Tag Archives: sleep

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