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Health Sense

Good night? Good luck.

As the economy sinks, insomnia increases and America searches for a good night's sleep

As the economy sinks, insomnia increases (Illustration by Headcase Design)
By Judy Foreman
March 9, 2009
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Chris Dalto is an affable fellow, a happily married father of two and a lawyer-turned-financial planner. Normally, he sleeps like a baby.

But last fall, when Lehman Brothers tanked and the stock market fell apart, Dalto began waking up at 3 a.m. "You take on the clients' stress, which made it impossible to get back to sleep," he says. He would spend the wee hours fretting and checking on the already-open Asian markets. Then, come 6 a.m., it was off to work again.

Even in normal times, an estimated 40 million Americans have trouble sleeping, according to the National Institutes of Health. Sleep troubles are more prevalent now because of the economy, some psychologists and psychiatrists say. A third of all Americans are losing sleep worrying about money, according to a poll done last fall and released last week by the National Sleep Foundation, a nonprofit research organization.

Uncertainty - and especially the fear of job loss - are precisely the kind of worries that makes for sleepless nights, says Carol Kauffman a McLean Hospital psychologist. "A hypothetical emergency is often harder to deal with, and can cause more insomnia, than an actual one," she says; the worst place to be is "in limbo, waiting for the other shoe to drop, and there's a millipede up there raining shoes."

So what are the stressed out masses supposed to do to get some sleep? Sleeping pills, once frowned upon by doctors, are now increasingly prescribed if non-drug treatments don't help.

Stress management, meditation, exercise, nighttime habits more conducive to sleep, and, of course, talk therapy, should be tried first, says psychologist Cynthia Dorsey, director of behavioral sleep medicine at the Sleep Health Centers, a for-profit network of sleep disorder clinics

But for those who need more - and many do; doctors wrote more than 56 million prescriptions in 2008, according to IMS Health, a healthcare information company - sleeping pills are an acceptable alternative.

What changed? For one thing, it's clearer that extended use of some sleeping pills can be safe. Until relatively recently, doctors advised patients to take sleeping pills for no more than two weeks, partly out of the "concern that nightly use of sleeping pills would lead to 'tolerance' - the need to increase doses to get the desired effect," says Dr. John Winkelman, medical director of the Sleep Health Center affiliated with Brigham and Women's Hospital.

But then a study, funded by the makers of Lunesta, showed that the sleeping pill was just as effective at six months as at day one, suggesting that people did not become tolerant, and thus would not be inclined to boost their dosage. The US Food and Drug Administration approved Lunesta in 2004 for long-term use. Ambien CR and Rozerem are also now approved for long-term use, although there is less data on whether patients develop tolerance to these drugs.

The other change was in attitude. There is now "more acceptance of the fact that sleep disorders are very disturbing to the individual who has them," says Winkelman. Thus, the medical community sees more value in correcting the problem, which can harm both mental and physical health, says Winkelman, a consultant to several companies that make sleeping pills.

A new study from Carnegie Mellon University illustrates the health risk of insomnia. It links poor sleep "efficiency" (the percentage of time in bed actually asleep) and shorter duration of sleep to a higher risk of coming down with a cold. People who slept fewer than 7 hours were 3 times more likely to get sick than people, equally exposed to the cold virus, who slept 8 hours or more.

Still, many people view sleeping pills with suspicion. A common worry is that stopping sleeping pills use will cause withdrawal symptoms, including worse sleep. This can happen, but is often preventable if a person tapers off a drug gradually, rather than stopping abruptly.

People also worry that sleeping pills will make them do strange things in the middle of the night. Bizarre side effects are rare, but people on Ambien have reported cooking, eating, talking on the phone, even having sex - with no memory of such things the next day.

Still others fear that sleeping pills will make them groggy the next day, which can occur if the dose is too high or taken too late into the night.

On the plus side, having a sleeping pill handy may help - even if you don't take it, says Kauffman, the McLean Hospital psychologist. Much of the problem in insomnia is not worrying about a real fear - such as losing a job - but is the "secondary anxiety" about losing sleep. Just knowing you can take a sleeping pill if you really need it can allay this secondary fear.

As for Chris Dalto - the sleep-deprived accountant worried about his clients, me among them - he never turned to sleeping pills. Nor did he seek therapy or change his sleep habits.

What he did do was to figure out what he could, and what he could not, control. The larger economy, clearly, was out of his hands. So he focused intently on managing his clients' portfolios - more bonds, fewer stocks - to reduce the inevitable losses of a bad market. It worked.

"Gradually," he says, "I started to string together two, three, four normal nights' sleep. Now, I'm sleeping like a baby."

Judy Foreman can be reached at foreman@globe.com.

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