Sleep Disorders, Sleep Deprivation
Sleeping Pills and Sleep Aids
Each year, there are about 40 million people in America who suffer from sleeping disorders.
An additional 20 million have occasional sleeping problems.

Research has shown that it takes a toll on us both mentally and physically. While we sleep,
our bodies secrete hormones that affect our mood, energy, memory, and concentration.
Sleep deprivation and fatigue have long been issues for professions that have traditionally
held long work hours. Pilots have federal regulations that limit their work hours to eight
hours of flying time within a 24-hour period. Truck drivers can't drive more than 10 hours
without a mandatory eight-hour break.

Recent research suggests that if sleep deprivation is long-term--whether because of
lifestyle choices or sleep disorders--it may increase the severity of age-related chronic
disorders such as diabetes and high blood pressure.

Short-term insomnia lasts only a few days and is usually not a cause for concern. For
example, with jet lag, your internal body clock will readjust itself within several days. It's
wise to read labels carefully and check with your doctor before using over-the-counter
(OTC) sleeping pills or sleep aids for short-term insomnia. These sleep aids use sedating
antihistamines to make you drowsy. Examples include Nytol (diphenhydramine) and Unisom
Nighttime (doxylamine). While, some use other methods e.g.

What are the causes for sleep deprivation or disorders?

Sleep Deprivation due to Lifestyles
People who work nights, for example, probably never completely adapt because our bodies
want to be awake during the day and asleep at night. We are governed by the circadian
rhythm, an internal clock that regulates sleep and wake cycles. Sleep deprivation can also
result when people choose to skimp on sleep in favor of work, parties or late-night

Can't Fall Asleep--Can't Stay Asleep
Most people experience short-term insomnia at some time. Insomnia includes having
trouble falling asleep, having trouble getting back to sleep, and waking up too early.
Insomnia is more common in females, people with a history of depression, and in people
older than 60.

Noise and Stressful Events
Temporary insomnia can be caused by noise or a stressful event like the loss of a job or a
death in the family.

Medications, Large meal before bedtime and Alcohol
Certain medications could keep you awake, particularly those that treat colds and allergies,
heart disease, high blood pressure, and pain. And some of us practice bad habits that
sabotage our sleep. This includes drinking alcohol and eating too close to bedtime.

Alcohol works as a sedative, but it's also metabolized quickly. You may sleep soundly for
the first couple of hours, then you wake up. And large meals in the two hours before
bedtime could cause indigestion or even heartburn.

People with breathing problems, glaucoma, or chronic bronchitis, pregnant or nursing
women, and people who have difficulty urinating due to an enlarged prostate should not
use these medicines. People with sleep apnea shouldn't take sleep-promoting medicine
because it could suppress their respiratory drive, making it harder to wake up when they
experience an episode of interrupted breathing.

Insomnia is considered chronic when it lasts most nights for a few weeks or more. This
longer-term condition deserves professional attention.

About 85 percent of people who have insomnia can be helped with a combination of
behavioral therapy and medicine.

Prescription hypnotic drugs act in areas of the brain to help promote sleep. There have
been advances with the development of more short-acting drugs to decrease drowsy
spillover effects in the morning. Sonata (zaleplon), for example, is a drug designed to help
you fall asleep faster, but not for keeping you asleep.
Ambien (zolpidem) is an example of a
drug indicated for both getting to sleep and staying asleep.

Insomnia has traditionally been viewed as a symptom of an underlying medical or
psychiatric illness, and drugs to treat insomnia are approved for short-term use only, until
the primary condition can be treated.

Hypnotic drugs are potentially addictive. Generally, their use is limited to 10 days or less.
However, most people with this chronic condition may need long-term treatment. About 20
percent of people with chronic insomnia have a primary form of it, which means it's not
associated with another medical condition. As with any prescription medication, it's
important to not increase doses or stop taking hypnotic drugs without consulting a doctor.
No drugs that promote sleep should be taken with alcohol. And because of the sedating
effects, caution must be used when getting out of bed, driving, or operating other

Sleepy During the Day

Feeling tired every now and then during the day is normal. But it's not normal for
sleepiness to interfere with your routine activities. For example, you shouldn't be dozing off
while reading the newspaper, during business meetings, or while sitting at a red light.
Slowed thinking, trouble paying attention, heavy eyelids, and feeling irritable are other
warning signs.

If you're feeling sleepy frequently during the day, you might simply need to make
more time to sleep.

Most adults need at least eight hours of sleep every night to be well rested, but this varies
from person to person. The bottom line is that you should sleep for the number of hours it
takes for you to feel rested, refreshed, and fully alert the next day. If you've had a good
sleep, you shouldn't feel drowsy during the day.

Naps before 3 p.m. and for no longer than an hour can be good,  so that it doesn't
interfere with falling asleep at night.

If you are sleeping an adequate amount and you still feel drowsy going about your
day-to-day routine, or if adjusting your sleeping habits hasn't helped, then you should talk
with your health-care provider.

Overwhelming daytime sleepiness could be due to a number of sleep disorders.

Narcolepsy People with narcolepsy experience excessive sleepiness even after a full
night's sleep. Some people may be able to sleep, but the sleep quality is no good, If you
look at the brain as a rechargeable flashlight, some people don't hold the charge very well.
They may have sleep attacks, sometimes at very inappropriate times such as while eating
or talking. But not all cases present this way. Provigil (modafinil) may be helpful for this
type of sleep disorder. The drug is approved by the FDA to improve wakefulness in people
with narcolepsy. Potential side effects include headaches and nausea.

Some people with narcolepsy experience episodes of cataplexy, a condition characterized
by weak or paralyzed muscles such as buckling knees. In July 2002, the FDA approved
Xyrem (sodium oxybate or gamma hydroxybutyrate, also known as GHB) to treat this

Snoring Snoring is noisy breathing during sleep that occurs when relaxed structures in
the throat vibrate and make noise. Most snoring is harmless, though it can be a nuisance
that interferes with the sleep of others. Some snoring can be stopped with lifestyle
changes, particularly losing weight, cutting down on smoking and alcohol, and changing
sleeping positions. This generally means keeping snorers off their backs and on their sides
as a way to keep the airway more open during sleep. There are over-the-counter nasal
strips that are placed over the nose to widen the space in the nose and make breathing
easier. Read labels carefully because these strips are only intended to treat snoring. The
labels point out certain symptoms that require a doctor's care.

The trick is figuring out the cause of snoring. It could be related to allergies or structural
abnormalities such as nasal polyps or enlarged adenoids, which are lymphoid tissue behind
the nose.

Sleep Apnea If your snoring is loud and frequent and you also have excessive daytime
sleepiness, you could have sleep apnea. People with sleep apnea tend to also be
overweight, and it's more common among men than women. When a person with sleep
apnea tries to breathe in air, it creates suction that collapses the windpipe and blocks the
flow of air. Blood oxygen levels fall and the brain awakens the person, who then snorts or
gasps for air and then resumes snoring. This cycle is typically repeated many times during
the night. It results in frequent awakenings that prevent people from reaching the deepest
stages of sleep, which leaves them sleepy during the day.

Sleep apnea has been linked to heart disease, high blood pressure, and stroke.
Recognizing the signs of sleep apnea in children is a challenge because unlike adults, kids
push through daytime sleepiness and keep going. Kids with sleep apnea may do poorly in

Doctors use an all-night sleep study to make a definitive diagnosis of sleep apnea. During
the test, sensors are attached to the head, face, chest, abdomen, and legs. The sensors
transmit data on how many times the person being tested wakes up, as well as changes in
breathing and in blood oxygen levels.

Medications generally aren't effective for sleep apnea. There are about 20 FDA-approved
devices available by prescription for snoring and obstructive sleep apnea. Most devices pull
the tongue or jaw forward to open the airway. There are no similar over-the-counter
devices approved by the FDA. Potential side effects include damage to the teeth and jaw

The most common treatment for sleep apnea is continuous positive airway pressure (CPAP)
with a device that pushes air through the airway at sufficient pressure to keep the airway
open while sleeping. Radzikowski says using CPAP makes her feel rested during the day. It
involves wearing a mask over the nose while sleeping. A blower attached to the mask
pushes air through her nasal passages.

Surgery also is an option to treat snoring and sleep apnea. This may include removal of the
tonsils or adenoids. To treat snoring, a laser-assisted procedure called uvulopalatoplasty is
used to enlarge the airway by reshaping the palate and the uvula, making them less likely
to vibrate. For sleep apnea, a laser procedure called uvulopalatopharyngoplasty is used to
remove excessive tissue at the back of the throat.

If you're troubled by sleep problems, ask your health-care provider about how your
problem should be evaluated and which treatments may be appropriate for you.

Tips for Better Sleep
1. Keep a regular sleep-wake cycle. Try to go to bed and wake up at
the same time every day.
2. Avoid caffeine, alcohol, and nicotine in the four to six hours before
3. Don't exercise within two hours of bedtime.
4. Don't eat large meals within two hours of bedtime.
5. Don't nap later than 3 p.m.
6. Sleep in a dark, quiet room with a comfortable temperature.
7. If you can't fall asleep within 20 minutes, do a quiet activity
8. Perform relaxing pre-sleep ritual -warm bath, soft music, or reading.
Lose weight if you are overweight.
10. Take antacid if you have

SOURCE FDA Consumer Magazine November-December 2002 Issue Pub No. FDA03-1325C