Tag Archives: sleep

A 5-Point Plan for Arthritis Pain Relief

Pain is a common symptom associated with rheumatoid arthritis (RA) and osteoarthritis (OA). We have a culture that promotes pills for pain — but we can do much better. Pain medications are “chemical band-aids” that should never be the first line of treatment. We should instead be investing our time and energy in non-pharmacological alternatives that not only treat pain more effectively, but spare the potential for serious side effects.

The 5-point plan below offers pain relief and increased function as well as better health and well-being for the arthritis patient.

1. Fight Pain with Food

Inflammation is what causes the muscle pain from arthritis. What you eat makes a big difference! The best choice to limit inflammation and the pain it causes is a whole-food, plant-based diet consisting of vegetables, fruits, nuts, berries and whole grains. If you want to include animal products in your diet, keep them to a minimum and be mindful of the quality. Avoid processed foods and those with added sugar.

This diet will not only support a healthy gut microbiome to reduce pain and inflammation and boost your immune system, but will support a healthy body weight to maintain joint health. (Extra weight means extra pressure on your joints.)

2. Push Yourself to Exercise

When we have pain, the last thing we feel like doing is exercising! Yet exercise is critical for the arthritis patient as it increases musculoskeletal strength and flexibility as well as reducing joint pain. Strong muscles that support already vulnerable joints reduce the torque and stress at the joint lines. Non-weight-bearing exercise such as isometrics, biking and swimming can be especially effective. Remember to stay hydrated and use heat before exercise (warm up) and ice after (cool down) as needed.

3. Mindfulness Meditation

Mindfulness meditation can be a valuable tool in the management of arthritis pain. Remarkably, after only 4 days of mindfulness meditation training, pain unpleasantness and intensity were reduced by 57% and 40% respectively, according to one study. My patients’ favorite meditation apps are Calm and Headspace. Deep breathing exercises can also help manage pain –- inhale for 4 counts, hold for 4 counts, exhale for 4 counts. These techniques are quite effective in reframing the pain from something to fight into something to acknowledge and accept (in small amounts).

4. Osteopathic Manipulation

Osteopathic manipulation is a manual therapy that can often provide immediate pain relief. These gentle, hands-on techniques involve stretching, mobilization and traction, which improves circulation and joint function as well as reducing muscle spasm, pain and swelling, without side effects. Osteopathic manipulation assists the body in healing itself on a cellular level to optimize function.

Find this type of care by seeking out a DO (Doctor of Osteopathy) near you. DOs have the same level of training that MDs do, with the same ability to write prescriptions. But don’t expect your DO to encourage medical intervention. Philosophically, DOs focus on whole-person care -— rather than treat the symptom, the DO will more likely encourage you to make lifestyle changes to eliminate the cause of the problem. Most, but not all, insurance programs will pay for osteopathic care.

5. Sleep – Rest and Repair:

Pain can be exhausting during the day and may keep you up at night. Sleep is when the body repairs and rebalances. Sleep deprivation decreases our threshold for pain and impairs healing. We should aim for 7 to 9 hours of sleep nightly.

To support your sleep success, have a regular bedtime, limit or refrain from alcohol use, shut off all devices with screens at least 1 hour before bedtime and keep the bedroom dark and cool. Valerian herbal tea is a safe and helpful sleep aid.

We all want to feel and function optimally, and we all have important choices in our healthcare. The best choices offer high rewards and low risks. The lifestyle modification program outlined above can safely reduce the pain of RA and OA along with improving health and well-being without side effects. The choice is yours!

Can the Pain Without the Meds: 8 Non-Pharma Therapies

“When your whole body is a giant toothache, nothing fixes it,” observes Charley Pavlosky, 62, recalling the systemic pain that plagued him 11 years ago. A lifelong athlete, he was familiar with the aches and pains of being active – he’d even had surgery to repair a disc – but this was new to him.

His chronic pain was so severe that he was only getting 2 hours of sleep a night, and during the day he experienced anxiety and panic attacks. The Santa Barbara, Calif., resident found a comprehensive nonpharmaceutical pain management program developed by spine surgeon David Hanscom, MD, author of Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain.

With the exception of a temporary prescription for Ativan (lorazepam) to help him sleep, Pavlosky began to create a pain-reducing lifestyle. Pavlosky was mostly pain free within 6 months of working on sleep hygiene along with cognitive behavioral therapy (CBT) and twice-daily expressive writing techniques. Then he gradually weaned himself off the Ativan. He also eats a whole foods diet, stays physically active, drinks plenty of water, and allows himself a massage as needed.

Pavlosky is one of the estimated 100 million adults who live with chronic pain, a condition that costs the United States between $560 and $630 billion annually in healthcare expenses and lost productivity, according to the American Academy of Pain Medicine.

People living with pain may be offered surgery or medications from numerous classes of drugs, including corticosteroids, muscle relaxants, anticonvulsants, antidepressants, opioid pain medications and more.

The landscape of pain management is changing rapidly, as legislatures and federal health agencies seek to more tightly control and monitor opiate pain medication prescription practices. These changes are in response to an increase in prescription pain medications – which quadrupled nationally between 1999 and 2014, according to the Centers for Disease Control and Prevention. Pain remains one of the leading reasons that people seek medical care.

“When we’re treating people with pain, are we treating suffering, or are we treating pain? The expectation of being pain free is an unrealistic expectation for the patient and the doctor,” says osteopath Doug Jorgensen, DO, founder of Patient360, a physician registry firm. Jorgensen observes that for the past 2 decades the trend has been to try to provide medication that would mask pain as much as possible.

“What medicine has done is, we keep throwing simplistic solutions at a complex problem. As the awareness of the complexity of pain grows, we believe in treating every aspect simultaneously,” says Dr. Hanscom, who lived with intense chronic pain for 15 years before developing his multilayered approach to pain management. Dr. Hanscom is in private practice with Swedish Neuroscience Specialists in Seattle.

The complexity of Hanscom’s program reflects the recommendations for non-pharmaceutical pain management outlined by the American College of Physicians clinical practice guidelines and in the Academic Consortium for Integrative Medicine & Health Pain Force White Paper published in 2017.

People with chronic pain might still need medications or surgery. These 8 strategies can be used on their own or with other medical treatments to reduce pain:

  1. Acupuncture. Nurse practitioner Elizabeth Spokoiny, DPNC, RN, on staff at the University of Washington Medical Center in Seattle, found relief from pain with acupuncture after a car accident in 2015, and then was able to tackle 20 years of pain caused by an autoimmune condition. In addition to acupuncture, she uses dietary change, meditation, bodywork and yoga to manage pain. Her experience with acupuncture is mirrored by clinical data. A research review published in a 2017 issue of Programme Grants for Applied Research showed acupuncture to be more effective than a placebo or no treatment.
  2. Massage therapy. At least an hour a week of massage therapy or other soft tissue manipulation could improve your experience of pain. Massage is recommended by the American College of Physicians Clinical Practice Guidelines for acute, subacute and chronic pain.
  3. Meditation, relaxation and biofeedback. These are practices that connect your mind and your body despite pain, and are recommended by the ACP. “My first experience with chronic pain was 40 years ago, when I was 25 years old,” recalls biofeedback practitioner Cindy Perlin, LCSW, author of The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free, in private practice in Albany, N.Y. “I also use exercise, nutrition, homeopathy, energy psychology, occasional massage, self-massage and, most recently, low-level laser therapy to deal with pain challenges that come up.”
  4. Yoga, tai chi and Pilates. Although pain can make you want to be still, movement can also reduce pain. “Movement causes us to produce endorphins, which are naturally occurring opioids,” says integrative medicine pain specialist Heather Tick, MD, associate professor of anesthesiology and pain management at the University of Washington in Seattle.
  5. Nutrition. Make sure your plate offers a rainbow of fruits and vegetables. “Most people don’t know that everything you eat can impact your body chemistry,” says Dr. Tick, lead author of the Consortium’s white paper. She recommends giving up sugary, fatty, processed foods. Instead, aim for the anti-inflammatory eating pattern outlined by the Academy of Nutrition and Dietetics. This approach emphasizes eating produce, whole grains, heart-healthy fats, plant-based proteins or fish, and fresh herbs as seasoning. Dr. Tick also advocates certain supplements, such as magnesium, vitamin D, fish oil and turmeric (curcumin).
  6. Hands-on manipulative therapies. Massage, osteopathic treatment and chiropractic treatments all are evidence-based approaches to pain management.
  7. Challenge your thoughts. CBT is an approach that helps identify harmful thought patterns and provide alternative thoughts, while also identifying and supporting your resilience. CBT has been shown to help with many aspects of pain management, according to a review of research published in the February issue of Physical Therapy.
  8. Sleep better. The relationship between pain and sleep is dynamic: Pain interferes with getting the sleep you need, and sleep deprivation makes pain feel worse. Taking steps to improve the quality of your sleep will be part of your pain management strategy. Pavlosky stresses the value of being more mindful about quality sleep habits. “I don’t look at screens for at least an hour to 2 to 3 hours before sleep. I dim the lights after sundown, so my body can slowly start preparing. I don’t have any coffee or caffeine after noon and no alcohol late at night,” he says.

Finally, whether you opt for any of these approaches, or medication or surgery, make sure your expectations for pain relief match up with the reality of the treatment, advises Sal Raichbach PsyD, LCSW of Ambrosia Treatment Center. Raichbach recommends a substantial conversation so that you and your physician understand both your hopes for pain relief, as well as what you might expect from any given mix of therapies.

Quick Hits: Payments from Drug Industry to Docs, Sleeping Pills Boost Fracture Risk & More

About half of US doctors have received payments of some type from pharmaceutical and/or medical device companies amounting to $2.4 billion in 2015. The results is that it encourages doctors to prescribe expensive drugs and medical devices peddled by sales representatives. Researchers analyzed data from Open Payments, a federal program that collects information on payments that biomedical companies make to physicians and hospitals. In 2015, almost 450,000 out of more than 933,000 doctors received some kind of payment, such as free meals or travel, speaking fees and other gifts. The Journal of the American Medical Association focused this week’s issue on conflicts of interests. Posted May 2, 2017. Via JAMA.

Older people who are prescribed sleeping pills like benzodiazepines and Ambien (zolpidem) have more than double the odds of a hip fracture in the first two weeks compared with non-users. Researchers assessed people over the age of 65 and found that new users of these medications experienced nearly 2.5 times the fracture rate, when compared with older people not taking them. An approximately 53% increase in fracture risk was identified in medium-term users (15 to 30 days), and a 20% increased risk of hip fracture in long-term users (30 days or more). Posted April 26, 2017. Via PLOS ONE.

The FDA approved Rydapt (midostaurin) for the treatment of adult patients with newly diagnosed acute myeloid leukemia (AML). Rydapt is for patients that have a specific genetic mutation and will be used in combination with chemotherapy. Some common side effects of Rydapt in include low levels of white blood cells, fever, nausea and inflammation of the mucous membranes. Women who are pregnant or breastfeeding should not take the medication because it may cause fetal harm. Patients who experience signs or symptoms of lung damage should stop taking the drug. Posted April 28, 2017. Via FDA.

Effective Natural Alternatives for Fibromyalgia Sufferers

From the outside, a person with fibromyalgia looks perfectly normal. But on the inside, it can feel like the pain volume dial has been cranked up to high and can’t be turned down. On top of this, the high level of fatigue can interfere with life on every single level.

“Fibromyalgia is a very interesting illness,” says Dr. Jordan Tishler, a Harvard-trained physician who focuses on holistic care. “Twenty years ago we felt that it was largely a psychological illness, partly because we couldn’t find much else wrong, and partly because it responds, at least for some, to antidepressants like SSRIs.

“We’re now coming to learn that fibromyalgia is a complex illness with multiple things going on,” he adds. “There is clearly a psychological component, but this exists on top of a vague immune condition that we’re still working to define.”

The symptoms of fibromyalgia are widespread diffuse pain; psychological symptoms such as depression and anxiety; and somatic symptoms such as fatigue, memory difficulties and poor sleep quality. Due to these wide-ranging symptoms, there are an equally wide number of medications commonly prescribed for fibromyalgia — everything from strong pain medicines and sleeping pills to antidepressants.

While medications may provide benefits, all pharmaceutical drugs come with side effects that may contribute to more negative outcomes, rather than the positive improvements you might hope for. That’s why we’re here to inform you about the possible side effects of commonly prescribed medications and to provide more information about natural treatment options that are known to be effective.

MEDICATIONS

Lyrica (pregabalin)

You may have heard of the heavily advertised fibromyalgia drug, Lyrica (pregabalin). It’s an antiepileptic, anticonvulsant medication that slows down seizure-related impulses in the brain, and also influences nervous system pain-signalling chemicals in the brain, which is why it’s commonly prescribed for fibromyalgia.

According to a recent review of studies on Lyrica, using the drug daily does reduce pain by 30 to 50%. But 70 to 90% of people also experience side effects, the most common being dizziness (38%), drowsiness (23%), weight gain (9%) and peripheral edema (8%).

Common side effects of Lyrica are:

  • dizziness
  • drowsiness
  • loss of balance or coordination
  • problems with memory or concentration
  • breast swelling
  • tremors
  • dry mouth
  • constipation

There are more serious side effects that can also occur:

  • mood or behavior changes
  • depression and anxiety
  • panic attacks
  • trouble sleeping
  • feeling impulsive
  • irritable, agitated, hostile, aggressive behavior
  • suicidal tendencies, or having thoughts about suicide or hurting yourself

If you experience any of these more serious symptoms, consult with your doctor immediately.

Antidepressants

Antidepressants such as tricyclics (amitriptyline and cyclobenzaprine), selective norepinephrine reuptake inhibitors (SNRIs) such at Cymbalta (duloxetine), Savella (milnacipran) and the SSRI Prozac (fluoxetine) are often prescribed. Though they can be effective, nearly all antidepressants are associated with side effects and can sometimes result in serious adverse events, too.

‘We’re now coming to learn that fibromyalgia is a complex illness with multiple things going on.’
— Jordan Tishler, MD

Opioids

For more severe pain, opioid receptor agonists may be prescribed, the side effects of which are sedation, dizziness, nausea, constipation (very high rate), tolerance (requiring higher doses) and psychological addiction/physical dependence on the drug. Chronic opioid use leads to changes in brain neuroplasticity, which is what causes this.

As you can see, it’s important to read up on the possible side effects because if you find your fibromyalgia symptoms are getting worse, not better, it could be the type of medication you’ve been prescribed. Don’t be afraid to ask your doctor to review your options.

Alternatively, you could try some natural treatments that have demonstrated efficacy.

NATURAL TREATMENTS

Regular Exercise

“Even though it seems counteractive due to the high levels of fatigue experienced by fibromyalgia sufferers, exercise (both aerobic and strength-based approaches) actually works to decrease symptoms and fatigue,” says Dr. Tishler. “The message here, though, is to ‘start low and go slow.’”

Eliminate Inflammatory Foods

Registered dietitian Ryan Whitcomb recommends identifying inflammatory and allergenic foods through a food sensitivity test known as an MRT (mediator release test.)

“This is my first go-to line of defense because it eliminates all the guesswork when it comes to problematic foods,” says Whitcomb. “Once these foods are identified, they are removed from the diet and we slowly add in safe, non-reactive foods.”

One such inflammatory food identified as a problem is gluten. Studies have shown that people with fibromyalgia commonly have non-celiac gluten sensitivity — not an allergy, but an intolerance to gluten. In one small study with fibromyalgia patients, 75% of them experienced a dramatic reduction in widespread pain after eliminating gluten. Some even no longer had pain at all. And in a few of the patients taking opioid medications, the drugs were discontinued, simply by following a gluten-free diet.

Address Nutrient Deficiencies

Once inflammatory foods are removed from the diet, it may be that people have nutrient deficiencies that also need to be addressed.

“Magnesium and vitamin D are common deficiencies,” says Whitcomb. “But rather than assuming that’s the patient’s issue, I run a comprehensive micronutrient panel that looks at 33 nutrients to get a broad overview of what’s really going on in their body.

“Once we know their deficiencies, we can talk about repleting through food and supplements. Food is preferable, but some nutrients, like vitamin D, need to be supplemented since there aren’t many foods that contain it.”

Examine Sleep Quality

“Poor sleep seems to be a major contributor to this illness, so good sleep habits, such as reducing stimulants like coffee, and the occasional use of prescription sleep aids are important approaches,” says Dr. Tishler.

Try Medical Cannabis Therapy

“I have many fibromyalgia patients in my practice and have found cannabis can be a very effective treatment,” says Dr. Tishler, who is also a medical marijuana specialist. “Cannabis is great for pain control and equally good for promoting sleep. In fact, it’s considerably better for sleep than any conventional medication. It’s also considerably safer for pain control than opioid options.

“And on top of this, cannabis is effective for mild depression and anxiety, both of which are associated with fibromyalgia as well. I have certainly found cannabis to be truly effective for fibromyalgia patients because it addresses the illness on so many levels,” he adds.

Episode 4: Insomnia Drugs

SR: Hi, I’m Su Robotti and I’m the founder of MedShadow. This is Jonathan Block, the Content Editor of MedShadow. At MedShadow, we focus on the side effects and long-term effects of the medicines that we all take every day. So today, what are we going to talk about Jonathan?

JB: We’re going to be talking about insomnia drugs.

SR: Oh, that should keep me up.

JB: It certainly should, but there are some good news about insomnia drugs, at least from the MedShadow perspective. The number of prescriptions for insomnia drugs has actually been going down in recent years. Why is this good news? Well, a number of things. Sleep aids such as Ambien and a newer one on the market called Belsomra, they seem to have a large number of side effects, which we’re going to go into a little bit later. And the other thing is that people tend to take these drugs for a lot longer than they should be taking it for. For example, they’re only supposed to be taking it for 7 to 10 days, at the most, and there’s instances of people taking it for weeks, months, even years.

SR: Well, let’s talk about the side effects, because I assume that’s why you’re not supposed to continue taking them.

JB: Right.

SR: So, what are the major, I mean, everyone has heard about the lawsuits that had to do with Ambien, and driving while asleep. Is that actually a thing? Does that really happen?

JB: Yes, it does happen. There have been instances — you mentioned Ambien — instances of sleep walking, sometimes. There have even been cases of people having sex while asleep after taking an Ambien, There’s also a problem of next day drowsiness where people wake up and they still really can’t function. But there’s actually so much many more serious side effects. For example, Belsomra, which is a rather new insomnia drug to come in the market — it came on the market last year. There was a study that found that about 2 percent of the people who were taking the drug in a study experienced temporary muscle paralysis, the inability to speak, so you can imagine taking something like Belsomra and having your muscles unable to move being unable to speak and how scary that could be.

SR: 2 percent sounds like not that many people but I guess when you think of it as two people out of every 100, I’d be the unlucky one to be that too or 1 out of 50.

JB: Perhaps. The other key thing is that there is a huge risk of dependency in taking these drugs where, again, if you take it for a long period of time, which is considered more than 10 days, you’re going to need more and more of the medication in order for it to have a therapeutic effect. Also, some people, if they take it for a long period of time, if they go off the medication, they’ll find that they can’t fall asleep. They can’t fall asleep unless they’re on the medication.

SR: Is that called the rebound effect?

JB: Yes it is.

SR: And how long does that — how do you get off of the rebound effect? How long does it take to break yourself off an Ambien or Belsomra addiction so to speak?

JB: Well it depends on the person, obviously, they have to work with their physician to figure out the best way to get weaned off it. B ut, like any other medication, that one might be addicted to, it’s something that will take some time.

SR: Good, okay, before we wrap up on this, what I did want to point out is that, unfortunately a big percentage of people, maybe up to 20 percent, seem to be mixing Ambien or Belsomra with either alcohol or opioid drugs that they may be taking for legitimate pain management issues. But you should never, ever, ever mix these two drugs. Never mix sleeping pills or alcohol or opioids because all of them depress your respiratory system, and that’s what kills movie stars. Don’t be like that.

JB: Yes, there’s a couple of things before we wrap it up Su, and that’s with the fact that insomnia medications, by and large, the efficacy of them is not really that great. What do I mean by that? It’s that with these medications, you don’t necessarily fall asleep that much faster than without taking the medication nor do you necessarily stay asleep longer than without taking the medication.

SR: Can you quantify that? I mean what is a little bit less and a little bit more?

JB: We’re talking a matter of minutes here and when I say minutes I’m talking maybe 15, 20 minutes, if that, sometimes. It’s only in the single digits.

SR: So that’s how you go is that you fall asleep, 15 minutes faster, you sleep maybe 15 minutes more on average with these pills.

JB: Correct.

SR: So, considering the side effects, considering the rebound effect, the need to continuously use in the matter of few days and the risk if you use them while interacting with other drugs or alcohol, at MedShadow we suggest you be very careful, you think about it, and you try to use other techniques that are proven to work well. At MedShadow, we have several articles on what’s called sleep hygiene. Ways to help yourself fall asleep more easily and sleep better. We also have a slide show on foods that will help you sleep better. So please go to our website: www.meadshadow.org.

JB: One of the techniques is to improve sleep habits themselves. This could be doing something known as cognitive behavioral therapy, and you could actually work with a professional to do this and you can actually get a much better night sleep without the use of any kind of drug.

SR: Or just turn off the TV and the computer an hour before you go to bed, and cut back on the caffeine. So from MedShadow please think carefully about the medicines you take and have a good night’s sleep.

Consumers Wake Up to the Reality of Insomnia Pills

A group of medicines that became wildly popular over the past 20 years ended up posing serious dangers to some of the people who took them and to public health.

But they also helped millions of people get a little bit more sleep.

Yes, we are talking about the insomnia drugs doctors wrote just under 40,000 prescriptions for Belsomra in May, for example, compared to 2.6 million for zolpidem, according to IMS Health, a drug sales tracking firm.  But prescriptions for zolpidem were down from just under 3 million in December 2014.  Similar drops occurred for the two other prescription insomnia drugs.   — Ambien, now sold mostly as a generic called zolpidem, being the most widely known and prescribed. We’re also talking about Belsomra (suvorexant), the newest drug in this class and one of the most heavily advertised drugs over the last year.

After years of reports and attention to the risks associated with these medicines, their misuse and abuse, and their general lack of effectiveness at resolving the underlying causes of chronic insomnia, prescriptions for them are on the decline. And sales of Belsomra are in the dumpster.

Doctors wrote just under 40,000 prescriptions for Belsomra in May, for example, compared to 2.6 million for zolpidem, according to IMS Health, a drug sales tracking firm.  But prescriptions for zolpidem were down from just under 3 million in December 2014.  Similar drops occurred for the two other prescription insomnia drugs.

Why You Should Avoid These Meds If Possible

But here’s the bottom line for people who occasionally have trouble sleeping (most of us) or the unlucky 5 to 10% who have chronic insomnia: Don’t take these medicines at all if you can avoid it, and if you do need to take one, do so for the shortest time possible. Not more than a week or so. A few days would be better.

Why? The mediocre effectiveness of insomnia drugs coupled with serious side effects and misuse should keep them out of your medicine cabinet. Here are some facts about the  effectiveness and side effects of these medicines, as well as data on their misuse, courtesy of Consumer Reports Best Buy Drugs. Additional information was provided by Steven Woloshin, MD and Lisa Schwartz, MD, both of the Geisel School of Medicine at Dartmouth, Thomas Moore of the Institute for Safe Medical Practices, and the FDA:

  • Though studies vary, as do individual experiences, time to fall asleep after taking zolpidem and the 2 other older insomnia drugs is improved by 6 to 20 minutes compared with placebo; time staying asleep is extended by 25 to 45 minutes compared to placebo.
  • People taking Belsomra fell asleep 6 minutes faster than those taking a placebo; they stayed asleep 16 minutes longer.
  • 2/3 of people taking zolpidem use it for weeks, months or even years — a pattern of use at significant variance with the FDA and manufacturer’s recommendations of 7 to 10 days use max. And, in one analysis, 1 in 5 people who took zolpidem combined it with an opioid, increasing their risk of potentially fatal depression of the central nervous system not to mention other ill effects.
  • 2%-6% of people taking lower doses of zolpidem experience next day drowsiness, even when they had taken the drug 6 to 7 or more hours prior to waking up; 7% to 15% of people taking higher doses of zolpidem experience next day drowsiness. (Because of this side effect and its link to traffic accidents and other untoward events, the FDA in 2013 lowered the recommended initial dose.
  • 7% of people taking either the 10mg or 20mg dose of Belsomra experienced next day drowsiness, compared to 3% who took a placebo, in clinical trials involving 1,784 patients.
  • Sleep-walking or doing other activities when you are asleep like eating, talking, having sex or driving a car have all been associated with insomnia medicines, including Belsomra. So have memory lapses, and hallucinations. Generally, fewer than 1 in 10 people experience these problems.
  • 2 in every 100 people who took Belsomra experienced the very frightening side effect of temporary muscle paralysis and/or an inability to speak. Essentially, they were semi-awake but could not move or speak. This rare but extremely unpleasant potential side effect is believed to be one reason doctors have been reluctant to prescribe the drug.
  • All the insomnia medicines, including Belsomra, carry a risk of dependency. It’s not so much physical dependency, as happens with opioids or benzodiazepines like Xanax. It’s more of a psychological dependency, abetted by rebound insomnia. That’s when you stop taking the medicine and, for a while, you have even more trouble falling or staying asleep.
  • By the end of last year, the FDA had received 2,378 reports of adverse events/problems associated with Belsomra, a relatively high rate of reported events given that less than 500,000 prescriptions have been written for the drug. The most frequent problem cited was that the drug was ineffective (38% of reports). The next most frequent was sleep disturbance (27%), which included abnormal dreams, hallucinations, and sleep paralysis (59 reported episodes).

So, doctors and patients appear to be getting wise to the downside of these medicines, and they have resisted Belsomra. Though this resistance is also probably to due to its cost: $70 to $80 for 7 pills compared to $10 to $20 for 7 to 10 zolpidem pills.

While the trend suggests, at long last, more caution in prescribing these medicines, millions of prescriptions are still being written. There are many reasons for this, the main one being that 1 in 4 Americans say they have sleep problems.

Sleep Easier

If you are among such people, here’s wise advice from Consumer Reports:

transparent-green-checkmark-26 Having occasional trouble sleeping is a universal human experience. Don’t take a pill if you’ve had trouble sleeping for just a couple nights, especially if the sleep disturbance is due to job or relationship stress or a temporary life upset. This almost always resolves in time.

transparent-green-checkmark-26 Before taking a pill, try improving your sleep habits. Studies show this works. Among the techniques: Relaxation training, setting and sticking to consistent bedtimes and wake-up times, regular exercise, quitting smoking, cutting back on caffeine and alcohol in the afternoon and evening, keeping your bedroom quiet and dark and not watching TV or using a computer in bed (including a smartphone). Read a book instead.

transparent-green-checkmark-26 If you still experience problems and/or have been diagnosed with chronic insomnia (three or more nights a week of poor sleep for 8 weeks or more), try cognitive-behavioral therapy. This involves working with a therapist (possibly at a sleep clinic) to learn a new set of behaviors around sleep. Numerous studies show CBT is as effective as sleeping pills in helping people with chronic insomnia.

transparent-green-checkmark-26 If you still want to try a chemical sleep aid, try nonprescription drugs containing an antihistamine For example, diphenhydramine, the active ingredient in Benadryl, is also sold as a sleep aid under the brand names Nytol and Sominex, and as a generic), or doxylamine (Unisom and generic).  Diphenhydramine is also in Advil PM and Tylenol PM, though you should steer clear of these products unless you are also experiencing pain or fever. Don’t take any of these over-the-counter drugs for more than a few nights. And don’t take one if you are also taking any other medicine that causes sedation.

transparent-green-checkmark-26 Don’t mix any kind of sleeping pill with alcohol.  This advice applies to people of all ages, but is especially important for people over age 65, who are prone to falls and the cumulative sedative effects of multiple medicines.

3 Situations Where a Child May Be Overdiagnosed with ADHD

The number of children diagnosed with ADHD has skyrocketed since the early 2000s, and with it, so have prescriptions for powerful stimulant medications — with a long list of side effects — that many doctors are too often eager to dole out.

So, what’s going on here? Why are so many more children being exposed to medications like Adderall and Ritalin, with side effects including poor appetite, stomach aches, irritability, sleep problems, and slowed growth. There are even some indications that ADHD meds are linked to hallucinations and psychosis.

Have so many of our children always had ADHD and we just missed it? Has some cataclysmic genetic or epigenetic shift taken place, causing ADHD to be the most prevalent childhood disease second only to obesity? I don’t think so.

I believe the increase is due to 2 factors: Overdiagnosis due to poor evaluation and pressure by society for treatment, and increasing pressure being put on children and families.

With this in mind, what’s a parent to do? As a pediatrician who has studied ADHD for decades, there may be situations where your child might be misdiagnosed with ADHD. Here are 3 such examples to look out for to make sure your child isn’t needlessly given medication and other possible issues are not overlooked.

1. If you do not see symptoms of ADHD both at home and at school

Your daughter, Sarah, is in the middle of 3rd grade and the teacher says that she is not able to focus on academic tasks and tends to be disruptive in class. You are puzzled because Sarah is quite well behaved at home and does not seem to have trouble focusing, getting work done, or have any other of the symptoms of ADHD that you have read about.

But you see your pediatrician, who speaks to you for a few minutes and then gives you ADHD questionnaires for yourself and her teacher. Two weeks later, you see the pediatrician again, and he says the teacher’s questionnaire is positive for ADHD and yours is not. The pediatrician suggests a trial of a stimulant medication like Ritalin, to see if Sarah really has ADHD. You wonder if perhaps you should give the medication a try.

This is a situation in which the possibility of overdiagnosis is very high. First, the accepted definition of ADHD is that the symptoms “have an impact in 2 areas of life.” In children, this is home and school. Clearly this is not the case. When the problem is only in one of these areas, one must look very carefully to see if there is some other issue that is causing problems that may be interpreted as ADHD.

Second, just using questionnaires is an inaccurate way to make the diagnosis. In one study, children had a complete ADHD evaluation and this was compared to the results of just using the questionnaires. Two-thirds of the children diagnosed as having ADHD only using the questionnaires were misdiagnosed; that is, they did not have ADHD based on a more complete evaluation. These questionnaires were never meant to be a “stand-alone” diagnostic tool. They are highly subjective, with scoring easily influenced by the intentions and prejudices of those filling them out.

Finally, a trial of a stimulant drug is not a good way to confirm a diagnosis of ADHD. Most kids will focus better with these medications whether they have ADHD or not, much like most adults focus better if they drink coffee. Therefore, this method should never be used to determine if a child or adult has ADHD.

So what would constitute a good ADHD evaluation and who would do it? There are a number of types of professionals who would be qualified to make the diagnosis of ADHD. These would include pediatric psychiatrists, pediatric neurologists and developmental pediatricians. Some general pediatricians and family doctors or nurse practitioners would be qualified if they had the time and expertise to devote to the evaluation, which is not true for most generalists. Child psychologists can make the diagnosis,  but a medically trained provider should be included in that case.

The evaluation should consist of interviews with both the parents and the child, separately when the child is old enough. Teacher feedback is crucial, at least with the questionnaires but ideally with telephone interviews or email feedback. Information from counselors, tutors or others directly involved with the child can be very helpful. In many cases, psychoeducational or neuropsychological testing to rule out learning disabilities, anxiety disorder, or other issues is very important, although not required for all children.

School observation can also be very helpful. In my opinion, blood tests for levels of iron and zinc are necessary, although this is not an opinion shared by most mainstream providers. Overall, if the initial evaluation and treatment plan are scheduled for less than 2 hours, I do not believe there will be time for an adequate evaluation.

2. When a child is having attention problems with only one subject area

Johnny is in 2nd grade. During any reading or writing assignment, he has trouble staying focused and finishing his work. He is falling behind academically. He may even be disruptive; talking to other students, getting out of his seat, becoming uncharacteristically defiant. At home, the reading and writing homework takes forever. Johnny does not want to sit down and do it. He needs frequent breaks, and anger and tears are common. As was the case with Sarah, ADHD questionnaires are positive, this time with both parents and teachers, and medication is recommended.

However, more in-depth questioning reveals that the opposite is true of math or any other assignment that that does not involve reading. He breezes through math homework both at home and at school. He has no trouble focusing on art projects, and is a well-organized boy who rarely loses things or forgets his assignments. Mom remembers that even early reading was very difficult for Johnny.

In this situation, dyslexia, or a reading disability, is a very strong possibility. Children with reading disabilities have a difficult time picking up the basics of learning. It can become frustrating and aversive to them. They may begin to act out or stop paying attention when any reading or writing work is required. This may also result in behavioral problems. The crucial issue here is the dyslexia, though, not the ability to pay attention.

The major clue here is the ability to focus and complete math assignments so easily. This would not be true if the only issue was ADHD. Johnny needs psychoeducational testing to evaluate for learning disabilities. This problem can be tricky because many children have both learning disabilities and ADHD. This is where a team approach, including testing by a psychologist, is crucial.

3. A child with emotional problems

These could include anxiety, depression, or PTSD. Children with these issues may find it very difficult to concentrate on academic subjects. Anxiety, especially, is often confused with ADHD. It is well known that a mild level of anxiety, as most of us feel when taking a test or meeting a deadline, can improve performance. However, higher levels of anxiety can severely impair performance. This can result in a destructive feedback cycle, as these children begin to do poorly and then become understandably more anxious about their poor performance. A similar pattern may occur with depression or PTSD.

As with learning disabilities, this can be difficult to sort out, as a child can have both emotional issues like anxiety or depression and ADHD. Again, this requires careful evaluation, often with the help of a mental health professional.

One thing to watch for especially is when a child who previously had no symptoms suggestive of ADHD suddenly develops these symptoms. This may indicate that some event has caused symptoms of anxiety, depression, or PTSD. Careful history may uncover a source of these feelings, including bullying, family issues, or even sexual or physical abuse.

These are just a few of many situations where ADHD may be overdiagnosed. I hope it is clear that the solution to these and other diagnostic problems rests with a careful and complete evaluation by a provider who is knowledgeable, skilled, and willing to take the time to do it properly.

Psychotherapy, Not Sleeping Pills, Best for Insomnia

Millions of Americans suffering from insomnia are quick to head to their medicine cabinets and pop an Ambien to get a good night’s sleep. But there’s a better way to meet Mr. Sandman that doesn’t come with the side effects of taking a sleep drug: psychotherapy.

A mix of talk therapy and education about proper sleep techniques, known as cognitive behavioral therapy for insomnia (CBT-I), is better than reaching for a pill for chronic insomnia sufferers, according to new guidelines out from the American College of Physicians (ACP). Chronic insomnia is considered having sleep difficulties that happen at least 3 times a week for a minimum of 3 months that can impair activities.

Although many with insomnia are quick to ask their doctor for a sleeping med prescription, those drugs can lead to a host of side effects, including excessive sleepiness, dizziness, lightheadedness and a “drugged” feeling. They are only supposed to be taken for a relatively short period, usually 4 or 5 weeks at the most.

“Although we have insufficient evidence to directly compare CBT-I and drug treatment, CBT-I is likely to have fewer harms,” ACP President Wayne J. Riley, MD, said in a statement. “Sleep medications can be associated with serious adverse effects.”

CBT-I is designed to change the behavior of insomniacs, thoughts about sleep and what they do while they are awake in order to promote better sleep. They are also required to keep sleep logs. The techniques can be done through individual or group therapy sessions, telephone, on the Internet or self-help books.

Some of the specific techniques involved include stimulus control (establishing consistency in sleep patterns by associating sleep with the bed and bedroom, aka, only going to sleep when tired), sleep restriction (limiting time in bed to sleep only) and relaxation training (controlling bedtime thought patterns that may impair sleep).

Although CBT-I can take several weeks to master as opposed to getting the instant relief of swallowing a pill, experts say that the lessons learned can be applied long after the therapy sessions are over.

The ACP came out with a second, albeit weaker, recommendation to follow when CBT-I doesn’t seem to work: that doctors weigh the benefits, risks and costs of short-term use of sleep meds in deciding whether to add it to an insomniac’s treatment plan.

ADHD meds may cause sleep problems in kids

For some kids with attention-deficit/hyperactivity disorder (ADHD), stimulant medications used to control symptoms may keep them from getting the sleep they need, a research review from the University of Nebraska-Lincoln confirms. About 3.5 million children who are diagnosed with ADHD are commonly-prescribed stimulant medications like Ritalin and Adderall. The analysis showed that both methylphenidate drugs like Ritalin and amphetamines like Adderall cause troubled sleep in kids. Via CBS News. Posted November 23, 2015.

–Alanna McCatty

How Mindfulness Meditation Can Help Reduce Meds

A growing number of American doctors are looking East as science seems to confirm that mindfulness meditation can play a role in reducing a need for meds for some patients. A 2015 study in JAMA Internal Medicine, for example, concluded that mindfulness meditation improved sleep quality in older adults, and mounting evidence suggests that a meditation practice can ease stress, chronic pain, anxiety, depression and even improve outcomes in treatments for addiction and cancer.

More recent studies have come to similar conclusions. For example, a meta-analysis — a study of studies — published in JAMA Psychiatry in June 2016 found that mindfulness meditation is effective in treating people whose depression has relapsed after trying several antidepressants.

Danielle Hark knows this first-hand. “For years, I suffered from insomnia, anxiety and severe depression — and took multiple medications to address all of those health concerns,” says the 34-year-old professional photographer in Millburn, New Jersey. Then, her doctor told her about mindfulness meditation and its potential to ease her symptoms. She started attending a meditation study group in her area twice a month and listened to short, guided mindfulness meditations every night before bed. And within a few weeks, she was able to stop taking Klonopin (her anti-anxiety medication) as well as reduce her sleeping medication to half doses or skip it entirely.

Check out a discussion of mindfulness meditation and its benefits for many ailments on MedShadow TV.

“I started feeling less anxious as soon as I started attending the meditation group and even more noticeable changes occurred when I started meditating every day at home,” says Hark. “I always thought I couldn’t meditate because it meant I’d have to sit silently on a pillow — and my mind is just too busy for that,” she says. “But as soon as I turned off the TV at night and started listening to 10- or 20-minute guided meditations, I noticed a huge change, and the benefits have stuck.”

What is Mindfulness Meditation?

While the phrase “mindfulness” has gotten a lot of buzz in recent years, touted as a way to help us do everything from lose weight to stress less, mindfulness meditation has been practiced for centuries. According to most definitions, it’s an adaptation of Buddhist breath work, aimed at helping those who do it learn to focus on emotions, thoughts and sensations occurring in the present moment with full acceptance and without judgment. The simplest way to start practicing mindfulness meditation is as follows: Sit on the floor or a chair with your back straight and get as comfortable as possible; then, focus on your breathing and as thoughts come up, notice that your mind has wandered and simply return your focus to your breaths.

How is this different from any other meditation? While mindfulness meditation trains the mind to be in the present moment and involves passive attention to breathing and any sensations, thoughts and emotions that may surface, basic meditation (sometimes called transcendental meditation) uses a mantra as a vehicle to let the mind settle down naturally and ultimately to transcend thought.

Essentially, the main difference is that the goal of mindfulness meditation is to anchor your thoughts in the present moment, whereas transcendental meditation aims to experience a state of awareness without an object of thought, says Eva Selhub, MD, a clinical instructor in medicine at Harvard Medical School and a Clinical Associate of the Massachusetts General Hospital and author of Your Health Destiny: How to Unlock Your Natural Ability to Overcome Illness, Feel Better, and Live Longer.

“I like to think of transcendental meditation as vertical meditation, with the goal being to go down as deep into yourself as possible,” says Dr. Selhub. “Whereas mindfulness meditation is horizontal — you’re still having observations and you’re encouraged to use your mind to observe your surroundings nonjudgmentally. In my experience, mindfulness meditation can be much easier to learn and implement right away, making it accessible to everyone and anyone willing to sit quietly even for just a few moments and simply focus on their breath.”

This accessibility and approachability is what led Bill Dinker, a 32-year-old director of a drug and alcohol rehab center in Nashville, to turn to mindfulness meditation 3 years ago, when he felt like he was suffocating under the weight of drug addiction and bipolar disorder.

“Prior to beginning my practice, I was severely addicted to heroin and taking lots of medication for bipolar disorder,” says Dinker. “I was taking so many prescriptions that I gained 60 pounds and finally decided something had to change.” So Dinker sought help for substance abuse and was introduced to mindfulness meditation while in treatment. The benefits of adding mindfulness meditation to other therapeutic treatments he received while in rehab were immediate.

“The first thing I noticed was how relaxed and at ease I felt,” he says. “In fact, the feeling was so foreign to me that at first, I thought something was wrong.” As he continued to practice, Dinker found he was not only able to stay sober and stay off the cocktail of medications he was previously taking, but he was promoted at work and started sleeping better, too.

Conditions Mindfulness Meditation Can Help

An increasing body of scientific research supports mindfulness meditation’s effectiveness in in relieving symptoms and reducing medication for a variety of health conditions. 3 illnesses for which the most solid evidence exists that mindfulness meditation can help include:

Stress, Anxiety and Depression

As Hark learned firsthand, quieting the mind and learning to tune in to the present moment can be a powerful vehicle for reducing anxiety — something that researchers from Johns Hopkins University in Baltimore, Maryland, found when they reviewed nearly 19,000 studies on meditation. Their findings, published in JAMA Internal Medicine, suggest that mindfulness meditation eases anxiety, depression and pain. Even better, more research indicates that you don’t have to commit a lot of time to the practice. One recent study from Carnegie Mellon University in Pittsburgh, published in the journal Psychoneuroendocrinology, found that a brief mindfulness meditation practice — just 25 minutes for 3 consecutive days — helps alleviate psychological stress.

Cancer

Considering the stress, anxiety and depression a cancer diagnosis can cause, it’s no wonder the research specifically looking at mindfulness meditation as a complement to cancer treatments has shown tremendous benefits. In one study of breast and prostate cancer patients, published in Integrative Cancer Therapies, mindfulness intervention done in a clinic-based group setting showed consistent benefits, including improved psychological functioning, reduction of stress symptoms, enhanced coping mechanisms and overall well-being in cancer outpatients. Another study, published in Psychosomatic Medicine, found similar results, showing cancer outpatients who receive mindfulness meditation intervention have significantly more vigor and less total mood disturbance, depression, anxiety, anger and confusion than those cancer outpatients not practicing mindfulness meditation. Still more research (pdf) found that mindfulness meditation significantly improved the quality of sleep in women with breast cancer.

Addiction

Once again, the power of mindfulness meditation to reduce stress and anxiety comes into play in relation to addiction, as the link between stress and substance is well-documented. Countless studies echo Dinker’s real-life experience: Mindfulness meditation creates a change in one’s relationship to the present moment, creating a “reperceiving” or “attentional control” that can help facilitate more mindful behavioral choices. To wit: Researchers from Yale University found that a 4-week mindfulness meditation training program was more effective as a treatment for smoking cessation than the American Lung Association’s “gold standard” treatment, with participants experiencing a 90% reduction in the number of cigarettes they smoked from 18 a day to 2 a day and 35 percent of participants quitting smoking completely. Other research found that just 5 20-minute sessions of mindfulness meditation prompted increased blood flow to the area of the brain vital to self-control with 11 hours of practice creating actual physical changes in the brain around this area.

Research supporting the benefits of mindfulness meditation when it comes to easing the symptoms of a host of other health conditions, including chronic pain, insomnia, irritable bowel syndrome, high blood pressure and even HIV/AIDS is still emerging.

“I’m convinced that we’ll continue to see more evidence of the benefits of mindfulness meditation in easing symptoms of a range of health conditions and helping people reduce their medication intake,” says Selhub. “And until that happens, we still have enough proof that starting a meditation practice can only help you get healthier and feel better.”

Getting Started: How to Start a Mindfulness Meditation Now

Maybe you’re suffering from one of the health conditions mentioned in this article and hoping to reduce symptoms and your medication intake. Or perhaps you’re simply intrigued by the power of mindfulness meditation to reduce stress and help you sleep more soundly. Whatever your reasons for wanting to try mindfulness meditation, Martha Hackett, MD, an integrative family physician in Mentor, OH, who teaches group meditation classes, wants you to know it’s easier than you might think to start.

“While you can certainly find a local meditation center to take classes or even consult with an integrative doctor or other practitioner for advice, most of us can quite simply carve out just a few minutes to sit in a quiet space and just breathe,” says Dr. Hackett. If you’re having trouble, relax — frustration and anxiety about not being able to sit for even a short amount of time is very normal. If this happens and you can’t seem to quiet your mind and body enough to sit through a few minutes of mindfulness meditation, you might try a guided meditation online or via an app for your smartphone. “There are so many wonderful sources with free guided meditations that can support you as you start this practice, says Hackett. A couple to try: UCLA’s Mindful Awareness Research Center, which has countless guided meditations you can download on iTunes, or HeadSpace, a popular app that offers 10-minute guided meditations.

If you start to wonder whether or not you’re doing it “right” or “wrong” or how good you are at the practice, it’s time to simply quiet those thoughts and bring your attention back to your breath. “The best part about mindfulness meditation is that there truly is no right or wrong way to do it,” says Dr. Selhub. “Simply stay in the present moment, tap in to what you’re sensing rather than what you’re thinking, and drop any judgment about yourself. If you can do that, true healing can happen.”

Like many holistic, alternative and integrative approaches, most insurance companies don’t cover mindfulness meditation classes or groups, says Dr. Hackett, though that may change in the future. “As more research emerges on the health benefits of this practice, I think insurance companies will have no choice but to cover meditation classes,” she says. In the meantime, there are plenty of resources — and scientific proof providing good reason — to give mindfulness meditation a try.

“I truly feel like in a lot of ways, I owe my life to mindfulness meditation,” says Dinker. Hark has similar sentiments. “Mindfulness meditation has helped me live a happier, more balanced life,” she says. “I believe it’s something anyone could try — and everyone could benefit from incorporating into their lives.”

Meghan Rabbitt is a freelance writer whose work is published in national magazines and websites, including Women’s Health, Dr. Oz The Good Life, Prevention, Redbook, Refinery29, LearnVest, Canyon Ranch and more.

For more information:

Brief Summary of Mindfulness Research (pdf) (UCLA Mindfulness Awareness Research Center)
Can meditation top medication? (Boston Globe)
Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances (JAMA)

Additional resources:

American Mindfulness Research Association
Guided Mindfulness Meditation Practices with Jon Kabat-Zinn (YouTube)
Insight Meditation Society (Insight Meditation Society)
UCLA Mindful Awareness Research Center

Project Deceptive? Lunesta Claims Short of Reality

The media frenzy around the Kerry Kennedy trial reminded me of a conversation that my husband and I had a short time ago. We had seen a 15-second advertising spot at least a dozen times in the past couple of weeks before my husband finally asked, “What is Project Luna?”

The animated ad has graceful neon-green butterflies flying out and above homes in the nighttime. The view pulls back to reveal first a town at night and then the entire U.S. with lights ablazing in the dark. Winsomely it begs, “Project Luna, join us.” The appeal is on the screen for 4 seconds and if you read fast, you will see it is sponsored by Sunovion.

Neither my husband nor I had any idea what was being advertised, so I pulled out my handy tablet and Googled Project Luna. Up popped an animated website with similar, soothing graphics of green nighttime moths. The copy claimed “Because we understand healthy sleep habits may work alongside medication to manage insomnia.” Immediately to the right of this headline was an offer for Lunesta at $0 (yes, zero dollars) and many of the legal required disclaimers in small text below. With just a click or 2, but not on the front page, were tips for better sleep hygiene.

I don’t like teaser ads. I had no idea it was sending me to a website designed to sell me a sleep aid. I am very uncomfortable with advertisements that don’t clearly state the name of the drug or even the name of the medical condition. It allows the pharmaceutical company to create an enticing environment that draws the consumer in without the consumer being forewarned. A siren call of calming, soothing butterflies lulling the consumer.

The website itself is beautiful, it’s easy to navigate and pushes the drug and has pharmacologic information easily available. It has non-drug suggestions. I’d hold this up as a model of good pharma advertising except for one thing. The drug does very little — almost nothing — to aid sleep.

The website claims that “In clinical studies LUNESTA was proven effective to help the majority of patients with insomnia fall asleep quickly and stay asleep for up to 7 hours. Individual results may vary.”

A little research showed me this is not exactly true. A clear, consumer-friendly “Drug Facts” review of the study presented to the FDA to base approval upon is available online and was developed by doctors Steve Woloshin, H. Gilbert Welch and Lisa Schwartz, all affiliated with the Center for Medicine, the Media and the Public at the Dartmouth Institute for Health Policy and Clinical Practice.

The study included 788 adult insomniacs, half were given a sugar pill and half of the adults got Lunesta to take daily for a total of 6 months. The sugar-pill people fell asleep within 45 minutes each night, the Lunesta takers within 30 minutes. A net gain of 15 minutes, not much difference. The definition of insomnia includes sleeping less than 6 1/2 hours per night. Sugar-pill takers got on average 5 hours and 45 minutes. Lunesta takers got 6 hours and 22 minutes. That is definitely better, but Lunesta did not solve the insomnia: the patients did not exceed 6 1/2 hours. Lunesta also did not get the majority of users to 7 hours of sleep as claimed online. Not to be overlooked, more Lunesta takers reported many more side effects, such as a metallic taste in the mouth, than sugar pill users.

What about all the bad news on sleeping meds and amnesiac activities? Ambien and Lunesta have a different main ingredient. However, the FDA is requiring both of them to supply extra patient information about possible side effects of sleep walking, eating, driving…you know the whole Kerry Kennedy driving under the influence issue (and before her, Patrick Kennedy who drove to the White House while asleep and under the influence of Ambien.)

From The New York Times: “Although most of the reports of sleep-driving and sleep-eating have involved Ambien, the agency (the FDA) concluded that the behavior can be caused by any of the sleeping pills.”

“One sleep expert, Dr. Mahowald of Minnesota, said that Ambien had received the most publicity because it was the most widely used. But ‘there’s no question that any of the sedative hypnotics can do this,’ he said,” the New York Times reported.

Maha Ahmad, MD, MMSc, Associate Director of the Sleep Disorders Institute in New York, reviewed side effects of “hypnotics” as the drug category is called in a recent Q&A. In addition to side effects listed above, she warned of a higher risk of falling in the elderly.

I don’t have insomnia, but the times I’ve been sleep-deprived have alerted me to what a negative effect insomnia must have on a life. However, Lunesta doesn’t “fix” insomnia. It has more side effects than a sugar pill. Lunesta users are risking Ambien-like side effects.

I’m not convinced that the benefits of Lunesta outweigh the risks.

Therapy, Meditation, Sleep and Exercise Can Help Lessen Anxiety

When Lisa Jones was in college, her once-manageable anxiety became overwhelming.“I was having three or four panic attacks a day,” she says. “My hands were shaking. I felt I needed to run and hide. I would hyperventilate sometimes to the point of blacking out. I knew I needed help.”

Lisa’s doctor referred her to Frances P. Thorndike, PhD, an Assistant Professor in the Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia Health System, in Charlottesville, who also has a private practice. Lisa’s doctor had prescribed medication, and Thorndike recommended that she also start a program of Cognitive Behavioral Therapy (CBT), a technique that gives patients tools to control their own anxiety. Lisa also began meditating, starting with 10 minutes a day, on her own.

Lisa very quickly started to see results. “Even though the treatment didn’t immediately cut down the number of panic attacks, I felt better,” she says. “I felt like I had control, and I didn’t have to let the panic attack take over my life.”

Lisa, who wasn’t opposed to medication, decided to hold off and try the therapy alone first. Still, knowing the medication was available gave her comfort. “It was helpful to know that it was OK to take it if I needed it,” she says. There is ample evidence that techniques including CBT, meditation, sleep strategies and exercise can help people with anxiety disorder. People who try these techniques may still need medication, however, to manage extreme symptoms, help get them through the first stages of therapy, or, like Lisa, to keep on the shelf for a “break-glass-in-case-of-emergency moment.”

CBT: Tools for Living

Many studies show that Cognitive Behavioral Therapy (CBT) can teach people with anxiety disorder to manage their condition. Recently, a November 2013 study, published in Behavior Research and Therapy, tracked 361 people with panic disorder as they completed an 11-session course of CBT. The study showed “strong evidence” that CBT reduced panic symptoms. “Medications for anxiety disorder can certainly be helpful,” explains Thorndike. “But CBT actually changes thought patterns and behaviors that cause anxiety and keep it going.”

If you choose this type of therapy you will learn techniques to cope with your situation and feelings, and those techniques will be tailored to your unique situation, Thorndike says. You will learn techniques to deal with anxiety, including relaxation and deep breathing, as well as cognitive tools – things you can say to yourself to challenge and control your fears. Eventually, you will practice using these techniques when exposed to your trigger, the situation that produces anxiety. “We start gradually,” Thorndike says. For example, if someone is afraid of dogs, “we may start by looking at pictures of dogs, and then going to a park and watching them from a distance,” she says.

To find a therapist who practices CBT ask your doctor or the Therapist Directory of the ADAA. While one-to-one therapy is ideal, you can also try to learn some of these techniques on your own. Thorndike recommends starting with The Anxiety and Phobia Workbook by Edmund J. Bourne (New Harbinger Publications, 2011). In addition, a review in the January 2014 issue of Current Opinion in Psychiatry found that “recent studies have confirmed the utility of computerized psychotherapy for anxiety” although more research is needed. If you want to try an online program, Thorndike recommends you use Beacon 2.0, to search for the right program.

Mindfulness Meditation: Living in the Moment

Another technique that has been proven to control anxiety is mindfulness meditation. This is a type of meditation that teaches you to be aware of the present moment—your thoughts, emotions, and sensations—with an attitude of acceptance.

Elizabeth Hoge, MD, an Assistant Professor of Psychiatry at Harvard Medical School in Boston, is a psychiatrist with a specialty in anxiety disorders. Her study on mindfulness meditation was published in the August 2013 issue of the Journal of Clinical Psychiatry (view a summary here). For this study, 93 people were asked about their symptoms and put through a stress test both before and after training. Half had training in mindfulness meditation, and half attended an education class. Those who learned to meditate had less stress on the second test than those who didn’t, says Dr. Hoge, who is also affiliated with the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital.

Why does meditation help? “Mindfulness meditation starts with a practice of focusing on your breath,” says Dr. Hoge. “As your thoughts arise, you are taught to just notice them there, like a cloud passing in the sky, and not react to them.” With practice, people with anxiety disorder can use these techniques to control their reactions to negative thoughts in daily life.

While any form of meditation will help, she says, her research study used mindfulness meditation, which is derived from Vipassana or Insight, meditation. You can find information on Insight meditation at the website of the Insight Meditation Society, www.dharma.org. There are also many books on meditation technique, including Wherever You Go, There You Are by Jon Kabat-Zinn (Hyperion, 2005).

Get Your Rest

Sleep and anxiety are intertwined, says Thorndike. “People who are anxious may struggle with falling asleep or wake up during the night,” she says. Being overtired can make people more prone to anxiety and less able to cope with its symptoms as well, she adds.

Try some simple steps to improve your sleep at night. “Your bed should be saved only for sleep or sex,” she says. “If you are awake for more than 15 or 20 minutes, leave the room. Don’t lie in bed and worry.”

It is also important to keep screens, phones, and TV out of the bedroom, maintain consistent bed and wake times, avoid caffeine in the afternoon and avoid exercising late in the evening. If you want help doing this, consider trying an online program. A 2013 study in the Journal of Clinical Psychology, co-authored by Thorndike, found that adults using an online sleep program saw improvements in both sleep and anxiety. Thorndike has helped develop one called SHUTi.

Get Moving

Exercise can help as well, Thorndike says. Researchers at Princeton University recently found that mice who exercised were calmer than those who were more sedentary — and had developed more new brain cells as well. Even if you are out of shape, “start wherever you can, depending on your fitness level,” Thorndike says. “It is only important to do it regularly and consistently.” Eventually, try to build to a program of exercise of at least 30 minutes 3 times weekly.

For Lisa, a little more than a year of therapy gave her the tools she needs to manage her anxiety daily. Today, she meditates daily, practices yoga, and uses the skills she learned from Thorndike. “I still get the symptoms of panic attacks,” she says. “I still have all the same triggers. But when I feel the attack coming on, I can use these tools to squash it.“

Ellen Wlody is a writer who specializes in health and parenting topics. She lives in upstate New York with her husband, children, and two dogs.