Are You Sleeping?

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Do you get enough sleep?

This is what happens to your body if it’s deprived of sleep:

  • You have problems with memory and concentration.
  • You have problems finding the right word.
  • You get irritable – you think so?
  • Neurotransmitters in the brain become altered.
  • You become more susceptible to infection.
  • At its extreme, sleep deprivation can lead to death.

h1sciqsleepwalkingIt seems that no matter how many Ambiens (zolpidem) and Lunestas (eszopiclone) we take, we wake up feeling like shit (sorry – there is just no other word!): feeling hung over and inattentive. So much so that the FDA recently cut recommended doses of Ambien and other drugs that contain zolpidem for fear that their use, even the night before, might impair driving or other activities the next day.

This is because Lunesta and Ambien affect GABA receptors, which are found throughout the brain and are associated with side effects, including thinking disturbances, and deficits in attention and memory, explains Jason Uslaner, lead author of a study published in the April 3 issue of Science Translational Medicine.

A new study funded by Merck (of which Uslaner is director of In Vivo Pharmacology at Merck & Co.) has shown that a new class of sleep medications appears to help people fall asleep without causing grogginess the next day (YES! You did read that correctly!)

These new medications – known as dual orexin receptor antagonists (DORA) – target a more specific region of the brain than the other popular sleep drugs, promoting sleep without affecting cognition.

About 15 years ago, scientists discovered chemical messengers known as orexins, which are released by a relatively small brain region known as the lateral hypothalamus. lateralThis area of the brain releases orexins during the day to keep us awake and lowers levels at night so we can sleep.

The appeal of orexin antagonists, said Dr Michael Thorpy, director of the Sleep-Wake Disorders Center at Montefiore Medical Center in New York City, is that they “target a system that’s more specific for sleep.”

That means, theoretically, fewer side effects and perhaps less of a tendency to be habit-forming, Thorpy explained.

Merck already has one such drug, suvorexant, under review by the FDA.

But with this study, Uslaner and his colleagues investigated a compound called DORA-22, which has the same mechanism of action as suvorexant, to see how it fared alongside Ambien, Lunesta and also diazepam (Valium) in rats and rhesus monkeys.

DORA-22 did not lead to the same mental impairments as the other three drugs. Rhesus monkeys and rats performed just as well on memory and attention tasks shortly after being administered DORA-22 as they did on the placebo.

This is the first time in years that scientists have targeted a totally different receptor in the quest to combat insomnia, said Dr Alexandre Abreu, co-director of the UHealth Sleep Center at the University of Miami Miller School of Medicine.

444-36-cartoonBut many questions remain as even experts note that findings from animal studies do not always hold up in human trials: Do the drugs truly have fewer side effects? Will they be habit-forming? And will they change the quality of sleep in any way?

Those questions will only be answered with more testing and use in humans…(waiting…waiting…waiting…)

 

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More Sleep (on this blog…not for us!)

Good news! The most widely prescribed sleeping pills DO help people get to sleep, but maybe not only because of the medicine, a new study suggests.

Chronic Comic 157When researchers combined studies of some of the newer prescription sleep drugs, they concluded that the drugs owe about half their benefits to a placebo effect. Personally, who cares? If the placebo effect gets me to sleep – that’s fabulous!

But at least one sleep expert disagrees with that conclusion.

AmbienLunesta, and Sonata and their generic versions were all included in the study.

The researchers conclude that these drugs improved people’s ability to fall asleep compared to a placebo; however, the size of the effect was small.

They add that the risk of side effects and the potential for addiction need to be considered when considering using these medications for treating insomnia.

Side effects of sleeping pills can include memory loss (would you actually notice through the fibro fog?), daytime sleepiness, and increased risk of falls, and researchers say the drugs may be especially risky for older patients.

But a sleep specialist says the study does little to convince him that the drugs are less effective than studies suggest.

“The fact is that it is difficult to measure the effectiveness of sleep medications in studies. Patients take them and they either work or they don’t.”

“I don’t see how these researchers can come to the conclusion that 50% of the effect of these sleeping pills are due to the placebo effect,” says David Volpi, MD, of the sleep disorders division of Lenox Hill Hospital in New York.

141. sleep deprivationAccording to researcher A. Niroshan Siriwardena, MD, PhD, one of the major limitations of studies submitted to the FDA is that they failed to measure some of the most troubling issues associated with sleep disturbances including total sleep time, waking after falling asleep, and daytime sleepiness.

“Because the studies didn’t measure these things, we cannot say whether these drugs are useful for improving these outcomes,” he says.

And, Volpi says prescription sleeping pills are often used by patients for much longer than they were originally intended – These drugs are overprescribed and patients stay on them too long, he says.

Siriwardena and Volpi also agree that other types of sleep treatments, such as talk therapy, are underutilized and could be used to help many more patients with sleep issues.

“There are so many things you can try for sleep problems, and cognitive behavioural therapy is one of the best things patients can do to get off of these medication,” Volpi says.

The new analysis, published in BMJ, was a collaborative effort by scientists from the University of Lincoln in the UK, Harvard University, and the University of Connecticut.

It included data from 13 trials submitted by pharmaceutical companies to the FDA for approval of eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien).

The studies focused on the time it took to fall asleep after taking the drug.

The new analysis shows that sleeping pill users fell asleep about 22 minutes faster than non-users. Those on placebo fell asleep after 42 minutes.

Prior to publication of this study, the manufacturer of Ambien declined to comment; and the makers of Lunesta and Sonata did not respond.

Feedback

Today I received an email from some-one, titled Wondering, who had read my previous post:

Hi. I just starting following you but have been to your site many times. A good friend sent me your link about a year ago. Anyway, I just read your post about yoga part 1 and your humor made me smile, I thank you for that. But It (the story) made me a little sad and depressed because it left me wondering and thinking to myself (omg how can she even do this? Is she on some major drugs or something. Maybe she just doesn’t have fibro as bad as me.) Because I have to tell you, there is NO WAY I could even attempt to do any of that. I can’t even get things done in my house I need to do. And I can’t remember the last time I felt good enough to even go to the store for milk, forget about doing the weeks shopping. So please tell me, how do you do it? Also in one part you mentioned running on 5 hours of sleep after getting 10 hours the night before. That made me envious. I never get more then an hour here, a couple hours here. heck, I’m jumping for joy if I sleep more the 3 hours at a time. Once in a while (very rare) I get a whopping 4 hours. Please understand I am in no way doubting your illness. I am just wondering how you do it.
This is what I responded (in case any of you are wondering, too):
I have only been diagnosed with FM since November. I started my FB page and blog in February. Right now, I am dedicated only to finding ways to feel better – I have been unable to work because my fibro fog is terrible (most of the time) and I am supposed to be a lawyer (who would want to see a lawyer who has trouble remembering and slurs when tired?). I am living on my credit card, which, sooner or later, will max out and I have no idea what I’ll do then; unless I can get better!
I take Lyrica (which is incredibly expensive) but it seems to help me with the pain, more than any other drug. Until the other night (10 hour sleep night), I was taking Stilnox every night (since December) for sleep. If I missed a dose, I didn’t sleep. The other night, I started Circadin (prescribed by my doctor) and was totally amazed when I slept for so long! This isn’t a common occurrence! Most sleep that I have is the kind where you doze off then wake up, then doze off again. I’m hoping the Circadin will help.
My house is a mess – I can only do one chore at a time (and I used to be the Queen of multi-tasking) so by the time I finish them all; it’s time to start at the beginning. And, as I said before, I am pretty much JUST doing the stuff that is supposed to help me. So yes, yesterday I went to hydro then yoga (actually that pretty much amazed me, too) but today, my cousin picked me up (I can’t drive because I feel like my reflexes are so slow that I’d be a menace) to go to my mother’s place, where I promptly fell asleep for a three-hour nap. It seems (and I only have the last week or so to compare anything to as that’s only how long I have been doing these classes) that I crash after a couple of days of this activity – big time crash! I have to hide inside with my sunglasses on and my heating pad(s) all around my body!
 I live alone so I don’t have to take care of anyone else – when I close my door and hide in my cave, it’s just me. Most of the time, it’s just me, my couch and my lap-top.
 So, yes, I seem to be doing lots and lots of activities – but that’s it for the day. I may do an hour of hydro (and if you have never tried it, you must! The warm water lets your body do all the things it used to do!) but then I come home and do absolutely nothing until the next class, on the next day. I don’t even cook – I live within a major shopping area where it is so much easier and cheaper to get take-away than cook for one. I must say that I feel better having done physical activity – not necessarily physically, but in my head. I feel enthused and energised again – almost like I could do anything (even though I know that I can’t)!
I try not to dwell on all the bad stuff when I’m writing my blog because a) it gets me down when I think about it; b) there are plenty of other people out in cyberspace talking about that stuff, and c) would you really be interested in reading only bad stuff? I’m trying (in my small way) to inspire and let you in on my journey towards feeling better. Because I am determined to do so.
Please read my post ‘A New (and better?) Philosophy’ (http://fibromodem.com/2012/03/17/a-new-better-philosophy/) so you know where I am coming from. I have decided it is all worth it.
And (try) to grab the good moments!
And while I am here, I am so honoured that you bother to read my blog. And I am incredibly thankful for your wonderful comments. Feedback makes it all worth it!

Started One Place…Finished Elsewhere

And back from Pilates

…having first asked them to display some Awareness:

But this post isn’t about the Awareness Campaign, it’s about my lousy night’s sleep last night…you know that sleep where you feel that you’re only ‘drowsing’ (is that a real word?) in and out, where anything can and does wake you, where you open your eyes and you’re still too tired to move or get up but you can’t fall back to sleep properly, where it feels like hours but it’s only been 4 minutes since you looked at the clock, where you never feel refreshed; and where you still have highly vivid dreams.

I am assuming that all of this is because I didn’t take my zolpidem last night and went with the melatonin – but I fell asleep well enough, I just couldn’t stay asleep……And I’m so tired but, at least, I know why.

I have been involved in some very carefully plotted murders, ending up by me running into a court and interrupting, holding a milk carton, and telling them to wait in a very dramatic turn of events.Think black and white movie a la 12 Angry Men, but with loads of action scenes a la NCIS and Criminal Minds; then add strobe.

It’s very difficult to watch and it hurts my head and my eyes, but I can’t really do anything about it as it’s playing on the huge screen in my head.

I always wake up before I know what happens next – no matter how much I fight to get back to that place in the movie. I don’t know if I actually wake up or if I was dreaming in my dream of me dreaming and waking up. All I know is that when I finally wake up (properly), I feel like I have done some big time running and thinking!

It is with that background that I attended Pilates today. On my walk to the gym, my stomach muscles began protesting – how did they know where I was going? It’s been a week since the previous class, so I had thought that any left-over delayed onset muscle soreness would have disappeared – WRONG! the minute I tried to do anything from the table top position (hee! hee! aren’t I the expert?), my transversus abdominus and internal oblique muscles began to scream. I would have thought that I would have been able to do more (as compared the previous class) this week – WRONG again! Not only did everything hurt more but I seemed to be much more uncoordinated. My entire balance was off, way off! And the room was spinning before my eyes after every new movement.

Think this will turn me off it? Not yet, I’m going back Thursday evening – the stretching still felt amazing (at the time, anyway)!

Circuitously Healthy

I have been working on being as pro-active as possible in my battle against FM: I’ve given up Pepsi-Max, I’m exercising my little heart out and I’m alternating therapy. I’ve been trying to change my diet and introduce more vegetables. When I went on that lunch with Thais, I had an absolutely amazing Harvest Pie – loaded with a massive amount of vegetables (you have no idea how hard that is for me to say!) Since then I have been trying to replicate that pie (and I DON’T cook) in both a pie and muffin version. In the process, I would not be under-estimating that I have thrown away about $80 of ingredients. So, that’s it – I am not trying again. I shall stick to the packet cake section of the supermarket (although one version of a pie was not bad)!

Anyway, back to the point, getting healthy. Yesterday I visited the doctor. As a side issue, I asked about melatonin. She was all for it and promptly gave me a script for Circadin. The active ingredient in Circadin is melatonin.

Melatonin is a hormone produced naturally by the human body. However, the amount of melatonin an individual’s body produces decreases with age.

Melatonin is secreted by the pineal gland (a hormone-producing gland in the brain) according to a circadian rhythm – that is, a time pattern that is repeated each day. The pineal gland begins secreting melatonin each day in the evening. Secretion peaks in the early hours of the morning (2–4 am), then diminishes in the remainder of the night and remains low throughout the day, before melatonin secretion commences again the following evening.

Melatonin, both naturally produced and added to the body in medication, functions to control the body’s circadian rhythm (its rhythm over a 24 hour period, including patterns of sleep and wakefulness). It also controls the body’s response to the dark-light cycle. It induces a hypnotic effect and increases sleepiness.

It’s very expensive for a drug that isn’t really a drug ($38.40). In fact, it is more than double the Zolpidem (Stilnox). I have to take it between one – two hours before bed-time, which means a) I have to remember, and b) I have to plan it, rather than just taking it and falling asleep almost immediately. I’ll have to let you know how this one goes.

And, once again, I got side-tracked…getting healthy! Despite all the complaints and pain during the last week, I have not been discouraged and I am about to embark upon my second Pilates class – hmmm…really, really long way to tell you that, huh?

In the Still of the…Day?

The last two nights I went to bed without taking a Stilnox – not quite at the time demanded by my evil doctor, but not too late either. Then today (or yesterday, as it is 3.25am) I cannot go to sleep at all. It got to about 2am (without a yawn) before I thought that I’d give up on a natural night’s sleep tonight and take a tablet – now where did I put that itsy-bitsy, teeny-weeny, one-and-only-one-left tablet…

Think sitcom dream sequence ripple effect across the screen:

Earlier on today, I was cleaning up my kitchen after it was covered in blue frosting and chocolate cake mix from my attempt at cupcakes, when I moved the super-duper, giant size tablet dosette. There, hidden behind the huge, white container,  was a little white tablet – shit! one of the 15 or 16 (depending on the day) tablets that I take daily each morning had escaped. Quick mouthful of water and I forgot all about it.

Back to my computer for some internet surfing…I began feeling incredibly nauseous and my water bottle was empty. Up, I had to get, to get a refill from the tap. Ooooh…the house is moving. Suddenly, my surroundings become a carnival fun-house ride – the floor is undulating up and down, tipped from side to side, and forward and back, by my weight. This wasn’t just a feeling – I was literally falling over.

So, despite my best intentions, I was desperately in need of a nap and I took myself off to bed at 3.30pm.

At about 6.15, my brother called, waking me out of a very deep sleep, to let me know he was 15 minutes away from picking me up for my warm water class. Holy Cow!

The 32 degree (celsius) water felt cold against my skin. The water wasn’t lifting away the dead weight of fibromyalgia, like it did every other week. When we leaned against the side of the pool to cycle our legs, I would have fallen off my bike; my legs were moving so slowly. Laying back to float in the water, I almost returned to dreamland.

Now, at exactly 3.54am, I know why all that happened…AND I know why I can’t find that damn itsy-bitsy, teeny-weeny, one-and-only-one-left tablet…