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How did you sleep last night?

Insomnia is rampant but treatable, our survey finds

Consumer Reports magazine: August 2012

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If you struggle to keep your eyes open during the day, you’re not alone. Almost 60 percent of subscribers we surveyed about their sleep habits said they had trouble falling or staying asleep, or woke up still feeling tired, at least three times a week.

It’s not surprising that the top reason cited for inadequate sleep among working respondents was job-related stress. And unemployed respondents were even more likely to have sleep problems than those with jobs (69 percent and 59 percent, respectively). But our data yielded some good news, too: Most problem sleepers had found at least one treatment that helped them. And while prescription sleep aids were deemed the most helpful, a number of people who tried alternative methods, such as regular exercise, meditation, yoga, and deep-breathing exercises, said they helped a lot. That suggests that for at least some insomniacs, help is within reach without the side effects.

Other key findings from our survey included the following:

  • Trouble staying asleep was the most common problem, cited by 57 percent of respondents. Of those, one in three woke up three or more times during a typical night. Women and obese people were more likely than others in our survey to have sleep problems.
  • Problem sleepers reported having experienced trouble sleeping for 12 years on average. And 9 percent had struggled with sleep for more than half their lives.
  • Almost half of those who tried prescription sleep drugs like zolpidem (Ambien and generic) or over-the-counter medication like Tylenol PM reported side effects such as next-day drowsiness. The dietary supplements melatonin and valerian caused fewer side effects, but they were also found to be less effective.
  • About one-third of problem sleepers said that they snored loudly (or had been told that they did), and 77 percent woke up feeling unrested three or more days a week. Together, frequent snoring and waking up tired are the hallmark symptoms of sleep apnea. But overall, only 16 percent had received a diagnosis of apnea or used a CPAP mask, the treatment typically prescribed for the disorder.

The walking tired

Much of what we found in our online survey of subscribers, conducted by the Consumer Reports National Research Center in February, echoed the findings of other research. For example, 30 percent of employed adults reported sleeping 6 hours or less in a study released in April by the national Centers for Disease Control and Prevention. (Most people should aim for at least 7 hours.) And in a recent poll by the National Sleep Foundation, one-fifth of pilots said they had made a serious error at work due to sleepiness.

Our subscribers aren’t necessarily representative of the general population. But a nationally representative poll of 1,016 adults we conducted found almost identical percentages of people reporting problematic sleep.

'We are currently a sleep-deprived nation.' — Steven Scharf, M.D., Ph.D.

“We are currently a sleep-deprived nation,” says Steven Scharf, M.D., Ph.D., director of the Sleep Disorders Center at the University of Maryland. That’s in part because we push our bodies to keep going in our 24/7 culture instead of setting limits and shutting down at night, he adds. But our bodies aren’t adapted for simply skipping sleep when it’s not convenient. Even small deficits can cause decreases in motor skills and memory, and ongoing lack of sleep can contribute to a slew of medical disorders including heart problems, high blood pressure, and type 2 diabetes.

What worked, what did not

The sleep-deprived have no shortage of options from which to choose. At some point, 40 percent of problem sleepers said they had tried over-the-counter sleep aids, and 30 percent took prescription medication. Overall, prescription drugs were deemed more effective for improving sleep than nonprescription options, which in turn were rated more effective than the dietary supplements melatonin or valerian. Newer prescription sleeping pills, such as zolpidem and eszopiclone (Lunesta), and older sleep drugs called benzodiazepines, such as temazepam (Restoril and generic), received some of the highest ratings for helpfulness by our survey respondents.

Some readers tried drugs that aren’t approved specifically for insomnia but have sedating effects, like the anti-anxiety drug alprazolam (Xanax and generic) and the antidepressant trazodone. Three percent of respondents who tried prescription drugs took an opiate pain reliever such as oxycodone (OxyContin). They were more likely than those taking other medication to report numerous unpleasant side effects including dizziness, headaches, and stomach problems. Our medical advisers say opiates shouldn’t be used off-label to treat sleep problems.

Not everyone uses sleep medication as recommended. At least 30 percent of those who took the newer sleep aids, benzodiazepines, or trazodone said they had used them at least 27 of the previous 30 nights, even though most of the drugs are approved for no longer than 10 days of continuous use. (Trazodone, which is approved for daily use, is an exception.) Taking such medication for longer can lead to dependency and rebound insomnia, and it increases the risk of side effects such as next-day grogginess and reduced effectiveness over time.

Aside from regular exercise, which 41 percent of problem sleepers had tried, few people overall had used most of the alternative therapies we asked about. But a number of those who tried most methods said they helped a lot, especially mind-body practices like meditation, yoga, and deep breathing. And many others said they helped at least a little. Keep in mind that respondents in our survey based their answers on personal experience, so the results can’t be compared with scientific clinical trials.

For details, see the Ratings table.

What our Ratings show

What you can do

Start with lifestyle changes. Given the risks of sleep medication, it makes sense to first try behavioral steps, such as waking up at the same time every day, taking time to unwind before bedtime, and getting exercise during the day, particularly in the morning. You might also try a white-noise machine ($20 and up), as 20 percent of problem sleepers in our survey did. Forty-three percent of those who tried the devices said they helped them sleep better.

Explore alternative methods. They don’t cause side effects, so you can try several at the same time, with or without the short-term use of medication. That might make more sense than taking melatonin or valerian, which rated about the same as the higher-scoring alternative methods.

Treat underlying conditions. Anxiety, arthritis, chronic pain, depression, heartburn, high blood pressure, hot flashes, leg cramps, and prostate enlargement can all interfere with sleep. Having one or more such conditions was the strongest predictor in our survey of sleep problems and related daytime symptoms, such as low energy and slowed reaction times.

Cautiously consider medication if needed. For a short-term sleep problem such as jet lag or stress, first try a nonprescription sleep aid containing diphenhydramine, our experts advise. If you’re still counting sheep after three nights, talk with your doctor about trying generic zolpidem. Consumer Reports Best Buy Drugs considers it the best initial prescription option for insomnia because of its efficacy, relative safety, and low price. But check with your doctor before taking any sleep aids, since they can interact with other medication and may cause different side effects in different people.

Don’t make drugs a permanent solution. Sleeping pills can be helpful for a few nights, but for ongoing insomnia a better option might be cognitive behavioral therapy (CBT), which can help you learn new behavior and mental techniques to improve sleep. Some sleep centers offer CBT; to find one, go to sleepcenters.org. Or use the online therapist finders at the Association for Behavioral and Cognitive Therapies and the American Psychological Association.

Getting professional help

One-third of problem sleepers had sought help from a medical professional. We found some minor differences in their experiences. Those who went to a pulmonologist or a sleep specialist were more likely to undergo sleep testing or be prescribed a CPAP mask than those seeing other types of providers.

Primary-care doctors were rated as slightly less helpful by those who saw them than pulmonologists, sleep specialists, or psychiatrists. Still, it makes sense for most people to start with their primary-care doctor and then get a referral to a specialist if needed, says Shelby Freedman Harris, Psy.D., director of behavioral sleep medicine at the Montefiore Medical Center in New York.

Secrets of good sleepers


Our survey included not just problem sleepers but also 8,900 “good sleepers”—people who reported few or no sleep difficulties over the past 30 days. People who slept soundly were more likely to:

• Exercise during the day.
• Unwind for 30 minutes before bed.
• Go to bed and wake up at a set time.
• Engage in sexual activity before bed.

But even good sleepers aren’t perfect. Some said that in the past week they left their cell phones on overnight, ate a big meal close to bedtime, or consumed alcohol or caffeine within several hours of going to bed, all considered threats to sound slumber. And 6 percent admitted that they checked e-mail or Facebook during the night.

Those findings could reflect that some people are just born good sleepers and aren’t hindered even by bad habits. Or it could suggest that certain sleep-related behaviors matter more than others. (Some good sleepers also got chemical help: One in 10 said they took prescription medication to help them sleep.) Either way, it makes sense for people who have trouble sleeping to consider some of the steps described above.

Do you have sleep apnea?

If you’ve been nudged awake by a bedmate and told that you’re snoring—loudly—more times than you care to admit, it might not be just your relationship that’s at risk. Frequent, loud snoring, coupled with daytime drowsiness, could indicate obstructive sleep apnea, a disorder in which your breathing stops repeatedly for 10 seconds or longer. The lapses in oxygen and the resulting interruptions to sleep in turn increase the risk of health conditions including high blood pressure and heart disease.

“Snoring and sleep apnea aren’t just cosmetic issues,” says Todd Swick, M.D., an assistant clinical professor of neurology at the University of Texas School of Medicine in Houston and medical director of Apnix Sleep Diagnostics, a sleep-medicine lab. “Sleep apnea can lead to significant health problems, and in many cases, significant morbidity and mortality.”

Roughly one in six respondents to our survey told us that they had received a diagnosis of sleep apnea from a doctor. Of them, 75 percent reported that they currently use a CPAP (continuous positive airway pressure) machine, which gently blows air into the throat to keep the airway open during sleep. It’s the most common treatment for apnea.

But our survey also uncovered a group of about 2,400 people, or 9 percent of the respondents, who might suffer from sleep apnea based on their responses but haven’t received a diagnosis. Fewer than a quarter of them had seen a doctor about their snoring and ongoing tiredness.

Anyone can have sleep apnea, but it’s most common among people who are obese, male, and middle-aged or older. In addition to loud snoring and daytime tiredness, symptoms include morning headaches, mood swings, and difficulty concentrating. If you don’t have a bedmate and aren’t sure whether you snore, you could try using a voice-activated pocket recorder for a couple of nights.

If you suspect you have apnea, first try self-help measures, including losing weight, sleeping on your side (not your back), and avoiding alcohol and sedating medication. If you still have symptoms, make an appointment with your primary-care doctor and keep a daily log, including how many hours you sleep each night, how you feel when you wake up and throughout the day, and whether you took medication or consumed alcohol or caffeine. Also track whether you exercised and at what times.

Your doctor might recommend a diagnostic sleep test, which can take place at a lab or even at home using a portable device. If you receive a diagnosis of apnea, CPAP is the standard for treatment, but it can require some adaptation. Swick, who has apnea himself, suggests wearing the mask for about 30 minutes before bed to adjust to how it feels and practice breathing through your nose.

“It took me about six weeks to get used to it,” Swick says. “Now I can’t sleep without it, and most of my patients feel the same way.”

Editor's Note: A version of this article appeared in the August 2012 issue of Consumer Reports magazine with the headline "Sleep Tighter."
   

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