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July 26-August 2, 2006

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Health and Fitness Issue:
Insomnia | Vitamin Center | NIA

Dr. Aaron Morse

Photographs by Michelle Benson
Doctor Sleep: Santa Cruz doctor Aaron Morse has spent more than 20 years working with the sleep-deprived.

Sleepless in Santa Cruz

Despite our reputation as a refuge from reality, stressed-out insomniacs still walk among us

By Rachel Stern

Bird flu and mad cow disease may be quick to surface in the minds of many Americans when asked to identify a major health epidemic. Maybe it's lack of sleep that prevents them from identifying what Dr. Aaron Morse of the Central Coast Sleep Disorders Clinic in Santa Cruz refers to as another "major public health threat": insomnia.

Insomnia, which affects 30 percent to 40 percent of adults in one form or another, according to the National Sleep Foundation, is characterized by an inability to fall asleep or stay asleep. Adults require seven to nine hours of sleep a night, while the average--often overworked, overcaffeinated and overweight--receives only six.

Struggling to stay awake for classes, in the office or behind the wheel, many Santa Cruzans have begun searching for solutions for more slumber.

The Young and the Restless

Stephanie Wilson, a film and digital media major at UC-Santa Cruz, started taking whatever "cheap, store brand" sleeping pills she could find in high school in order to receive enough shut-eye for the dreaded Monday morning. Once in college, Wilson was able to trade in her 8am classes for ones late enough to provide her with a full night's sleep.

She now uses sleeping pills, also known as hypnotics, a couple of times a month, and has plans to take them again to be well rested for her two-week, 10-hour-a-day job as a UCSC orientation leader--which requires her to be up by 6am.

"I can't adjust my sleep schedule by more than an hour or two at will," said Wilson. "I need the pill if I need to be up before 8am for any reason. I usually can't fall asleep before 2am without assistance."

Wilson is one of the 7 percent to 10 percent of adolescents and young adults who experience Delayed Sleep Phase Syndrome (DSPS), an often misdiagnosed form of insomnia that causes one difficulty in falling asleep before 2 to 5 am, and rising from bed the next morning.

Unlike other types of insomnia, people with DSPS sleep well when they go to bed at their body's "night," and have a normal need for sleep, according to Dr. Morse, who's been certified for the past twenty years by the American Board of Sleep Medicine. When they follow their own sleep schedule, DSPS individuals feel well rested when they wake up in the late morning or early afternoon.

Still, not everyone can afford to act like a rock star and sleep until noon.

"It's not uncommon to see students use drugs or alcohol to help them fall asleep [earlier]," said Dr. Morse, who has over 1,000 clients in Santa Cruz that range in age from 2 to 90, with the most common being middle aged. "[DSPS] is sort of like being in a different time zone."

The National Sleep Foundation (NSF), based in Washington, D.C., believes that drugs--including sleeping pills--should not be one's first choice for any sleep disorder.

"We don't recommend sleeping pills," said Jessica Rollins, communications coordinator of the NSF. "Before people get any kind of sleeping aid, we recommend that they talk to their doctors."

But for Wilson--who's tried warm milk, various herbs and meditation to fall asleep--sleeping pills appear to be her only solid method for getting to sleep.

"I'm worried about being dependant on [sleeping pills]," said Wilson. "It's not healthy. I can't rely on my schedule enough to have a regular sleep schedule. Maybe when I have a 9-to-5 job I won't be as dependent on them. Until, then, though, pills seem like the easiest and cheapest alternative."

Ambien Generation

Sleeping pills are nothing new. In Victorian times, opium was commonly used to induce sleep. In the early twentieth century, barbiturates--drugs that act as central nervous system depressants--were introduced to the market.

In the 1990s, many sleepless skeptics breathed a sigh of relief as a safer form of anti-insomnia sleeping aids--nonbenzodiazepine hypnotics--became common. This newest class of prescription-only pills--which includes Lunesta, Sonata and Ambien--quiet the nervous system, inducing sleep. Because they're metabolized quickly, they reduce the risk of side effects occurring the next day, according to the Mayo Clinic.

Carissa Purnell is an English literature major at UCSC with "stress-related insomnia." She has been taking Lunesta two to three times a week for the past year--and sleeping pills since she was 16--in order to combat worries over upcoming papers and her soon-to-be entrance into the "real world."

"I know that [the pills] aren't healthy," said Purnell, "but I feel slightly addicted psychologically to something I know will guarantee me sleep I supposedly can't achieve on my own."

In attempts to flee her addiction, Purnell tried hypnosis, which she was unable to take seriously, and checking out library books on better sleep. In them, she found more cheap tricks--"Counting sheep is the worst possible suggestion I've ever received," said Purnell--than helpful advice.

Despite their long-term use by folks like Wilson and Purnell, sleeping pills are supposed to be a temporary solution for insomnia, according to the Mayo Clinic. Most over-the-counter varieties are meant to be taken, at most, for two to three days at a time. When they're taken too frequently, some sleeping pills can cause rebound insomnia--sleeplessness that resumes in maximum force when one stops taking their medication.

While Dr. Morse feels that people should try to find alternative sleep solutions to pills, he believes that they are a beneficial "last resort."

"Lots of people do well every night on sleeping pills," he said.

Mark Gilliland, a recent high school graduate and new resident to Santa Cruz, takes the over-the-counter Tylenol PM only on the occasional mornings when he has to rise early "because I don't want to form a dependence."

"I've taken my dad's Ambien," said Gilliland, "but I realized how nasty they are. If you don't fall asleep immediately, you feel as though you're in some sort of pilled-out void, generally suffering from delirium."

Lauren, a sophomore at Cabrillo College in Aptos, has been using Trazadone--a sedative antidepressant--and sometimes Valium, for the past three years on an average of once a week to fall asleep when worried about school or personal finances.

Is she worried about becoming dependent on them?

"No," said Lauren. "The pills are just convenient, you know?"

Central Coast Sleep Disorders Clinic

All Wired Up: Slumber is a science at the Central Coast Sleep Disorders Clinic.

When the 'Real World' Becomes Too Overwhelming

As soon as the traffic light turned red, Janet Schuster, a 27-year-old preschool teacher in Santa Cruz, used to find herself falling asleep behind the wheel.

"You know, just the head bob, then the head jerks, and you think, 'Oh my God, this is bad,'" said Schuster, who received one hour of uncontinuous sleep a few nights a week before being prescribed Ambien four years ago. She was simultaneously diagnosed with clinical depression, for which sleep disturbance is a major side effect.

Although she averages seven to eight hours of sleep on the pill, Schuster will not take Ambien more than three nights in a row in fear of forming an unhealthy dependence on them. However, she often sees side effects at work when she does not take the pills.

"I work with 4- and 5-year-old children," said Schuster. "If I'm tired, it doesn't matter. They expect me to be cheerful and ready to go. It gets hard to fake that after awhile and there isn't enough coffee to keep you going all day. When I get tired, my patience is the first thing to go, and that isn't fair to them."

Insomnia can be a financial drain, as well. The direct costs of insomnia treatment--which include health-care services, hospitalization and nursing care--are estimated at about $14 billion annually, according to the National Institutes of Health. Indirect costs, however, such as work loss, property damage and transportation to and from health-care providers, is estimated to be $28 billion.

Nancy Lowe, a 52-year-old licensed acupuncturist, experienced the costs of insomnia for five years. After "inner turmoil" was triggered by the end of a three-year long relationship, she fell into a largely sleepless slump that neither prescription sleeping pills nor acupuncture could pull her out of.

"I wasn't sharp and I certainly wasn't relaxed," said Lowe, who finally overcame her insomnia through counseling. "It was hard to be present. I could still function, but I never felt good."

Although she uses still uses sleeping aids such as Valium to overcome temporary bouts of insomnia, Lowe feels on the right sleep track--unlike many others.

"Sleep is very undervalued in America," she said. "People will brag about how little sleep they get, and how much they accomplish."

Holistic Alternatives

Dr. Ruth Bar-Shalom of the Holistic Health Institute in Aptos feels that there is no one right method of treating a person with a sleeping disorder. As a practitioner of naturopathic medicine, she closely examines the whole person from a physical, mental, emotional and spiritual point of view--concentrating on the cause of the disorder, as well as the symptoms.

"It may not be herbs that help people sleep, but rather eliminating stress in their everyday lives," said Dr. Bar-Shalom.

For better sleep, Dr. Bar-Shalom often recommends a bedroom with a sedative effect--removing bright red walls, noisy appliances like electric clocks and TVs or anything with an "excitatory effect"--and only using the bed for relaxing.

The NSF also recommends creating a sleep-friendly environment that is quiet, dim, cool and comfortable. In addition, they say, one should establish a regular time of both hitting the sack and rising in the morning, no matter how much one has slept the night before.

One should also not eat or drink too much before bedtime.

Bar-Shalom frequently prescribes various methods of Ayurvedic treatment--a holistic method of medicine originating from the Indian subcontinent. Most commonly she uses the Shirodhara treatment, in which warm sesame oil is poured on the center of the forehead--often after a massage--to calm one's nerves, and hence release the stress and anxiety that can lead to insomnia.

And when all else fails, there are plenty of herbal solutions.

At least according to Michael Pecot, an herbal consultant at the Herb Room in Santa Cruz. His store supplies pills containing a variety of natural sources like Valerium Root.

He takes a holistic view on herbal remedies--believing they are most effective when combined with other measures to ensure their physical and psychological well-being.

"It's most important to eat well, get lots of exercise, and [work through] mental processes," said Pecot. "You can't eat bad and be healthy, for example."

J. Jacobson, a graduate student in earth and planetary sciences at UCSC, started taking Gaia Herb: Sleep Sound supplements--which contain 75 milligrams of Valerium per tablet--two years ago, after using over-the-counter medications since high school.

"I tried [the herbs] and found them to be equally effective," said Jacobson, who enthusiastically recommended a couple more drug-free remedies for sleep--hour-long walks and sexual activity.

But Morse believes most herbal remedies only work on the patient's psychology.

"There's nothing wrong with a placebo because you think they're going to work," said Dr. Morse. "If someone tells me they're taking a root and it's working for them, I tell them to go for it."

Dr. Gregg Jacobs, Ph.D., in his book Say Goodnight to Insomnia, stresses how thoughts alone can contribute to a better night's sleep. One should simply discard negative thoughts of being unable to sleep without pills, he writes, and replace them with more positive, soothing ideas about how just getting a core, 5 1/2 hours' worth of sleep will still make one functional the next day.

"By recognizing and replacing your NST's [negative sleep thoughts] with more accurate, positive thoughts about sleep, you will be less anxious and frustrated about sleep," wrote Dr. Jacobs. "As a result, you will relax and sleep better."

And that's vital to the full-functioning person, stressed Dr. Bar-Shalom, who believes sleep truly is a cycle: "A healthy person sleeps well," she said, "and a person that sleeps well has a chance of being healthy."

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