Sounder Sleep System

"PEOPLE who take up smoking may do so because they are getting up too early. That's just one symptom of a permanently misaligned body clock, a condition dubbed "social jetlag" that could affect more than half of us.

"Till Roenneberg at Ludwig Maximilians University in Munich and his colleagues used questionnaires to assess the "chronotype" of more than 500 volunteers - a measure of how much of a night owl or early bird you are. As with previous large studies, they found that the average person prefers to sleep between 12.30 am and 8.30 am, although chronotypes vary so widely that the latest owls are still awake when the earliest larks are rising.

"Roenneberg says that for many people this natural rhythm, which is largely genetically determined, doesn't fit comfortably with their work routines. Although exposure to daylight can adjust people to even the most unsuitable routines for their chronotype, most office workers get nowhere near enough light to do this. Roenneberg believes that more than half the population are in effect socially jet-lagged all the time, because their body clock is permanently out of synch with their working hours (Chronobiology International, vol 23, p 497).

"His team also studied stimulant use among the same volunteers and found that those suffering from social jet lag were much more likely to smoke. Only around 10 per cent of people living within an hour of their natural body clock were smokers, but this rose linearly to around 70 per cent of people with 7 hours' social jet lag or more, as measured by the difference between the mid-point of their sleep time on work days and free days. "Those that get up too early and live at odds with their body clocks are most likely to become smokers," says Roenneberg."

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Ambien and other sleep drugs have become the first choice of treatment for mild insomnia, according to CBS Evening News. While the relentless marketing push for the new generation of sleep drugs has netted billions for manufacturers, most consumers remain in the dark about the availability and proven effectiveness of non-pharmaceutical solutions like sleep hygiene, short-term psychotherapy, and sleep-inducing relaxation techniques.

Over 26 million prescriptions for Ambien were sold last year, raking in $2 billion in sales for the company. A recent New York Times article citing medical concern over increased sleeping-pill use, puts total sleeping-pill scrips at 42 million for last year, up nearly 60 percent since 2000.

As drug use increases, misuse of Ambien appears to be fueling highway accidents. In an article entitled Concern Over Ambien and Driving, CBS News correspondent Trish Regan reports that drivers who fell asleep at the wheel after taking Ambien the night before often claim they have no memory of the events leading to the accident. The Times article reports similar effects, citing sleepwalking and short-term memory loss as side effects of Ambien.

The CBS piece cites forensic toxicologist Laura Liddicoat, who tested 2300 impaired drivers in Wisconsin and found that 53 drivers exhibiting "the most extreme cases of erratic behavior at the wheel" all had measurable levels of Ambien in their blood. Liddicoat, supervisor of the state of Wisconsin's lab for alcohol and drug tests in impaired driving and death investigations, says the drivers were disoriented and suffered from memory loss.

"Ambien has a very short half life and a quick elimination period," Liddicoat explains. "If it's taken as directed, there will be no drug left in the blood after eight hours of sleep, or at least a very low amount of the drug, so therefore it really should not be seen in drivers."

Sanofi-Adventis, the French pharmaceutical juggernaut that manufactures the drug, concurs. The company claims memory problems could be avoided if people took the drug only when they can set aside seven to eight hours for sleep. The problems arise when users take higher-than-recommended doses of the drug, swallow the pill halfway through a sleepless night, or roll out of bed after less than eight hours of Ambien-induced shuteye. In those cases, users may remain partially--and in some cases heavily--drugged as they take the wheel for their morning commute. "The driving was so bizarre," recounts Liddicoat, "driving on the opposite side of the road, having head-on collisions."

With today's fast-paced, overscheduled, overworked lifestyles, few people feel they have enough time to get everything done. Shaving minutes or hours from our sleep schedule seems like a smart way "save time." However, that ignores the long term health effects of sleep deprivation, which increases the risk of stroke, heart disease, and depression, accelerates the aging process, and undermines mood, alertness, and cognitive performance. Add a time-sensitive drug like Ambien or Lunesta to that equation, and even the short-term effects can be deadly.

Sleeping pills are a valuable treatment of last resort in cases of intransigent, chronic insomnia. They are not the first choice of treatment for cases of mild, transitory insomnia. Doctors should be educated about the proven effectiveness of non-pharmaceutical alternatives. Medical consumers should consider safer, gentler approaches that nurture our inborn faculty for natural restful sleep.

See also: The Insomnia Solution: The Natural, Drug-Free Way to a Good Night's Sleep, by Michael Krugman, MA, GCFP (Warner Books 2005)