and I'm having trouble sleeping through the night. I have a CPAP machine. I go to bed at about 11 p.m., but I still wake up too early, usually 3 or 4 a.m. Sometimes earlier. Then I can't get back to sleep. I'm tired all the time. Should I take over-the-counter or prescription medication to help me sleep?

Answer:
Sleep medication probably isn't the answer. Many sleep aids help you fall asleep but most aren't as effective at helping you sleep through the night. In addition, medication may change the course of your sleep. That might sound like a good thing, as your sleep patterns aren't what you want them to be. But using medication regularly to change sleep patterns can cause other problems.

Most of these drugs, used over a long time, tend to lose their benefit. So although you may take more, they will have less effect. Also, once you get into the habit of taking medication to help you sleep, you may have difficulty breaking the pattern. In some cases, people become dependent on these drugs. In addition, sleep aid medications can interfere with memory.

The good news is that medication is not the only option. Making some lifestyle changes may help you sleep and feel better.

Staying active is one of the best ways to promote healthy sleep. If you don't exercise regularly, I strongly recommend you start. After a physically active day, your body will be tired and better prepared to sleep. If you aren't sure what type of exercise program to pursue, talk to your doctor.

Exercise can also help control weight. That's important for some people because excess weight can cause sleep disturbances such as sleep apnea, a disorder in which breathing repeatedly stops and starts during sleep. You mention you use a continuous positive airway pressure (CPAP) machine. These devices are commonly used to treat sleep disorders by delivering air pressure through a mask placed over your nose while you sleep. The air pressure can help keep upper airway passages open, preventing apnea and snoring. If you are overweight, shedding those extra pounds may decrease your need for a CPAP machine, as well as improve your sleep patterns.

Take a look at what you do before bedtime. Identify any habits that may be disrupting your sleep. For example, drinking alcohol, consuming caffeine or eating a meal less than two hours before you go to bed can make sleep difficult.

Alcohol, in particular, can be a problem. If you drink alcohol along with a meal or evening snack, it slows digestion. Instead of taking the usual two hours after a meal for your stomach to be comfortable, alcohol will prolong the digestive process. Also, although alcohol may seem to make falling asleep easier, people who consume alcohol before bedtime commonly wake up during the night.

To create a sleep-friendly environment, keep your bedroom cool, dark and quiet when you're sleeping. Also, to avoid distraction and promote good sleep habits, keep the computer and TV in another room.

If you follow the tips I've mentioned, and you're still waking up too early, you should see your doctor for an evaluation. It's possible that an underlying medical problem may be the source of your sleep disruption. In addition, a trip to a sleep clinic might be in order. There, your sleep can be studied while you're using your CPAP machine to help determine if adjustments are necessary or if you need additional treatment.

— Eric Tangalos, M.D., Primary Care Internal Medicine, Mayo Clinic, Rochester, Minn.