INSOMNIAC GOES TO SLEEP
…to the sleep meetings, that is, SLEEP2009, Seattle. (No, not to sleep, not at a conference— I was as sleepless in Seattle this year as I was in 2002, as I was all the other years… this is my 8th annual sleep conference.)
But there’s been some progress since 2002. There’s more recognition that insomnia may be a risk factor for depression. The old story was, you had insomnia because you were depressed. Now there’s some understanding that you may be depressed because you have insomnia. (It’s nice to see science catch up with common sense.) And there was more discussion of the neurophysiology and genetics of insomnia, which is great, because that’s where I think the breakthroughs will come from.
POSSIBLE THERAPY?
Eric Nofzinger at University of Pittsburgh has been doing neuroimaging studies that find that insomniacs’ brains are metabolically very active during sleep, working overtime—no surprise to those of us who live with the condition. He and his colleagues tried putting a cooling device on the scalp, and 5 out of 8 insomniacs showed reductions in brain metabolism and a faster drop in core body temperature around the time of sleep onset (a temperature drop is necessary for good sleep). 75% of these subjects reported sounder and more refreshing sleep.
Granted, this was only 8 insomniacs and not all of them responded, but it might be worth a try. I wonder about those cooling caps for chemotherapy, designed to prevent hair loss (since cooling slows metabolism). That might be a way to go. Or, try wearing an icepack to bed! Can’t hurt…
http://www.medicalnewstoday.com/articles/153772.php
NEW MEDICATIONS in the works…
The mainstay medications most of us take, like Ambien, Lunesta, Restoril, work on the GABA system, the inhibitory neurotransmitter of the brain.
· A new medication will target the hypocretin/orexin system, the wakeup neurotransmitter narcoleptics have too little of. It may be that insomniacs have too much of this, or too active a system, and damping it down will give us better sleep. An expert I talked to thought it might be more “natural” than the knockout current remedies provide; he says it may be on the market in 4-5 years. Another said, “yuck, induced narcolepsy.”
· Another drug, eplivanserin, works on the 5 HTT, serotonin receptor. This has been in development for awhile; I’m not sure what’s taking it so long to get to market…
· And there’s also a new version of an oldie but goodie that seems close to FDA approval, zolpidem in nasal or sublingual (under the tongue) forms, for faster acting, middle of the night usage. I’m interested in this, since middle of the night is when I usually take zolpidem.
NIGHT EATING SYNDROME
… is when you consume half your calories after 8 PM. I heard a paper that reminded me how bad this is for sleep, how it destabilizes insulin and hormonal balances, especially the stress hormones and hunger hormones, and makes for frequent nighttime waking.
http://en.wikipedia.org/wiki/Night_eating_syndrome/
They have a support group, unlike insomniacs:
http://www.mdjunction.com/night-eating-syndrome
Hearing about the dangers of night eating reminded me of an email I got from a guy was certain his sleep was screwed up by the supplement Juvenon—and it never did return to normal. Supplements can be scary, as I wrote in INSOMNIAC—red flag this one! After many a trial and error, he’s found that the only way he can get any sleep at all is by skipping dinner. He emailed me:
Russians have a saying to the effect that one should “eat breakfast yourself, share lunch with a friend and give dinner away to your enemy.” The link is http://english.pravda.ru/society/family/26-03-2006/77863-eat-0
On the other hand, there are people who find a big plate of pasta soporiphic. Me, I know I’m better off when I stop eating 3 hours before sleep. Now if I could only kick the after-dinner popcorn habit….
Speaking of kicking habits, I gave up drinking, May 2008. Reading over my blog from New Year’s Eve 2007, I have to tell you, the champagne days are over. Even the wine glass in the author photo is out of date. I wish I could tell you it’s transformed my sleep, but it hasn’t. It has maybe made my sleep a little bit better, kinda, sorta; but I was hoping for more. So alcohol goes on that long list of things that can make sleep worse, though giving it up doesn’t seem to make sleep better. Go figure.
WAGES OF WAR
There were a few papers at this conference about soldiers’ sleep, or lack thereof. Guys come back with PTSD or traumatic brain injury, both of which are disastrous for sleep.
Prazosine, 2-5 mg., seems to help sleep and reduce nightmares. I have no idea what else it does, what side effects it has; and when you stop it, the symptoms come back.
http://en.wikipedia.org/wiki/Prazosin
Imagery Rehearsal Technique, a way of rewriting your dreams, sounds like a more effective long-term therapy.
http://pn.psychiatryonline.org/cgi/content/full/36/18/23
Also, I’ve read that people who learn to do lucid dreaming can sometimes rescript their nightmares.
DREAM ON…
Speaking of dreams, there was hardly anything at this conference about dreams—and there has been hardly anything about dreams in all the years I’ve been going to these meetings. At the one dream presentation I found, the speaker began by commenting that nobody’s working on dreams anymore, except for nightmares related to PTSD. He said he gave a questionnaire to his patients, asking whether they make use of their dreams in their life. Very few said they did, and those few tended to be involved in creative work: writers, screenwriters, actors had the highest dream recall and made use of their dreams.
What I want to know is: do creative types remember their dreams because they’re creative, or are they creative because they remember their dreams? If creativity is linked to dreaming, then it seems sad and a little risky to lose our dreams. We’re a society that doesn’t have much use for dreams. Everyone prides themselves on how little sleep they need: who needs sleep, who needs dreams? I need them. I hate it when I go long periods of time without remembering my dreams, as happens when my life’s too busy or when I take too much sleep medication.
On the other hand, I know perfectly productive and highly creative people who have no converse with their dreams. Go figure…
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When I am working on a film, my dreams are attenuated and frequently stop completely, particularly at the end of the schedule close to deadline. Subsequently, when the film is finished, the dreams return with a vengeance, as if they were aircraft which had been circling, waiting for permission to land. And the dreams are rigorously realistic, avoiding the usual fanciful imaginative leaps. If someone crosses a room, I dream every footstep.
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I rarely dream at all…I thought it was a function of the sleeping pills that do not get you into the rem stage. The last time I remember dreaming was definately before I started on Ambien
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Gayle,
I’m reading through your book, and appreciating the honesty and scepticism, the willingness to take science so seriously. One question: you have nothing on the use of Seroquel for sleep. My partner takes it, in addition to Clonopin–with good results. Another friend just called with concerns—her doc. had prescribed Seroquel, (after she went off REmeron and stoped sleeping) it help–but has left her with a hung over feeling. Small sample I know, but it seems Seroquel is the new drug on the block. Your thoughts? any research?
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Hi everyone, Gayle you are wonderful! I left my comments on sleepstarved.org. Should I be posting on here?
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Seroquel is definitely the new kid on the block–kind of a strong drug, though, i’d be careful of it. I don’t know about addiction problems, or long term effects…of course that’s a question with all the sleep meds.
thanks, robbie, for posting…
are you guys having trouble leaving posts? there seems to be something weird about writing in this box!