I used to be addicted to Ambien. I couldn't sleep without it. I tried everything – all the recommendations I gave my patients to improve "sleep hygiene." I exercised every day. I went to bed at the same time every night. Nothing helped.
I've never had an easy time sleeping, but in the first few years after my 2009 MS diagnosis, I wondered if I would ever sleep normally again. I felt dizzy – my main MS symptom – all day, and I wanted so much to have a restful sleep at night, but I could not. I felt like Sleep was a beautiful room, beckoning to me, but an impenetrable door blocked my passage. My husband, next to me, would float right in, but I was left pounding at the door: "Please! Open up!"
Ambien was the only thing that seemed to work. I tried other medicines: Benadryl, melatonin, Chinese herbs. I went for acupuncture and restorative yoga classes. But every night that I tried to sleep without Ambien led to the same late-night internal conversation: Why can't I sleep?! Should I get up and take Ambien? No, I need to learn to sleep without it. What is wrong with me? Why am I addicted to this medicine? I'll have a horrible day tomorrow if I don't sleep. Maybe just half a pill. Tomorrow night I can try again.
Up to 10% of U.S. adults suffer from insomnia and report significant functional distress. Sleep problems in chronic disease are especially tricky to manage. A disease like MS can, itself, cause insomnia, and sometimes medications used to treat the disease can interfere with sleep. Anxiety and worry about the disease compound the problem. Medicines like Ambien have a role in the treatment of insomnia, but they have their own side effects and potential problems.
At some point, I realized Ambien was making my daytime dizziness worse, and I finally quit taking it. Generally, I'd rather be tired than dizzy. And gradually, my sleep improved without it.
Although sleep hygiene measures have fallen out of favor to some extent, I think they did help me:
- Go to bed and wake up at the same time, seven days a week.
- Avoid caffeine within eight hours of trying to sleep. (I quit caffeine almost completely when I realized it, too, seemed to worsen my dizziness).
- Exercise every day, but usually not within two hours of sleep.
- Use your bed for sleep (and sex, if you are in a relationship) only – avoid TV, video games, working on your phone or computer, eating, etc. while in bed.
- Avoid using alcohol to fall asleep.
- If you can't fall asleep after 15-20 minutes in bed, get out of bed and go to a different room where you should do a quiet activity until you start to feel tired; then try again. This last tip is the hardest, but it's the most critical!
More importantly for me was my discovery of mindfulness meditation about three and a half years ago. I completed an eight-week mindfulness-based stress reduction meditation class, led by Geeta Cowlagi here in Austin. I didn't expect meditation to have a dramatic impact on sleep, but it has almost cured my insomnia. It's also given me a tool to deal with sleep issues and anxiety when they occur. I now do a short meditation every night just before falling asleep. It's pretty great, because I usually DO fall asleep.
Cognitive behavioral therapy is another excellent option for treating insomnia – and it seems to have a better evidence base of success than sleep hygiene recommendations. Best of all, it's noninvasive and nonaddictive.
I don't believe in a one-size-fits-all approach to insomnia cures, but I do think getting restful and adequate sleep is important for all of us. Please add your tips and recommendations below in the Comments section. I hope this is helpful!