How to Get a Good Night's Sleep

Whether you tossed and turned all last night fretting about the dinner party that you're hosting or could not fall asleep until 2 A.M., you were not alone. Today, more than 60 percent of all women experience symptoms of insomnia at least a few nights per week, according to the National Sleep Foundation (NSF). But thanks to the highly effective pills now available, a good night's sleep is within your reach.

How much sleep do you really need?
A healthy adult requires an average of eight hours per night, according to the NSF. Currently, however, 65 percent of women report getting less during the workweek. And at least 12 percent admit to using some type of sleeping aid at least a few times per month.

Why is sleep so critical?
Besides boosting your immune system and giving your brain time to recharge, there are other surprising benefits of a good night's rest:

• A stable weight: In studies at the University of Chicago, sleep-deprived subjects were shown to have significantly lower levels of leptin, a hormone that suppresses your appetite by signaling the brain that your body feels full. Production of human growth hormone, which helps the body effectively process glucose that might otherwise be stored as fat, has also been shown to be negatively affected by lack of sufficient sleep.
• Healthy Skin: During sleep, damaged skin cells are repaired, new skin cells are produced, and collagen and elastin (proteins that give skin a youthful, wrinkle-free appearance) are strengthened. Since you are resting and not exerting yourself, your body depends on this time to mend itself.

Are over-the-counter sleep medications safe and effective?
Most nonprescription sleep aids, such as Tylenol PM and Sleep-­Eze, contain the sedating antihistamine diphenhydramine hydrochloride (DPH), which blocks histamine, a neurotransmitter in the brain that helps us stay awake. According to James Dillard, M.D., an assistant clinical professor at Columbia University's College of Physicians and Surgeons, "These medications' effectiveness may wear off if you take them for more than 10 days straight." He suggests using them no more than once per week. And because these drugs' powers take time to kick in, Dillard advises to "take them about an hour before you go to bed." Be forewarned, however, that these sleep aids may lead to next-day grogginess.

What medication do doctors most often prescribe to combat sleeplessness?
Ambien (zolpidem tartrate), a nonbenzodiazepine, which induces sleep by depressing activity in the central nervous system, is the sleep aid doctors in the United States most often prescribed. Since Ambien stays in the system for up to eight hours, experts agree that it is particularly effective for people whose main problem is staying asleep through the entire night.

Unlike barbiturates like Seconal and Nembutal, which were the sleeping aids of old, Ambien does not appear to hinder deep sleep; it is also less likely to suppress breathing or result in grogginess the following day. Because it may cause dependence, however, the manufacturer suggests that you avoid taking it for more than seven to 10 days without re-consulting your physician. If you suffer from chronic insomnia, some doctors will, in fact, prescribe more than a 10-day supply of Ambien.

Is there a popular prescription alternative to Ambien?
Sonata (zaleplon), also a nonbenzodiazepine, is prescribed frequently today and, according to Dillard, it is particularly helpful if your main problem is falling asleep. Because Sonata "starts to clear out of your system in just an hour," it is the only medication the Food and Drug Administration has approved that can be taken in the middle of the night. Thus, you could take Sonata at 4 A.M. and still wake up easily when the alarm goes off four hours later. However, the experts we spoke with don't recommend taking Sonata more than once during the night. The manufacturer cautions that you should not take Sonata for longer than two to three weeks without a medical reevaluation.

Are there other prescription options besides these two drugs?
Doctors once regularly prescribed benzodiazepines [such as Dalmane (flurazepam hydrochloride) and Restoril (temazepam)] that stimulate a chemical in the brain that inhibits neuron excitability, thus inducing sleepiness. But these medications are less popular nowadays since the newer drugs have fewer side effects. According to Phyllis Zee, M.D., Ph.D., director of the Sleep Disorders Center at Northwestern University Medical School in Chicago, benzodiazepines suppress deep sleep. Also, patients who abruptly go off these medications are more likely than users of Ambien or Sonata to experience the rebound effect in which insomnia returns--even more intensely than before--for one or two nights. Users should gradually wean themselves from these medications by tapering off the dosage over a period of two weeks or so. State regulations vary regarding prescriptions; the maximum is a 90-day supply.

Are antidepressants helpful at all?
If depression is the primary cause of your insomnia, antidepressants work well with less risk of dependency or rebound than benzodiazepines. But experts aren't yet certain how effective they are for nondepression-induced insomnia or for how long, says Timothy Roehrs, Ph.D., director of research at the Sleep Disorders and Research Center at Henry Ford Hospital in Detroit. Plus, antidepressants may cause troubling side effects, such as low blood pressure, abnormal heart rhythms, weight gain, sexual dysfunction and headaches. Still, doctors have been prescribing low doses of sedating antidepressants like Desyrel (trazodone hydrochloride) as sleep aids more than three times as often as they did a decade ago, according to Roehrs.

Do alternative sleep aids such as melatonin and valerian really work?
The consensus among experts is that melatonin, a hormone secreted by the brain's pineal gland primarily at night, plays a role in regulating the sleep/wake cycle. Studies show it may be useful for resetting your biological clock after changing time zones or missing a night of sleep. Because over-the-counter synthetic melatonin is classified as a dietary supplement and doesn't require FDA approval, some doctors are cautious about its regular use. "If you take melatonin, try 0.3 to 1 mg, two hours before bed, no more than once or twice per week," says Dillard.

The herbal remedy valerian is also a popular sleep aid. "Though no one is completely certain how it works, valerian seems to target the same neurotransmitters as conventional sleep medications," says Dillard. Because valerian is available in different forms, such as in tea bags and as an extract, Dillard says to always consult the label for the recommended dosage. He also advises to take valerian about 30 to 60 minutes before bed, no more than once or twice per week.

Calcium (800 mg), magnesium (400 mg) and vitamin B (50-100 mg) are also all-natural sedatives people take to induce sleep (note: In some people, B vitamins act as stimulants). But according to Dillard, the effects of these three are very mild.