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Gregg D Jacobs, Ph.D.  
Male

Interests: Sleep medicine, Behavioral Medicine
UMass Memorial Medical Center
Sleep Disorders Center
Worcester, MA
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10 tips to better sleep

Dec 16, 2008 - 43 comments
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improve sleep

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Insomnia



If you want to sleep better, there are proven non-drug methods for improving sleep. The following is a list of the 10 most important behavioral (non-drug) techniques for improving your sleep:

1.The belief that everyone must get eight hours of sleep is a myth. People who live the longest sleep 7 hours per night, not eight, so don’t worry about getting 8 hours of sleep. Most people need between 6 and 8 hours of sleep to function effectively during the day.

2.Get out of bed within a half hour of the same time every day, including weekends, no matter how little or poorly you have slept.

3.Reduce your time in bed so that it more closely matches the amount of sleep you average each night.

4.Use the bedroom for sleep and sexual activity only.

5.Make sure you feel drowsy when you turn the lights off to go to sleep. If you do not fall asleep within 20-30 minutes, go to another room and engage in a quiet, relaxing activity until you feel drowsy.

6.Don’t take sleeping pills regularly. They have side effects and inconsistent benefits, particularly in older adults.

7.Practice relaxation techniques at bedtime including muscular relaxation, mental focusing, and breathing techniques.

8.Take an afternoon nap after a poor night’s sleep

9.Increase your exposure to early morning sunlight as soon as you wake up to establish a more consistent sleep rhythm.

10.Exercise by taking a brisk walk 3-6 hours before bedtime. This will improve your sleep by causing a greater rise and fall in your body temperature.

Dr. Gregg D. Jacobs
www.cbtforinsomnia.com/mh

To read about 10 additional tips for better slip, read my later entry at: http://www.medhelp.org/user_journals/show/60664







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by Dalubaba, Dec 21, 2008
I started Alprozalam from 1991with 0.25 mg. Now I am taking 0.75 to 1 mg.I am having sensation of tightness in my feet.since last 3 yrs. can this be the side effect of Alprozalam? How to overcome this addiction?
I get 4 to 5 hour's sleep with the above dosage.Can i increas the dosage?Or any other substitute?Tryin very hard to get rid of this dependance.I do Yooga,and many alternative threrapies only for this problem.So far I am not successful.Please comment.

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by Gregg D Jacobs, Ph.D.Blank, Dec 21, 2008
A common problem with benzodiazepine medications like Alprazolam is tolerance (the medication does not work as well with repeated use) and escalating dosage as a result. Talk to your doctor about switching to a less habit forming sleep medication such as Ambien or Lunesta if Alprazolam is being prescribed for insomnia or an SSRI anxiety medication if it is being prescribed for generalized anxiety. Your doctor can answer questions about your chest tightness/side effects since he/she is prescribing it and can provide guidelines for gradually tapering alprazolam as well.

Next, you should begin implementing the 10 key sleep tips I recently posted on 12/16. However, you may need more structured help using behavioral methods to reduce your reliance on medications. If you have a sleep clinic in your area, call them to see if they offer behavioral therapy for insomnia. if not, see my website for an online, interactive behavioral therapy program than contains techniques for reducing sleep medications.

Dr. Gregg D. Jacobs
www.cbtforinsomnia.com


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by stumpedforsolong, Jan 05, 2009
Hi Dr. J.
   i have had insomnia for approximately 14 years now, and treated with medication for the past 4.  Currently i am on zoplicone for one year now since the other two lost efficacy, but am concerned about habit-formation and potential side effects from long-term use.  
   i would appreciate your input
L.L.

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by Gregg D Jacobs, Ph.D.Blank, Jan 05, 2009
All sleep meds, including newer ones such as zopiclone, are potentially habit forming and have side effects (which is why  they are classified as controlled substances). They can certainly be psychologically habit forming and possibly physically habit forming if they are taken long enough and in a high enough dose. Other side effects include amnesia while the drug is taken, a daytime hangover effect, and loss of efficacy with long-term use. You should consider using cognitive behavioral therapy (CBT) since it is more effective than sleep meds and helps to reduce and eliminate sleep meds. You can learn more about online, interactive CBT on my website.

Dr. Gregg D. Jacobs
www.cbtforinsomnia.com


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by kelly_7, Jan 05, 2009
Dr Jacobs,
I will be starting a night shift soon, already have trouble sleeping at night, and I'm concerned about getting enough quality sleep.  What are your thoughts on keeping the night shift schedule on my "days off," or switching back and forth so that I may join the daylight world?  Any advice?  
Thank you,
Kelly

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by Gregg D Jacobs, Ph.D.Blank, Jan 05, 2009
The more closely you follow the same sleep schedule on your days off that you follow on work days, the fewer sleep problems you will have. Shift workers create a chronic 'jet lag' that disturbs sleep be arising at widely varying times during the week (they arise at different times on days off compared to work days). The more consistent your arising time on all days, the better you will sleep.

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by Snaz7, Jan 05, 2009
Overall good info, although I do have one question.  Do you have any references for the statement that the people who live longest average 7 hours per night?  I know individual differences allow variablility in the amount of sleep required, but much I have read about sleep have often suggested as much as 9 hours, and rarely less than 7.  I personally know that i require at least 8-9 hours, and any less than 8 leads to obvious functional impairment.  There are studies that clearly state that "what is confidently known is that less than 6.5 hours of sleep produces clear decrements in both mental and physical functioning."  That quote was from an article in the Journal of Women's Health called Toward Optimal Health: The Experts Discuss Sleep Sufficiency and Health.  That was just a quick example I found, but I was suprised to see someone recommend as low as 6.  And as I asked above, I'm also curious where the 7 hour average came from as I have never heard that.  

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by Leana064, Jan 05, 2009
I have currently been on Klonopin for the past year, 0.5 grams twice a day.  I recognize the tolerance build-up and now the dependency.  I was placed on the drug because of anxiety and panic attacks.  The attacks now come nearly nightly and during the day.  I don't fear them as I did in the beginning because I recognize that they will soon pass.  My question is how do I wean myself from the Klonopin?  I feel I need it but at the same time it almost seems that the drug is causing the very symptoms from which I'm trying to rid myself.  I find that I get the jitters as the drug wears off.  I often feel like I'm in a fog during the day because I don't rest well at night. I experience tight muscles in the chest, arms, back, neck and head.  My lab work and EKG's come back normal.   Exercise and a healthy diet have been very beneficial but they haven't cured me.  I'm also on birth control pills to help regulate the hormones since my gyn thinks that some of my anxiety is hormonal.  I'm 44 years old.

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by redplanet, Jan 05, 2009
The tips you described work for some, not for others.  I was kept in a room by one of the founders of the Stanford sleep clinic who would not let me leave unless I agreed with him that they worked. The nurse was knocking on the door asking him to see other patients. I finally got up and left. Somewhere, this sleep hygiene stuff has become the holy grail and people refuse to look at other causes. I think I have hpa axis problems. I slept fine for the six years I had GHB. It normalizes sleep architecture. Asleep at midnight, up at 8.  Waking up was incredible - cheery, wide awake, looking forward to the  day. It was so damn normal. Then the pharmcos found out how non toxic GHB was, how easily it could be made, started a disinformation campaign with the govt, and turned it into XYREM. I went from purchasing at the health food store, to having an Rx for $60 per month, to seeing it zoom up to $700 per month.  I now take kava, OTC pills, GABA, Taurine, and a Valium if I have one. I am asleep usually by 5 am. If I could get GHB, now XYREM, I would be back to normal. I can exercise from here to kingdom come and it makes no difference. I hike, bike, swim. You need to put a disclaimer that your method does not work for everyone. BTW, there are others at Stanford that agree that GHB is  excellent  for sleep, but the disinfo campaign was so strong, many think GHB is dangerous. Actually, it is a neurotransmitter in our brains and all living animals have it. That's why it is found in autopsies.  BTW, Wm Dement, the other founder of Stanford Sleep Clinic was a professor of mine and he is not opposed to sleeping pills when necessary. He also works for later school hours for teens. This is a really important topic - their brains keep them up at night, yet they need more sleep.

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by helena7, Jan 05, 2009
I am another person that needs 8-9 hours of sleep. I can function on 6-7 hours once in a while but a few nights in a row makes me extremely tired and I feel my body is "falling apart", I feel sick. Working nights evokes a similar feeling since my daytime sleep has very poor quality and this sleep does not provide enough rest. Is long term use of Flexeril for pain and insomnia has any danger? Any ideas how to treat menopausal hot flushes that wake me up several times each night?

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by Gregg D Jacobs, Ph.D.Blank, Jan 05, 2009
Your prescribing doctor is the person who should assist you on weaning from the Klonopin. He/she and you should discuss SSRI anxiety medications instead of a benzodiazepine medication such as Klonopoin. Since you are taking it for anxiety, I am not the best person to query on this since I am a sleep specialist,  not an anxiety disorders specialist. You should try to find a psychologist or psychiatrist who specializes in cognitive behavioral therapy for anxiety to help you learn non-drug techniques for managing anxiety.

Dr. Jacobs
www.cbtforinsomnia.com

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by sjwilson, Jan 05, 2009
my husband has recently returned from Iraq and at first his sleeping and waking patterns were "normal" but have since deteriorated in the last two weeks. (He's been home not quite a month.)

He often is up all night and comes to bed as I'm getting up to go to work. He has not yet returned to his regular 8-5 job so it's not causing him to miss work. But, the pattern is causing him to be depressed and it's frustrating and worrisome for me.

What can we do to reverse this cycle?

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by bulbous, Jan 05, 2009
My trouble sleeping is breathing. I just can't catch my breath when I'm laying down. I've had a whole host of health problems such as a ruptured brain aneurysm and decompression surgery for a chairi malformation. I've had a total of 8 brain and spinal surgeries over the past 12 years but the breathing problems didn't start until after decompression. My sleep doc prescribed xanax to help with the anxiety I feel at night, and it worked for a while. We just doubled the dosage because I was having trouble again. some nights are better than others when it comes to breathing but almost every night I struggle when first falling asleep. Once I'm asleep I'm fine. It's just getting there that's difficult. I'm also worried that we had to double the xanax dose-I'm worried my body will keep tolerating the dose and we'll have to keep increasing it. I've taken xanax before for generalized anxiety and had no problems getting off it but still I'm a little concerned.

Any thoughts?



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by Gregg D Jacobs, Ph.D.Blank, Jan 05, 2009
In response to Snaz7's request for a reference on the finding that 7 hour sleepers live the longest, some scientists and the media continue to suggest that everyone needs at least eight hours of sleep per night  and that any resulting “sleep debt” may contribute to health problems. A significant amount of new research strongly suggests that this is not the case.

In a landmark study involving over 1 million adults, Dr. Daniel Kripke and his colleagues at the University of California-San Diego measured the relationship between sleep duration and mortality. (21) They found that people who slept seven hours per night had the lowest death rates over a six-year period while people who slept eight or more hours had a greater risk of dying over the same period. Two additional large studies involving over 80,000 people have replicated and extended these findings by showing that eight or more hours of sleep is actually associated with increased risk of death. In one of these studies, people who slept nine hours had a greater risk of death than people who slept five hours, and people who slept 10 or more hours had a higher risk of death than those who slept four hours .(22) All three studies found that long sleep is associated with greater mortality than short sleep.

This U-shaped curve involving sleep duration and mortality has now been found in almost 20 epidemiologic studies (the lowest mortality is found at seven hours of sleep with mortality increasing with both  progressively shorter and longer sleep durations). However, the effect of sleep duration on health is modest compared to the effects of other lifestyle factors such as physical inactivity, smoking, and stress. Moreover, the significance of short sleep has generally decreased or disappeared after controlling for factors known to be associated with mortality such as smoking, alcohol use, and physical inactivity. (23) In contrast, large studies have consistently shown that sleeping eight or more hours is associated with elevated mortality risk even after controlling for smoking and similar factors.
21. Kripke, D.F., Garfinkel, L., Wingard, D.L., et al. (2002). Mortality associated with  sleep duration and insomnia. Archives of General Psychiatry, 59:131-136.
22. Tamakoshi, A., and Ohno, Y. (2004). Sleep duration as a predictor of all-aause mortality: results of the Japan collaborative cohort study. Sleep, 27: 51-54.
23 Hublin, C., Partinen, M., Koskenvuo, M., and Kaprio, J. (2007). Sleep and mortality: a population-based 22- year follow-up study. Sleep, 30: 1245-1253.

Dr. Jacobs




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by keianna, Jan 05, 2009
I have been taking seroquel 100mgf or about a year and nothing else works for me.  I started having sleep problems after an accident.  I believe I am addictive to that or gabapentin 300mg, arithrotec75, and melatonin.  I take these pills and others every day.  I would like to get off of them.  My oxygen level gets low and I am on oxygen at night and a Cpac.  Can you tell me if anyone of these drugs is a controlled substance and likely cause an addition.   Sometimes when I try to stop I feel like bugs are crawling over me.  Also I can stay up days at a time if I don't take the seroquel..  I also take hydrocodone and ibuoprofen at times.  Please advise.  Thanks

Simply Dianne

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by Gregg D Jacobs, Ph.D.Blank, Jan 05, 2009
You are taking more than one medication and none of these are approved sleep medications. Therefore, you should direct these questions to the doctor who is prescribing them.

Dr. Jacobs

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by californiaken, Jan 05, 2009
Im taking Tranzodone sometime I take it sometimes I dont. I have been needing it latly to sleep. I was pescribed 300mg and I also take Giadon and Lamictal for anxiety and depression. My brother commited suiside and I have a hard time sleepin and sometimes nightmears

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by californiaken, Jan 05, 2009
I also have Sleep Apnia...

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by 8123, Jan 05, 2009
I have a problem with not being able to wake up in the morning. this has been going on for about 10 years. It doesn't matter how many hours sleep I get. I just can't wake up. any sugestions

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by saskboy02, Jan 05, 2009
As I sit here reading another web-site on Insomnia I ask myself "Is it asking to much to be able to do one of lif'e's basic bodily functions Sleep" I don't think it's asking for the world so why all the people with this problem?
I am a 58yr old male who has been through hell for the last 30yrs just trying to get a normal nights sleep.
I went to my doctor when I was in my late 20's because I thought if I could only get a decsent nights sleep I would get rid of my anxiety attacks. Wrong!!
I was given a sleep medication called Dalmane for a period of 8 yrs. Well as I found out later this was not the brightest thing my doctor & myself ever did. Depression, Panic Attacks, Agoraphobia all at once was my reward for being able too sleep!!
I spent 5 weeks in the hospital withdrawing from the Dalmane & was put on Antidepressants to help with all the problems I had been left with. As a lot of people know one of the side affects from taking Antidepressants is Insomnia. Here we go again!!!!
After 20 yrs of Antidepressants I had just about all I could take of 2-4 hrs of sleep with the odd 5-6 hr mixed in so I said no more drugs!!! It has taken a little over a year but I no longer take Antidepressants and am the better for it except I still suffer from Insomnia. I've tried Melatonine with no success as well as Velarian from the Health Food store but no luck. In 3 days I will be taking my first Accupuncture treatment with hope that that will work!!
One thing I will never do again is go the "Drug Route"

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by DonnaLynn2008, Jan 05, 2009
Thank you Dr. Jacobs for this insight...Lots of good info here.  I am happy to say that I am on the "other side" of a sleeping problem.  There is a lot of bad information out there - I have been given all kinds of meds and even been in mental hospitals over the past three years, and lost a lot of friends and family ties along the way.  It is good to have a knowledgeable source and question and answer ability.   For me, and others I have talked with, it ended up being hormonal/perimenopause...Especially if taking birth control/estrogen while going through it - those adrenal glands run rampant!  And, for women who are in their 40's and have spent their lives running full steam, it is debilitating...that surge of energy quickly leads to adrenal fatigue.  Again, thanks for making this forum available.  Best wishes to everyone working through such a frustrating health issue.  I will keep you in my prayers, and want you to know that there is a light on the other end of that dark tunnel.

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by lippy22, Jan 05, 2009
Hello, I agree with your tips for better sleep...and a good diet is also important.  
Currently, I'm still having problems with sleeping patterns due to hyper and restlessness.  I follow the same routine such as jogging in the morning before having a breakfast, lunch and dinner with low carbohydrate food.  In between meals, I go walk with my dog also before going to bed.  I kept waking up in the middle of the night, my heart racing very fast and my body shook few minutes.  It happened sereval times over the last few weeks (around in November).
My body is very tiring and my mind is just kept me going on without putting a brake on it.  How can I solve this problem?  Many thanks.

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by tor61, Jan 05, 2009
Gregg, I am a bipolar patient who had big sleep issues in the past.  Some of what was described above I relate to and also what i don't relate too such as taking various meds just for sleep although I have been on a long term mood stabiliser.  I thank God that my own situation is not PTSD as the gentleman from Iraq may be suffering or more grievous situations.
I hope that members take notice of what I say next but I have discovered Horlicks.  This is a malt drink taken at bedtime and it works.  I was tipped to this by a psych nurse here in Australia that I was talking to on a long train ride last September.  He told me that the thing that wakes you is the reflux from the anxiety mentally ill people amongst others suffer.  The drink soothes the reflux and leaves you sleeping.  For me it is the waking at 3am to my anxiety that does the damage.  If I am still awake at 430 then I reckon (perceive) it is almost not worth staying in bed.  You all know what I mean.
I don't know if it available in the US but if you can get it try it.  Google Horlicks and the advice on the site re sleeping is the same as Gregg's.  Also the other things are not panicking due to stringing sleepless nights together.  Perhaps you have to work some things out.  Anxiety is horrible but maybe we are better off easing the related symptoms and then getting realistic on the issues that are causing the anxiety.  I acted as if my situation was hopeless untill I got realistic.  In the gentleman from Iraq's case or any one else who has suffered trauma perhaps he should realise his situation is serious and not be surprised or ashamed that he is depressed and distressed after leaving a war zone. Early morning may be the ideal time to think about stuff and just recognising you have issues to work on can be calming.  Check sleep apnoea too or having had a few too many drinks close to bedtime.  
God Bless you all.

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by pri2des, Jan 06, 2009
i am still getting there - just got off Alzam more than a week ago. I have had terrible side effects - still feel as if I am blacking out with fatigue sometimes. The effort to come to wrok is horrendous - I am not sure i could work a full day. But I am trying to get of the drug route. I have had anxiety of the years. I also had aloot to cope with last year wit my hernia which is no longer - but getting back to myself is harder than i thought.

All i crave is 8 hours of sleep per night. i am lucky some nights - other nights I hardly get in 2-4 hours. It is hard with 2 toddlers in toe.

But I am going to try that 10 step technique to get my sleep pattern back - and let u no how it goes.


pri2des

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by turquoise26, Jan 06, 2009
A pleasant day to you! I would like to ask, if there is a connection, that my left arm felt numb, even after a few days, i slept on the left side. Thanks

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by ruth577, Jan 07, 2009
dear doctor, have you done any study on these new litewave sleep patches.  was able to get a sample patch, 1 patch lasts two days. my sleeping problems have been life long .The first day I used the patch, I slept six hours, woke up once, but fell quickly back to sleep, which is a big improvment for me, I also had plentiful vivid dreams which is also a rarety for me.  The second day, I slept eight hours, again waking up once or twice, but quickly falling back to sleep, while I did dream the second day, they just didn't seem has vivid which is no big deal.  I work the night shift and I know you say to keep the same hours on days off, but if I did that my husband and I would have no time together and I wouldn't be able to get anything else done, ***@****

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by Karl1000, Jan 07, 2009
I saw a psychologist Dr Steven Phillipson for my anxiety and insomnia problems. The sleep part was the easiest to fix. I was taking Ambien at the time but I didn't want to take anything. He told me to go to bed without any Ambien and tell my brain to go ahead and keep me up all night if it wanted too. It did. He then told me to do it agin the next night and to keep doing it if need be. He said your brain will put you to sleep when it wants to and fighting it or taking pills will teach my brain that I was trying to control it and thats something that I couldn't. My brain got the message that I didn't care if I slept or not and by giving in like this sleep is easy to come by. It works wonders if you just let your brain put you to sleep when its ready to. It will. I sleep like a baby now without drugs because I don't care if I do or not. Its sounds simple but fighting it is the wrong thing to do. You wont die from not sleeping.

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by raymoe, Jan 08, 2009
I have actually come up with personal proof that us deemed non sleepers,indeed have much more sleep than we can ever possibly realize.
I was convinced that I never hardly slept a wink many nights, and repeatedly told my wife this. Her response was very often a smile and saying " yes I know, thats why you often disturb my sleep with your snoring and dream talking"

Feeling put down by those often replies, I decided to camcorder us throughout the night,and to my utter  astonishment the recordings proved that I was indeed actually dreaming that I was lying awake, and its true my sleep dreaming frustration was actually waking up my wife....
Now I have a tailored reply for any other such comment..."No my dear its you dreaming that I am dreaming and keeping you awake. (I have now secretly deleted my recording) but I still feel the same, as I now dream that all I have just experienced and explained,may just simply have been a dream......Sleep well.....Ray


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by alabamaslim, Jan 12, 2009
I am now 50 years old. I worked in the medical field for 30 years...on-call, long hours, nights, evenings, days. My last position was nights 7 on 7 off...11-12 hour shifts. It really messed my sleeping patterns up and I tried every non-medication methods, relaxation tapes, no TV in bedroom, etc, now that I am out of the rat-race, I expected my sleep patterns to normalize to the rest of the world  such as 10-11PM  to  5 or 6 AM, (my "best fit" sleeping pattern prior to all the work and stress). I tried Ambien and it worked getting me to sleep but as soon as my blood level dropped, Boom ! I was wide awake at 2 AM...It was very expensive at that time. We then switched to Restoril 30mg (temazepam) and I had much better results. Due to a series of unfortunate family medical problems, I was again "on duty" all the time...I soon developed an episode of Recurrent  Major depression and currently take Lexapro for  that. However, I still had poor appetite and chronic insomnia. I learned a little "pearl" from an old doc years ago. He used a combination of a benzo plus a small dose of one of the old (Cheap antidepresants). Now I am on Restoril 30mg plus doxepin 50mg ..since then I have greatly improved sleep and a more RESTFUL sleep than ever .When all else fails, what worked for me was "combination treatment" as well as the steps Dr. J recommends, except I walk in the AM and I use a sound machine at night.  Those worried about dependency , well there's a medication that is a combination of amitriptyline 25mg and Librium 10mg Brand name is Limbitrol 10-24 (now generic and inexpensive plus Both of which are low doses. It's dificult to get dependent on the Librium without having intolerable side effects from the amitriptyline.  For me and other patients Combo is the way to go !  Your thoughts Dr.J ?
Dr. B

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by alabamaslim, Jan 12, 2009
As an addendum to my previous post, I believe in Quality of life and not Quantity....therefore, with regard to sleep meds that may be habit forming, it is up to you and your physician to discuss the dependency issue. I think, in my professional opinion, just the idea that one is dependent on a potentially habit forming sleep aid adds to much anxiety and therefore feelings of guilt when one consumes a pill or two every night at bedtime. In my opinion, it depends on the age of the patient....if the insomniac is in their 20's ot 40's....sure it is best to use non-medical (Behavioral methods such as the tips Dr. J recommends). However,  my above post indicates that I am now 50 and Quality of life is Very Important to me.  I know first hand how chronic insomnia affects not only the patient but the family as well.  My previous post about "combination drugs" PLUS Dr. J's tips work for me. My previous post assumes all other medical tests are normal or other causes ruled out ...such as obesity and sleep apnea, thyroid disorders, caffeine consumption, chronic pain management, etc. With these issues  addessed and corrected or controlled.
  The "Pearl" I talked about involves a benzodiazepine such as Restoril (temazepam) plus a small dose of tricyclic antidepressant such as Elavil (amitriptyline) or Sinequan (doxepin). Also the medication Limbitrol  whic is  a combination of Librium (chlordiazepoxide) and Elavil (amitriptyline) within the SAME tablet. It comes in generic at doses of 5-12.5 and 10-25 mg respectively.
  There are side effects associated with tricyclic antidepressants such as increased appetite-weight gain, dry mouth, postural hypotension and tachycardia...however, these effects tend to subside over the first week or so and dosages should be started low and increased every 2-3 days until you reach your target dosage or effective dosage.  These issues are EXTREMELY important when STARTING combination medication therapy. If not prescribed low and slow, increased as tolerated, it is very effective and prevents patients from quiting the medication due to side affects when the medication is started incorrectly. The dosages can , as your body adjusts to the side effects, be "fine tuned" by your physician. "Combo Medication" treatment also assumes there are NO contraindications to the tricyclic antidepressants...such as a patient with obesity related sleep apnea would not be a candidate for this treatment...weight loss is the issue and likely to resolve the insomnia. Again, the most effective treatment involves BOTH Behavioral Modification along with Medication.
   Also, I believe too many people become overly concerned about "potential Addiction" causing anxiety and guilt which adds even more to the insomnia. If your insomnia is significant  enough to decrease the Quality of your life and your family (who are likely affected as well), I am in favor of using BOTH Behavioral Therapy and medication...especially the ones I listed. I do not recommend Ambien unless an individual travels a lot and their work requires different time zones or situational (brief) insomnia...it works well in those whose mind races as the are trying to get to sleep but it is not good for those who have difficulty staying asleep.Even the Ambien CR as well.
  In closing, Insomnia has a significant effect on people's lives. In fact, sleep deprivation has been used as a method of TORTURE. That's how serious this disorder can be.However through Behavioral Therapy with or without medication , this disorder can be treated successfully.
Your thoughts ?
Dr.B

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by girijaselvakumar, Apr 20, 2009
Dear doctor, I am facing sleeping problem for the past 5 months. The problem is ,i am getting dreams in the sleep every day. Dreams pattern is different for each day. If i work more,then its about my work in the dream. If not, something about the people i meet in the past.but not the same happening.Sometimes i couldn't understand what i am dreaming when i wake up.What could be the reason for this.

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by jupps, May 18, 2009
i notice u r all adults with sleep problems, but i have a 10 year old daughter who just can not sleep at night staying awake until gone 2 am is turning into the norm for her, she goes to bed at around 9 pm but just can not get to sleep, she has tried reading the winding down ,relaxing, deep breathing exercises , baths with lavender, lavender on her pillow.
the room is dark enough for her to sleep she has a younger sibling who shares her room but whilst the younger one has no problems except her sister waking her to talk, the older child still has problems getting to sleep.
her dad is in the armed forces and is away quite a bit and she seems to use this to add fuel to the fire but he was in the forces when i met him which was 3 years before she was born so military life is the norm for her.
She is constantly tired during the day and it is affecting her getting up and going to school, she is tearful at school but no matter how tired she is she just can not get to sleep she has coped off 4 hours sleep before now and still can not sleep the following night, it is now affecting family life as in her siblings and i am also so tired because with the increasing tiredness comes the bad mood swings and these mood swings can be directed at anyone ( normally her dad and her brother) i know hormones are normally kicking in around now as in pre teen stuff and i am very realistic in my parenting and i am not one of those who will mamby pamby my child so basically yes i guess i am a bit strict at times but i believe children need firm but fair guidance.
we have tried everything apart from medical help but now i am going to take that route as she has no problems going to bed, she has no problems staying in bed, she has no problems just laying there apart from telling me every now and again "mum i cant sleep" so basically she goes to bed and can just lay there for up to 5 hours not able to fall asleep and it is now really upsetting me as i am worried about her and know her quality of life is not what it should be because of the lack of sleep and please dont think this has just come on as she has had problems sleeping since she was a baby it has now just escalated to the point where it is getting beyond a joke.
any advice on this would be great as can not see her gp until the end of the week and even then not to sure how much help he/she will be
s b


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by kruza, Aug 24, 2009
hi 20mg amitriptilyne /7.5mg zopiclone taken together . any inherent dangers. have dropped amitrip to 10mg recently.  These have been given together by specialists theory =less if poss.

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by mkhueser, Nov 22, 2009
For the last 4 years I've been experiencing secondary insomnia from the fall to spring.  Right after the time change in the fall, I start waking up at 3 and not falling back to sleep.  This occurs until about March or April in the spring.  I fall asleep fine at about 10 in the evening.

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by Lily2you, Jan 17, 2010
Hello,
I also have been given amitriptylene 25 mg and Zopiclone 7.5.mg.  I have Fibromyalgia, and couldn't sleep with just the Amitriptylene alone, but the amitrip. stops my muscles from spasming, the Zopiclone helps me to sleep more, I only wake up 1 or 2 times at night, at least 3 times a week.  Without it I wake up 4-5 times a night, and am exhausted in the mornings.  Last night was my 4th night of the 2 together (Amitrip and Zopl), I ingested 3 glasses of red wine and then I went to bed.  I awoke two times with my heart pounding in my chest.  I also had a dream between both episodes of my throat stuffed with cardboard, and I could barely breathe.   I don't think that this is normal.  I have been told by my Pharmacist that I have to stay away from alcohol completely.  I rather enjoy having the occasional glasse of wine now and then, Is there anything out there that would help me out to sleep, that is safe non hypnotic, non altering, non heart pounding... with the occasional glass of wine?? I have a high RF factor as well, and have gained 70 lbs in the last 2 years, so I have something else going on with me as well, and I will see a Rheumatologist in March.  


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by 100165, Mar 09, 2010
I started having trouble sleeping about 6 months ago when my school schedule was different everyday, and required me to wake up at different hours. This carried over to the next school term even though I had no morning classes. I know that my circadian rhythm is disrupted, and I've developed some sleep anxiety because of it. A lot of the time I dread the thought of night time because I`m scared I won`t be able to fall asleep. I sometimes fall asleep without any problem but often wake up after only a few hours with sleep misperception, but other times I can't fall asleep all know. I've been prescribed zopiclone 7.5 by my doctors, but i'd really like to get past this on my own since I am 100% it's all in the mind.
Are there any tips you could possibly give me beside the 10 you posted above, and how long does it normally take to overcome a problem like this. Recent;y ive been writing in a journal and telling myself that like all other things this to will pass and that it will just take time, and a little mind relaxation on my behalf.
any other tips would be much appreciated.

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by SleeperTip, Aug 03, 2010
some good tips here. i think routine and relaxing (breathing and stretching) before bed are the two that have helped me most to master my sleep routine.

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by daniypapi, Jun 14, 2011
(My English is not good) Good afternoon, my name is Daniela, I´m 20 years and I´m from Colombia. My father has insomnia for three years, he has taken medication as (REMERON, RIVOTRIL, SOMNIL), but this medication haven´t done anything, I need to know ¿what I do to help my father?. I beg you to collaborate. I am willing to travel with him wherever needed to see him so well.

Thanks!

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by ejj9754, Aug 10, 2011
I have been taking a small amount of Suboxone daily since January. I am also prescribed 10mg of Adderall 6x/day and Effexor XR 150mg. I stopped taking Suboxone about 7 days ago. After 2-3 days I have not been able to sleep. I have restlessness in my arms and legs. I have ulnar nerve untrapment and my neurologist thinks something is up with my spine in the neck region because my reflexes (when he hit my knee) was too severe. I'm very afraid of an MRI and haven't had one. While taking the suboxone I did not have restless leg or arm symptoms. I just want to go to bed! I am so tired I sit and cry praying I can fall asleep. OTC sleeping pills do not help. If I take a bath I can sleep for about an hour but then I wake up. Is something going on here or should I just wait it out and hope it's just withdrawal symptoms?

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by luci_grc, Jan 26, 2012
Dear Dr. J,

I've been having poor sleep for this past year.
I go to bed at 10-10.30, and fall asleep apx 40 mnt-1 hour later.
But I wake up 2-3 times every night. I had panic attacks about a year ago, my doctor gave me xanax 0.5 mg for 3 weeks, and gradually decrease the dosage within 2 months.
Ever since I've been having insomnia. I seldom have trouble falling asleep, but when I woke up it's quite difficult to go back to sleep.
I can still function quite well at work, despite the sleepiness in the afternoon and sometimes light migrane.
About 3 months ago, I was given rozerem + xanax 0.25 mg, which I took every night for about 1 month. But showed no result. My sleeping problem still there.
Now I sometimes took zolmia if I can't go back to sleep within 2 hours. Sometimes I take xanax 0.5 mg (like every 3-4 days).
If I can't get good sleep in 3-4 days, my blood pressure go up, and it worries me. But if I got enough sleep (with the help of sleeping pills), my blood pressure went back to normal.
This insomnia issue is very disturbing to me, since I used to have good quality of sleep (means 7-8 hours continously, seldom dreaming, wake up feeling refreshed) before the anxiety attacks (which I don't have anymore).
I really want to get off the drugs, and try CBT.
I live in Jakarta. How do I join your program, since I live in Indonesia, will the CD be shipped to me after I pay ?
I guess insomnia is not a very interesting topic for doctors in Indonesia, since there is only one sleep specialist in Jakarta.
I'm looking forward for your reply, doctor. My email is luci_ppi***@****.
Please help !
Many thanks. GBU

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by jeannedearc, Apr 08, 2014
Dr. Jacobs,

I would first like to say that I took your online sleep insomnia course in May of 2013--my sleep improved by 80% since last May.  However, about a week ago, I began to have problems again, since I returned from a conference on the other side of the country.  Because of the three hour time difference and DST beginning the week before, I am wondering if my circadian rhythm is messed up again.  This is the first time I have dealt with a time change since the course.  If I normally go to sleep between 11 and 11:15 P.M., do I go an hour later during DST; also if there is a 3-hour time difference (Pacific Time) earlier at the place where I am visiting for a week, do I go to bed three hours earlier while I am there?  Please advise.  Also, I have begun to do some spiritual reading in bed before sleep for about 20 minutes --is than not a good move?

God Bless, Jane

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