Restless sleepers have taken to the Internet with their frustrations. In the past year, inquiries like "I'm tired," "I need sleep," "Why can't I sleep?" and "Help me sleep" have increased by 15 to 30 percent, according to Google's internal search data.
A survey conducted by the Pew Research Center and released last week found that one-quarter of Americans had trouble sleeping and that a third napped throughout the day.
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It's no wonder that the sleep-aid market, which includes over-the-counter drugs like Tylenol PM, herbal supplements, devices like sound machines, ear plugs and even aromatherapy candles, is estimated by the research firm Packaged Facts to be worth at least $20 billion.
The diverse choices may be comforting, but they often distract from proven treatments like cognitive behavioral therapy and prescription medication. They also ignore the fact that researchers know little about how the brain controls sleep, and therefore, how to best treat each patient.
"Theoretically, there could be a magic bullet," says Dr. Lisa Shives, a sleep doctor in Evanston, Ill., and a spokeswoman for the American Academy of Sleep Medicine. "But there are different parts of the brain involved ... and it's not something we know how to map out yet."
What Works
Shives frequently treats patients with prescription sedatives or hypnotics, but urges them to consider and adopt lifestyle changes in a process known as cognitive behavioral therapy. Both treatments have been tested in clinical trials and found to be comparable; CBT, which is therapy that incorporates stress-prevention and relaxation techniques, has performed as well as or better than prescription medication in alleviating chronic sleep conditions such as insomnia.
Many products marketed as sleep aids, on the other hand, offer the experience of relaxation or rejuvenation. Johnson & Johnson's "Melt Away Stress" night cream promises to "calm and relax [the] senses." The company Dream Essentials sells light-blocking eye masks made of taffeta for as much as $25. Such products may help establish a nighttime ritual, but do little to address basic and common-sense lifestyle choices at the heart of sleeplessness.
One major factor, Shives says, is using electronic media just before bed. She recommends shutting it off an hour or two before bedtime to limit mental activity and the amount of light bombarding the eye--the stimulant can trick the brain into staying alert well into the night.
She also tries to break common bad habits like watching television in bed, lying in bed anxiously trying to sleep and using alcohol as a sedative. Finally, she asks that patients learn a relaxation technique that helps "ratchet them down during the day."
New Approaches
That's what Dr. Ramadevi Gourineni is trying to achieve by introducing her patients to a form of meditative yoga known as Kriya, which involves controlled breathing and visualization.
Gourineni, director of the insomnia program at Northwestern University's Sleep Disorders Center, recently conducted a small study with 11 patients who suffer from chronic insomnia. For two months, all patients were given tips on how to get a good night's sleep, including directives to avoid caffeine, keep a regular sleep schedule and quit smoking. One group of patients practiced Kriya yoga 10 to 15 minutes twice a day.
In June, she presented the preliminary findings of the study--which was funded by the university's General and Clinical Research Center and the Woman's Board of Northwestern Memorial Hospital--at the annual American Academy of Sleep Medicine meeting. So far, those practicing yoga experienced improved sleep.
Gourineni is hopeful that further research on yoga and meditation will lead to evidence-based recommendations for its use with sleep-disordered patients.
If meditation isn't an appealing option, consider "sleep fitness." It's a key (and trademarked) concept behind the Zeo, a $399 sleep-monitoring alarm clock that is marketed as a personal sleep coach. Using a wireless headband, it tracks the wearer's sleep patterns throughout the night and offers detailed statistics on light, deep and REM sleep, all of which are important for feeling well-rested the next day.
The data are uploaded onto the company's Web site, where an interface offers tips on how to get better sleep. But the "sleep fitness" advice draws on the simple, common-sense principles like regular exercise, forbidding pets and children to sleep in the bed, and establishing a consistent sleep schedule.
Dr. Michael Breus, a clinical psychologist and member of Zeo's scientific advisory board, admits the company is still working on how Zeo users can measure success.
It's challenging, he says, because "there's no sleep program for everyone."
And that's one of the few ideas all sleep doctors can agree on.
